Implementation Guide
TI Common
Version 1.4.0-ballot.2 - ballot

Resource Profile: TIMedicationPharmaceuticalProductDgMP - Detailed Descriptions

Active as of 2026-08-27

Definitions for the ti-medication-pharmaceutical-product-dgmp resource profile.

Guidance on how to interpret the contents of this table can be foundhere

0. Medication
Definition

This resource is primarily used for the identification and definition of a medication for the purposes of prescribing, dispensing, and administering a medication as well as for making statements about medication use.

ShortDefinition of a Medication
Control0..*
Is Modifierfalse
Summaryfalse
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource 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())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
ti-med-1: Medication code, name, or ingredients must be specified (code.exists() or ingredient.exists())
2. Medication.meta
Definition

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.

ShortMetadata about the resource
Control0..1
TypeMeta
Is Modifierfalse
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. Medication.meta.versionId
Definition

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.

ShortVersion specific identifier
Comments

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

Control0..1
Typeid
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
6. Medication.meta.lastUpdated
Definition

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

ShortWhen the resource version last changed
Comments

This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

Control0..1
Typeinstant
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
8. Medication.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

ShortA set of rules under which this content was created
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Control0..1
Typeuri
Is Modifiertrue because 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
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
10. Medication.contained
Definition

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

ShortContained, inline Resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Control0..0*
TypeResource
Is Modifierfalse
Summaryfalse
Alternate Namesinline resources, anonymous resources, contained resources
12. Medication.extension
Definition

An Extension


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.

ShortExtensionAdditional content defined by implementations
Comments

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

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on Medication.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 14. Medication.extension:context
    Slice Namecontext
    Definition

    Extension for indicating the context.

    ShortExtension
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(ContextExtension) (Extension Type: code)
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    16. Medication.extension:rxPrescriptionProcessIdentifier
    Slice NamerxPrescriptionProcessIdentifier
    Definition

    This extension is used to track medication prescription transactions between the E-Rezept-Fachdienst and the ePA. The RxPrescriptionProcessIdentifier is generated by the ePA Medication Service and consists of the PrescriptionId and the authoredOn date of the operation parameters request. It ensures consistent referencing and management of medication-related resources across different systems.

    ShortExtension
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(RxPrescriptionProcessIdentifierExtension) (Extension Type: Identifier(RxPrescriptionProcessIdentifier))
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    18. Medication.extension:isVaccine
    Slice NameisVaccine
    Definition

    Indicator of whether this is a vaccine.

    ShortExtension
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(MedicationIsVaccineExtension) (Extension Type: boolean)
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    20. Medication.extension:drugCategory
    Slice NamedrugCategory
    Definition

    Extension for indicating the medication category.

    ShortExtension
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(DrugCategoryExtension) (Extension Type: Coding)
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    22. Medication.extension:drugCategory.extension
    Definition

    An Extension


    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.

    ShortExtensionAdditional content defined by implementations
    Comments

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

    Control0..0*
    TypeExtension
    Is Modifierfalse
    Summaryfalse
    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    SlicingThis element introduces a set of slices on Medication.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 24. Medication.extension:drugCategory.url
      Definition

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

      Shortidentifies the meaning of the extension
      Comments

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

      Control1..1
      Typeuri
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      Fixed Valuehttps://gematik.de/fhir/epa-medication/StructureDefinition/drug-category-extension
      26. Medication.extension:drugCategory.value[x]
      Definition

      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

      ShortValue of extension
      Control10..1
      BindingThe codes SHALL be taken from For codes, see https://gematik.de/fhir/terminology/ValueSet/ti-drug-category-vs
      (required to https://gematik.de/fhir/terminology/ValueSet/ti-drug-category-vs)
      TypeCoding, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      28. Medication.extension:drugCategory.value[x].system
      Definition

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

      ShortIdentity of the terminology system
      Comments

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

      Control10..1
      Typeuri
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Requirements

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

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      30. Medication.extension:drugCategory.value[x].code
      Definition

      Drug Category


      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).

      ShortCategorySymbol in syntax defined by the system
      Control10..1
      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Requirements

      Need to refer to a particular code in the system.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      32. Medication.extension:normSizeCode
      Slice NamenormSizeCode
      Definition

      Description of the therapy-appropriate package size (e.g., N1)

      ShortPackage size according to N-designation
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(ExtensionNormgroesseDeBasis) (Extension Type: code)
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      34. Medication.extension:normSizeCode.extension
      Definition

      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.

      ShortAdditional content defined by implementations
      Comments

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

      Control0..0*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      SlicingThis element introduces a set of slices on Medication.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 36. Medication.extension:normSizeCode.url
        Definition

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

        Shortidentifies the meaning of the extension
        Comments

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

        Control1..1
        Typeuri
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        Fixed Valuehttp://fhir.de/StructureDefinition/normgroesse
        38. Medication.extension:normSizeCode.value[x]
        Definition

        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

        ShortValue of extension
        Control0..1
        BindingThe codes SHALL be taken from For codes, see https://fhir.kbv.de/ValueSet/KBV_VS_SFHIR_KBV_NORMGROESSE
        (required to https://fhir.kbv.de/ValueSet/KBV_VS_SFHIR_KBV_NORMGROESSE)
        Typecode, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        40. Medication.extension:packaging
        Slice Namepackaging
        Definition

        Information on the packaging of a formulation.

        ShortExtension
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(MedicationFormulationPackagingExtension) (Extension Type: string)
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        42. Medication.extension:manufacturingInstructions
        Slice NamemanufacturingInstructions
        Definition

        Manufacturing instructions regarding the preparation of a formulation (Subscriptio).

        ShortExtension
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(MedicationManufacturingInstructionsExtension) (Extension Type: string)
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        44. Medication.extension:type
        Slice Nametype
        Definition

        Extension for EPAMedication types

        ShortMedication Type
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(Medication Type) (Extension Type: Coding)
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        46. Medication.extension:type.extension
        Definition

        An Extension


        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.

        ShortExtensionAdditional content defined by implementations
        Comments

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

        Control0..0*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        SlicingThis element introduces a set of slices on Medication.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 48. Medication.extension:type.url
          Definition

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

          Shortidentifies the meaning of the extension
          Comments

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

          Control1..1
          Typeuri
          Is Modifierfalse
          Must Supporttrue
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          Fixed Valuehttps://gematik.de/fhir/epa-medication/StructureDefinition/epa-medication-type-extension
          50. Medication.extension:type.value[x]
          Definition

          Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

          ShortValue of extension
          Control10..1
          BindingThe codes SHALL be taken from For codes, see https://gematik.de/fhir/terminology/ValueSet/ti-medication-type-pharmaceutical-product-vs
          (required to https://gematik.de/fhir/terminology/ValueSet/ti-medication-type-pharmaceutical-product-vs)
          TypeCoding, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          52. Medication.extension:type.value[x].system
          Definition

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

          ShortIdentity of the terminology system
          Comments

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

          Control0..1
          Typeuri
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Requirements

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

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          54. Medication.extension:type.value[x].version
          Definition

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

          ShortVersion of the system - if relevant
          Comments

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

          NoteThis is a business version Id, not a resource version Id (see discussion)
          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          56. Medication.extension:type.value[x].code
          Definition

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

          ShortSymbol in syntax defined by the system
          Control0..1
          Typecode
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Requirements

          Need to refer to a particular code in the system.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          58. Medication.extension:type.value[x].display
          Definition

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

          ShortRepresentation defined by the system
          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Requirements

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

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          60. Medication.modifierExtension
          Definition

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

          ShortExtensions that cannot be ignored
          Comments

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

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
          Summaryfalse
          Requirements

          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.

          Alternate Namesextensions, user content
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          62. Medication.identifier
          Definition

          Business identifier for this medication.

          ShortBusiness identifier for this medication
          Comments

          The serial number could be included as an identifier.

          NoteThis is a business identifier, not a resource identifier (see discussion)
          Control0..*
          TypeIdentifier
          Is Modifierfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          SlicingThis element introduces a set of slices on Medication.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ $this
          • 64. Medication.identifier:RxOriginatorProcessIdentifier
            Slice NameRxOriginatorProcessIdentifier
            Definition

            Business identifier for this medication.

            ShortBusiness identifier for this medication
            Comments

            The serial number could be included as an identifier.

            NoteThis is a business identifier, not a resource identifier (see discussion)
            Control0..1*
            TypeIdentifier(RxOriginatorProcessIdentifier)
            Is Modifierfalse
            Summarytrue
            Pattern Value{
              "system" : "https://gematik.de/fhir/epa-medication/sid/rx-originator-process-identifier"
            }
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            66. Medication.code
            Definition

            A code (or set of codes) that specify this medication, or a textual description if no code is available. Usage note: This could be a standard medication code such as a code from RxNorm, SNOMED CT, IDMP etc. It could also be a national or local formulary code, optionally with translations to other code systems.

            ShortMedication in coded form or as free text if necessaryCodes that identify this medication
            Comments

            Depending on the context of use, the code that was actually selected by the user (prescriber, dispenser, etc.) will have the coding.userSelected set to true. As described in the coding datatype: "A coding may be marked as a "userSelected" if a user selected the particular coded value in a user interface (e.g. the user selects an item in a pick-list). If a user selected coding exists, it is the preferred choice for performing translations etc. Other codes can only be literal translations to alternative code systems, or codes at a lower level of granularity (e.g. a generic code for a vendor-specific primary one).

            Control0..1
            BindingFor example codes, see SNOMEDCTMedicationCodeshttp://hl7.org/fhir/ValueSet/medication-codes|4.0.1
            (example to http://hl7.org/fhir/ValueSet/medication-codes|4.0.1)

            A coded concept that defines the type of a medication.

            TypeCodeableConcept
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            68. Medication.code.coding
            Definition

            A reference to a code defined by a terminology system.

            ShortCode defined by a terminology system
            Comments

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

            Control0..*
            TypeCoding
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Requirements

            Allows for alternative encodings within a code system, and translations to other code systems.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            SlicingThis element introduces a set of slices on Medication.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ $this
            • 70. Medication.code.coding:pzn
              Slice Namepzn
              Definition

              A reference to a code defined by a terminology system.

              ShortCode defined by a terminology system
              Comments

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

              Control0..0*
              TypeCoding
              Is Modifierfalse
              Must Supporttrue
              Summarytrue
              Requirements

              Allows for alternative encodings within a code system, and translations to other code systems.

              Pattern Value{
                "system" : "http://fhir.de/CodeSystem/ifa/pzn"
              }
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              75. Medication.code.coding:atc-de
              Slice Nameatc-de
              Definition

              A reference to a code defined by a terminology system.

              ShortCode defined by a terminology system
              Comments

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

              Control0..*
              TypeCoding
              Is Modifierfalse
              Must Supporttrue
              Summarytrue
              Requirements

              Allows for alternative encodings within a code system, and translations to other code systems.

              Pattern Value{
                "system" : "http://fhir.de/CodeSystem/bfarm/atc"
              }
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              77. Medication.code.coding:atc-de.system
              Definition

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

              ShortIdentity of the terminology system
              Comments

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

              Control10..1
              Typeuri
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Requirements

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

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              79. Medication.code.coding:atc-de.version
              Definition

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

              ShortVersion of the system - if relevant
              Comments

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

              NoteThis is a business version Id, not a resource version Id (see discussion)
              Control10..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              81. Medication.code.coding:atc-de.code
              Definition

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

              ShortSymbol in syntax defined by the system
              Control10..1
              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Requirements

              Need to refer to a particular code in the system.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              83. Medication.code.coding:atc-de.display
              Definition

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

              ShortRepresentation defined by the system
              Control0..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Requirements

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

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              85. Medication.code.coding:ask
              Slice Nameask
              Definition

              A reference to a code defined by a terminology system.

              ShortCode defined by a terminology system
              Comments

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

              Control0..*
              TypeCoding
              Is Modifierfalse
              Must Supporttrue
              Summarytrue
              Requirements

              Allows for alternative encodings within a code system, and translations to other code systems.

              Pattern Value{
                "system" : "http://fhir.de/CodeSystem/ask"
              }
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              87. Medication.code.coding:ask.system
              Definition

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

              ShortIdentity of the terminology system
              Comments

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

              Control10..1
              Typeuri
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Requirements

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

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              89. Medication.code.coding:ask.code
              Definition

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

              ShortSymbol in syntax defined by the system
              Control10..1
              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Requirements

              Need to refer to a particular code in the system.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              91. Medication.code.coding:ask.display
              Definition

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

              ShortRepresentation defined by the system
              Control0..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Requirements

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

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              93. Medication.code.text
              Definition

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

              ShortPlain text representation of the concept
              Comments

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

              Control0..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Requirements

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

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              95. Medication.status
              Definition

              A code to indicate if the medication is in active use.

              ShortStatus of Medication Informationactive | inactive | entered-in-error
              Comments

              This status is intended to identify if the medication in a local system is in active use within a drug database or inventory. For example, a pharmacy system may create a new drug file record for a compounded product "ABC Hospital Special Cream" with an active status. At some point in the future, it may be determined that the drug record was created with an error and the status is changed to "entered in error". This status is not intended to specify if a medication is part of a particular formulary. It is possible that the drug record may be referenced by multiple formularies or catalogues and each of those entries would have a separate status.

              Control0..1
              BindingThe codes SHALL be taken from Medication Status Codeshttp://hl7.org/fhir/ValueSet/medication-status|4.0.1
              (required to http://hl7.org/fhir/ValueSet/medication-status|4.0.1)

              A coded concept defining if the medication is in active use.

              Typecode
              Is Modifiertrue because This element changes the interpretation of all descriptive attributes.
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              97. Medication.manufacturer
              Definition

              Describes the details of the manufacturer of the medication product. This is not intended to represent the distributor of a medication product.

              ShortManufacturer of the MedicationManufacturer of the item
              Comments

              Here, the actual manufacturer of the medication can be named, primarily in the case of active ingredient mixtures (compounding prescriptions), such as the hospital pharmacy. It is important to note that the licensing organization, as mentioned in the PZN (Pharmaceutical Central Number) data, is not considered the manufacturer.

              Control0..1
              TypeReference(Organization)
              Is Modifierfalse
              Must Supporttrue
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              99. Medication.manufacturer.display
              Definition

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

              ShortText alternative for the resource
              Comments

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

              Control10..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              101. Medication.form
              Definition

              Describes the form of the item. Powder; tablets; capsule.

              ShortForm of Dispensingpowder | tablets | capsule +
              Comments

              When Medication is referenced from MedicationRequest, this is the ordered form. When Medication is referenced within MedicationDispense, this is the dispensed form. When Medication is referenced within MedicationAdministration, this is administered form.

              Control0..1
              BindingFor example codes, see SNOMEDCTFormCodeshttp://hl7.org/fhir/ValueSet/medication-form-codes|4.0.1
              (example to http://hl7.org/fhir/ValueSet/medication-form-codes|4.0.1)

              A coded concept defining the form of a medication.

              TypeCodeableConcept
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              103. Medication.form.extension
              Definition

              An Extension


              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.

              ShortExtensionAdditional content defined by implementations
              Comments

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

              Control0..*
              TypeExtension
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Alternate Namesextensions, user content
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              SlicingThis element introduces a set of slices on Medication.form.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 105. Medication.form.extension:dataAbsentReason
                Slice NamedataAbsentReason
                Definition

                Provides a reason why the expected value or elements in the element that is extended are missing.

                Shortunknown | asked | temp | notasked | masked | unsupported | astext | error
                Control0..1
                TypeExtension(Data Absent Reason) (Extension Type: code)
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                107. Medication.form.coding
                Definition

                A reference to a code defined by a terminology system.

                ShortCode defined by a terminology system
                Comments

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

                Control0..*
                TypeCoding
                Is Modifierfalse
                Must Supporttrue
                Summarytrue
                Requirements

                Allows for alternative encodings within a code system, and translations to other code systems.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                SlicingThis element introduces a set of slices on Medication.form.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ $this
                • 109. Medication.form.coding:kbvDarreichungsform
                  Slice NamekbvDarreichungsform
                  Definition

                  A reference to a code defined by a terminology system.

                  ShortCode defined by a terminology system
                  Comments

                  KBV updates its "Schüsseltabellen" package more often than ePA versions get released. However, the eRezept clients and eRezept service take over new KBV package versions quickly after release and thus hands them over to the ePA Medication Service. Since the Medication Service is potentially fixed onto an older version of the KBV package, it would reject the forwarded eRezept data. In the future, the Medication Service will be enabled to update to the latest KBV package versions without the need for a new ePA release. Since the eRezept does check the codes against the latest KBV package version, the Medication Service will not receive any "invalid" codes and clients can rely on the Medication Service data conforming to the latest KBV package.


                  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.

                  Control0..1*
                  BindingThe codes SHALL be taken from For codes, see https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_KBV_DARREICHUNGSFORM
                  (required to https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_KBV_DARREICHUNGSFORM)
                  TypeCoding
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Allows for alternative encodings within a code system, and translations to other code systems.

                  Pattern Value{
                    "system" : "https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_KBV_DARREICHUNGSFORM"
                  }
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  111. Medication.form.coding:kbvDarreichungsform.system
                  Definition

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

                  ShortIdentity of the terminology system
                  Comments

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

                  Control10..1
                  Typeuri
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

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

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  113. Medication.form.coding:kbvDarreichungsform.code
                  Definition

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

                  ShortSymbol in syntax defined by the system
                  Control10..1
                  Typecode
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Need to refer to a particular code in the system.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  115. Medication.form.coding:kbvDarreichungsform.display
                  Definition

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

                  ShortRepresentation defined by the system
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

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

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  117. Medication.form.coding:ifaDarreichungsform
                  Slice NameifaDarreichungsform
                  Definition

                  A reference to a code defined by a terminology system.

                  ShortCode defined by a terminology system
                  Comments

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

                  Control0..1*
                  BindingThe codes SHALL be taken from For codes, see https://fhir.ifaffm.de/CodeSystem/IFA_DARREICHUNGSFORM
                  (required to https://fhir.ifaffm.de/CodeSystem/IFA_DARREICHUNGSFORM)
                  TypeCoding
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Allows for alternative encodings within a code system, and translations to other code systems.

                  Pattern Value{
                    "system" : "https://fhir.ifaffm.de/CodeSystem/IFA_DARREICHUNGSFORM"
                  }
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  119. Medication.form.coding:ifaDarreichungsform.system
                  Definition

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

                  ShortIdentity of the terminology system
                  Comments

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

                  Control10..1
                  Typeuri
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

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

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  121. Medication.form.coding:ifaDarreichungsform.code
                  Definition

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

                  ShortSymbol in syntax defined by the system
                  Control10..1
                  Typecode
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Need to refer to a particular code in the system.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  123. Medication.form.coding:ifaDarreichungsform.display
                  Definition

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

                  ShortRepresentation defined by the system
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

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

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  125. Medication.form.text
                  Definition

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

                  ShortPlain text representation of the concept
                  Comments

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

                  Control0..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

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

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  127. Medication.amount
                  Definition

                  Specific amount of the drug in the packaged product. For example, when specifying a product that has the same strength (For example, Insulin glargine 100 unit per mL solution for injection), this attribute provides additional clarification of the package amount (For example, 3 mL, 10mL, etc.).

                  ShortAmount of drug in package
                  Control0..1
                  TypeRatio
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  129. Medication.amount.numerator
                  Definition

                  The value of the numerator.

                  ShortNumerator value
                  Control0..1
                  BindingThe codes SHOULD be taken from For codes, see UCUMCodes
                  (preferred to http://hl7.org/fhir/ValueSet/ucum-units)
                  TypeQuantity
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  131. Medication.amount.numerator.extension:packagingSize
                  Slice NamepackagingSize
                  Definition

                  Specification of the package size according to divided quantity (e.g., 100, 2x25), only appears in conjunction with "unit" (e.g., 100 Stück).

                  ShortExtension
                  Control0..1
                  TypeExtension(MedicationPackagingSizeExtension) (Extension Type: string)
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  133. Medication.amount.numerator.extension:totalQuantity
                  Slice NametotalQuantity
                  Definition

                  Total quantity of the formulation (without the unit).

                  ShortExtension
                  Control0..1
                  TypeExtension(MedicationTotalQuantityFormulationExtension) (Extension Type: string)
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  135. Medication.amount.numerator.comparator
                  Definition

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

                  Short< | <= | >= | > - how to understand the value
                  Control0..1
                  BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
                  (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                  How the Quantity should be understood and represented.

                  Typecode
                  Is Modifiertrue because 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
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Requirements

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

                  Meaning if MissingIf there is no comparator, then there is no modification of the value
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  137. Medication.amount.denominator
                  Definition

                  The value of the denominator.

                  ShortDenominator value
                  Control0..1
                  BindingThe codes SHOULD be taken from For codes, see UCUMCodes
                  (preferred to http://hl7.org/fhir/ValueSet/ucum-units)
                  TypeQuantity
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  139. Medication.amount.denominator.value
                  Definition

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

                  ShortNumerical value (with implicit precision)
                  Comments

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

                  Control0..1
                  Typedecimal
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Precision is handled implicitly in almost all cases of measurement.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  141. Medication.amount.denominator.comparator
                  Definition

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

                  Short< | <= | >= | > - how to understand the value
                  Control0..1
                  BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
                  (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                  How the Quantity should be understood and represented.

                  Typecode
                  Is Modifiertrue because 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
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Requirements

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

                  Meaning if MissingIf there is no comparator, then there is no modification of the value
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  143. Medication.amount.denominator.unit
                  Definition

                  A human-readable form of the unit.

                  ShortUnit representation
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

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

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  145. Medication.amount.denominator.system
                  Definition

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

                  ShortSystem that defines coded unit form
                  Control0..1
                  This element is affected by the following invariants: qty-3
                  Typeuri
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

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

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  147. Medication.amount.denominator.code
                  Definition

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

                  ShortCoded form of the unit
                  Comments

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

                  Control0..1
                  Typecode
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

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

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  149. Medication.ingredient
                  Definition

                  Identifies a particular constituent of interest in the product.

                  ShortActive or inactive ingredients of the medication, including pharmaceutical substances as well as individual medicinal products in combination packs.
                  Comments

                  The ingredients need not be a complete list. If an ingredient is not specified, this does not indicate whether an ingredient is present or absent. If an ingredient is specified it does not mean that all ingredients are specified. It is possible to specify both inactive and active ingredients.

                  Control0..*
                  TypeBackboneElement
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  151. Medication.ingredient.extension
                  Definition

                  An Extension


                  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.

                  ShortExtensionAdditional content defined by implementations
                  Comments

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

                  Control0..*
                  TypeExtension
                  Is Modifierfalse
                  Summaryfalse
                  Alternate Namesextensions, user content
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  SlicingThis element introduces a set of slices on Medication.ingredient.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 153. Medication.ingredient.extension:darreichungsform
                    Slice Namedarreichungsform
                    Definition

                    Dosage form of an ingredient in a formulation.

                    ShortExtension
                    Control0..1
                    This element is affected by the following invariants: ele-1
                    TypeExtension(MedicationIngredientDarreichungsformExtension) (Extension Type: string)
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    155. Medication.ingredient.modifierExtension
                    Definition

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

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

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

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                    Summarytrue
                    Requirements

                    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.

                    Alternate Namesextensions, user content, modifiers
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    157. Medication.ingredient.item[x]
                    Definition

                    The actual ingredient - either a substance (simple ingredient) or another medication of a medication.

                    ShortThe actual ingredient or content
                    Control1..1
                    TypeCodeableConcept, Reference(Substance, Medication)
                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                    Is Modifierfalse
                    Must Supporttrue
                    Summaryfalse
                    Requirements

                    The ingredient may reference a substance (for example, amoxicillin) or another medication (for example in the case of a compounded product, Glaxal Base).

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    SlicingThis element introduces a set of slices on Medication.ingredient.item[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                    • type @ $this
                    • 159. Medication.ingredient.item[x]:itemCodeableConcept
                      Slice NameitemCodeableConcept
                      Definition

                      The actual ingredient - either a substance (simple ingredient) or another medication of a medication.

                      ShortEncoded description of the substance or component.The actual ingredient or content
                      Control01..1
                      TypeCodeableConcept, Reference(Substance, Medication)
                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                      Is Modifierfalse
                      Must Supporttrue
                      Summaryfalse
                      Requirements

                      The ingredient may reference a substance (for example, amoxicillin) or another medication (for example in the case of a compounded product, Glaxal Base).

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      161. Medication.ingredient.item[x]:itemCodeableConcept.coding
                      Definition

                      A reference to a code defined by a terminology system.

                      ShortCode defined by a terminology system
                      Comments

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

                      Control0..*
                      TypeCoding
                      Is Modifierfalse
                      Must Supporttrue
                      Summarytrue
                      Requirements

                      Allows for alternative encodings within a code system, and translations to other code systems.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      SlicingThis element introduces a set of slices on Medication.ingredient.item[x].coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ $this
                      • 163. Medication.ingredient.item[x]:itemCodeableConcept.coding:ask
                        Slice Nameask
                        Definition

                        A reference to a code defined by a terminology system.

                        ShortCode defined by a terminology system
                        Comments

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

                        Control0..*
                        TypeCoding
                        Is Modifierfalse
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        Allows for alternative encodings within a code system, and translations to other code systems.

                        Pattern Value{
                          "system" : "http://fhir.de/CodeSystem/ask"
                        }
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        165. Medication.ingredient.item[x]:itemCodeableConcept.coding:ask.system
                        Definition

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

                        ShortIdentity of the terminology system
                        Comments

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

                        Control10..1
                        Typeuri
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

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

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        167. Medication.ingredient.item[x]:itemCodeableConcept.coding:ask.code
                        Definition

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

                        ShortSymbol in syntax defined by the system
                        Control10..1
                        Typecode
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        Need to refer to a particular code in the system.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        169. Medication.ingredient.item[x]:itemCodeableConcept.coding:ask.display
                        Definition

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

                        ShortRepresentation defined by the system
                        Control0..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

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

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        171. Medication.ingredient.item[x]:itemCodeableConcept.coding:atc-de
                        Slice Nameatc-de
                        Definition

                        A reference to a code defined by a terminology system.

                        ShortCode defined by a terminology system
                        Comments

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

                        Control0..*
                        TypeCoding
                        Is Modifierfalse
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        Allows for alternative encodings within a code system, and translations to other code systems.

                        Pattern Value{
                          "system" : "http://fhir.de/CodeSystem/bfarm/atc"
                        }
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        173. Medication.ingredient.item[x]:itemCodeableConcept.coding:atc-de.system
                        Definition

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

                        ShortIdentity of the terminology system
                        Comments

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

                        Control10..1
                        Typeuri
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

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

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        175. Medication.ingredient.item[x]:itemCodeableConcept.coding:atc-de.version
                        Definition

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

                        ShortVersion of the system - if relevant
                        Comments

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

                        NoteThis is a business version Id, not a resource version Id (see discussion)
                        Control10..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        177. Medication.ingredient.item[x]:itemCodeableConcept.coding:atc-de.code
                        Definition

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

                        ShortSymbol in syntax defined by the system
                        Control10..1
                        Typecode
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        Need to refer to a particular code in the system.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        179. Medication.ingredient.item[x]:itemCodeableConcept.coding:atc-de.display
                        Definition

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

                        ShortRepresentation defined by the system
                        Control0..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

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

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        181. Medication.ingredient.item[x]:itemCodeableConcept.coding:pzn
                        Slice Namepzn
                        Definition

                        A reference to a code defined by a terminology system.

                        ShortCode defined by a terminology system
                        Comments

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

                        Control0..*
                        TypeCoding
                        Is Modifierfalse
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        Allows for alternative encodings within a code system, and translations to other code systems.

                        Pattern Value{
                          "system" : "http://fhir.de/CodeSystem/ifa/pzn"
                        }
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        183. Medication.ingredient.item[x]:itemCodeableConcept.coding:pzn.system
                        Definition

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

                        ShortIdentity of the terminology system
                        Comments

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

                        Control10..1
                        Typeuri
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

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

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        185. Medication.ingredient.item[x]:itemCodeableConcept.coding:pzn.code
                        Definition

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

                        ShortSymbol in syntax defined by the system
                        Control10..1
                        Typecode
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        Need to refer to a particular code in the system.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        187. Medication.ingredient.item[x]:itemCodeableConcept.coding:pzn.display
                        Definition

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

                        ShortRepresentation defined by the system
                        Control0..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

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

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        189. Medication.ingredient.item[x]:itemCodeableConcept.text
                        Definition

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

                        ShortPlain text representation of the concept
                        Comments

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

                        Control0..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

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

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        191. Medication.ingredient.item[x]:itemReference
                        Slice NameitemReference
                        Definition

                        The actual ingredient - either a substance (simple ingredient) or another medication of a medication.

                        ShortEine Medication für ein pharmazeutisches Produkt innerhalb einer Kombipackung darf keine weiteren untergeordneten Medications enthalten.“The actual ingredient or content
                        Control01..01
                        TypeReference(Medication, Substance, Medication), CodeableConcept
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Requirements

                        The ingredient may reference a substance (for example, amoxicillin) or another medication (for example in the case of a compounded product, Glaxal Base).

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        193. Medication.ingredient.isActive
                        Definition

                        Indication of whether this ingredient affects the therapeutic action of the drug.

                        ShortIs it an active ingredient?Active ingredient indicator
                        Control0..1
                        Typeboolean
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Requirements

                        True indicates that the ingredient affects the therapeutic action of the drug (i.e. active). False indicates that the ingredient does not affect the therapeutic action of the drug (i.e. inactive).

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        195. Medication.ingredient.strength
                        Definition

                        Specifies how many (or how much) of the items there are in this Medication. For example, 250 mg per tablet. This is expressed as a ratio where the numerator is 250mg and the denominator is 1 tablet.

                        ShortStrengthQuantity of ingredient present
                        Control0..1
                        TypeRatio
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        197. Medication.ingredient.strength.extension:amountText
                        Slice NameamountText
                        Definition

                        Free-text amount of the ingredient for classical Latin notations such as "ad 100.0" or "quantum satis," including the unit.

                        ShortExtension
                        Control0..1
                        TypeExtension(MedicationIngredientAmountExtensions) (Extension Type: string)
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        199. Medication.ingredient.strength.numerator
                        Definition

                        The value of the numerator.

                        ShortNumerator value
                        Control0..1
                        BindingThe codes SHOULD be taken from For codes, see UCUMCodes
                        (preferred to http://hl7.org/fhir/ValueSet/ucum-units)
                        TypeQuantity
                        Is Modifierfalse
                        Must Supporttrue
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        201. Medication.ingredient.strength.numerator.value
                        Definition

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

                        ShortNumerical value (with implicit precision)
                        Comments

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

                        Control10..1
                        Typedecimal
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        Precision is handled implicitly in almost all cases of measurement.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        203. Medication.ingredient.strength.numerator.comparator
                        Definition

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

                        Short< | <= | >= | > - how to understand the value
                        Control0..1
                        BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
                        (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                        How the Quantity should be understood and represented.

                        Typecode
                        Is Modifiertrue because 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
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

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

                        Meaning if MissingIf there is no comparator, then there is no modification of the value
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        205. Medication.ingredient.strength.numerator.unit
                        Definition

                        A human-readable form of the unit.

                        ShortUnit representation
                        Control0..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

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

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        207. Medication.ingredient.strength.numerator.system
                        Definition

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

                        ShortSystem that defines coded unit form
                        Control0..1
                        This element is affected by the following invariants: qty-3
                        Typeuri
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

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

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        209. Medication.ingredient.strength.numerator.code
                        Definition

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

                        ShortCoded form of the unit
                        Comments

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

                        Control0..1
                        Typecode
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

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

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        211. Medication.ingredient.strength.denominator
                        Definition

                        The value of the denominator.

                        ShortDenominator value
                        Control0..1
                        BindingThe codes SHOULD be taken from For codes, see UCUMCodes
                        (preferred to http://hl7.org/fhir/ValueSet/ucum-units)
                        TypeQuantity
                        Is Modifierfalse
                        Must Supporttrue
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        213. Medication.ingredient.strength.denominator.value
                        Definition

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

                        ShortNumerical value (with implicit precision)
                        Comments

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

                        Control10..1
                        Typedecimal
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

                        Precision is handled implicitly in almost all cases of measurement.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        215. Medication.ingredient.strength.denominator.comparator
                        Definition

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

                        Short< | <= | >= | > - how to understand the value
                        Control0..1
                        BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
                        (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                        How the Quantity should be understood and represented.

                        Typecode
                        Is Modifiertrue because 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
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

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

                        Meaning if MissingIf there is no comparator, then there is no modification of the value
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        217. Medication.ingredient.strength.denominator.unit
                        Definition

                        A human-readable form of the unit.

                        ShortUnit representation
                        Control0..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

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

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        219. Medication.ingredient.strength.denominator.system
                        Definition

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

                        ShortSystem that defines coded unit form
                        Control0..1
                        This element is affected by the following invariants: qty-3
                        Typeuri
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

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

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        221. Medication.ingredient.strength.denominator.code
                        Definition

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

                        ShortCoded form of the unit
                        Comments

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

                        Control0..1
                        Typecode
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Summarytrue
                        Requirements

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

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

                        Guidance on how to interpret the contents of this table can be foundhere

                        0. Medication
                        Invariantsti-med-1: Medication code, name, or ingredients must be specified (code.exists() or ingredient.exists())
                        2. Medication.meta
                        Must Supporttrue
                        4. Medication.meta.versionId
                        Must Supporttrue
                        6. Medication.meta.lastUpdated
                        Must Supporttrue
                        8. Medication.contained
                        Control0..0
                        10. Medication.extension
                        SlicingThis element introduces a set of slices on Medication.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 12. Medication.extension:context
                          Slice Namecontext
                          Control0..1
                          TypeExtension(ContextExtension) (Extension Type: code)
                          Must Supporttrue
                          14. Medication.extension:rxPrescriptionProcessIdentifier
                          Slice NamerxPrescriptionProcessIdentifier
                          Control0..1
                          TypeExtension(RxPrescriptionProcessIdentifierExtension) (Extension Type: Identifier(RxPrescriptionProcessIdentifier))
                          Must Supporttrue
                          16. Medication.extension:isVaccine
                          Slice NameisVaccine
                          Control0..1
                          TypeExtension(MedicationIsVaccineExtension) (Extension Type: boolean)
                          Must Supporttrue
                          18. Medication.extension:drugCategory
                          Slice NamedrugCategory
                          Control0..1
                          TypeExtension(DrugCategoryExtension) (Extension Type: Coding)
                          Must Supporttrue
                          20. Medication.extension:drugCategory.value[x]
                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                          22. Medication.extension:drugCategory.value[x].system
                          Control1..?
                          Must Supporttrue
                          24. Medication.extension:drugCategory.value[x].code
                          Control1..?
                          Must Supporttrue
                          26. Medication.extension:normSizeCode
                          Slice NamenormSizeCode
                          Definition

                          Description of the therapy-appropriate package size (e.g., N1)

                          ShortPackage size according to N-designation
                          Control0..1
                          TypeExtension(ExtensionNormgroesseDeBasis) (Extension Type: code)
                          Must Supporttrue
                          28. Medication.extension:normSizeCode.value[x]
                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                          Must Supporttrue
                          30. Medication.extension:packaging
                          Slice Namepackaging
                          Control0..1
                          TypeExtension(MedicationFormulationPackagingExtension) (Extension Type: string)
                          Must Supporttrue
                          32. Medication.extension:manufacturingInstructions
                          Slice NamemanufacturingInstructions
                          Control0..1
                          TypeExtension(MedicationManufacturingInstructionsExtension) (Extension Type: string)
                          Must Supporttrue
                          34. Medication.extension:type
                          Slice Nametype
                          Control0..1
                          TypeExtension(Medication Type) (Extension Type: Coding)
                          Must Supporttrue
                          36. Medication.extension:type.url
                          Must Supporttrue
                          38. Medication.extension:type.value[x]
                          BindingThe codes SHALL be taken from https://gematik.de/fhir/terminology/ValueSet/ti-medication-type-pharmaceutical-product-vs
                          (required to https://gematik.de/fhir/terminology/ValueSet/ti-medication-type-pharmaceutical-product-vs)
                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                          40. Medication.extension:type.value[x].system
                          Must Supporttrue
                          42. Medication.extension:type.value[x].version
                          NoteThis is a business version Id, not a resource version Id (see discussion)
                          Must Supporttrue
                          44. Medication.extension:type.value[x].code
                          Must Supporttrue
                          46. Medication.extension:type.value[x].display
                          Must Supporttrue
                          48. Medication.identifier
                          NoteThis is a business identifier, not a resource identifier (see discussion)
                          SlicingThis element introduces a set of slices on Medication.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ $this
                          • 50. Medication.identifier:RxOriginatorProcessIdentifier
                            Slice NameRxOriginatorProcessIdentifier
                            NoteThis is a business identifier, not a resource identifier (see discussion)
                            Control0..1
                            TypeIdentifier(RxOriginatorProcessIdentifier)
                            Pattern Value{
                              "system" : "https://gematik.de/fhir/epa-medication/sid/rx-originator-process-identifier"
                            }
                            52. Medication.code
                            ShortMedication in coded form or as free text if necessary
                            Must Supporttrue
                            54. Medication.code.coding
                            Must Supporttrue
                            SlicingThis element introduces a set of slices on Medication.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • value @ $this
                            • 56. Medication.code.coding:pzn
                              Slice Namepzn
                              Control0..0
                              Must Supporttrue
                              Pattern Value{
                                "system" : "http://fhir.de/CodeSystem/ifa/pzn"
                              }
                              61. Medication.code.coding:atc-de
                              Slice Nameatc-de
                              Control0..*
                              Must Supporttrue
                              Pattern Value{
                                "system" : "http://fhir.de/CodeSystem/bfarm/atc"
                              }
                              63. Medication.code.coding:atc-de.system
                              Control1..?
                              Must Supporttrue
                              65. Medication.code.coding:atc-de.version
                              NoteThis is a business version Id, not a resource version Id (see discussion)
                              Control1..?
                              67. Medication.code.coding:atc-de.code
                              Control1..?
                              Must Supporttrue
                              69. Medication.code.coding:atc-de.display
                              Must Supporttrue
                              71. Medication.code.coding:ask
                              Slice Nameask
                              Control0..*
                              Must Supporttrue
                              Pattern Value{
                                "system" : "http://fhir.de/CodeSystem/ask"
                              }
                              73. Medication.code.coding:ask.system
                              Control1..?
                              Must Supporttrue
                              75. Medication.code.coding:ask.code
                              Control1..?
                              Must Supporttrue
                              77. Medication.code.coding:ask.display
                              Must Supporttrue
                              79. Medication.code.text
                              Must Supporttrue
                              81. Medication.status
                              ShortStatus of Medication Information
                              Must Supporttrue
                              83. Medication.manufacturer
                              ShortManufacturer of the Medication
                              Comments

                              Here, the actual manufacturer of the medication can be named, primarily in the case of active ingredient mixtures (compounding prescriptions), such as the hospital pharmacy. It is important to note that the licensing organization, as mentioned in the PZN (Pharmaceutical Central Number) data, is not considered the manufacturer.

                              Must Supporttrue
                              85. Medication.manufacturer.display
                              Control1..?
                              Must Supporttrue
                              87. Medication.form
                              ShortForm of Dispensing
                              Must Supporttrue
                              89. Medication.form.extension
                              Must Supporttrue
                              91. Medication.form.extension:dataAbsentReason
                              Slice NamedataAbsentReason
                              Control0..1
                              TypeExtension(Data Absent Reason) (Extension Type: code)
                              Must Supporttrue
                              93. Medication.form.coding
                              Must Supporttrue
                              SlicingThis element introduces a set of slices on Medication.form.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ $this
                              • 95. Medication.form.coding:kbvDarreichungsform
                                Slice NamekbvDarreichungsform
                                Comments

                                KBV updates its "Schüsseltabellen" package more often than ePA versions get released. However, the eRezept clients and eRezept service take over new KBV package versions quickly after release and thus hands them over to the ePA Medication Service. Since the Medication Service is potentially fixed onto an older version of the KBV package, it would reject the forwarded eRezept data. In the future, the Medication Service will be enabled to update to the latest KBV package versions without the need for a new ePA release. Since the eRezept does check the codes against the latest KBV package version, the Medication Service will not receive any "invalid" codes and clients can rely on the Medication Service data conforming to the latest KBV package.

                                Control0..1
                                BindingThe codes SHALL be taken from https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_KBV_DARREICHUNGSFORM
                                (required to https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_KBV_DARREICHUNGSFORM)
                                Must Supporttrue
                                Pattern Value{
                                  "system" : "https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_KBV_DARREICHUNGSFORM"
                                }
                                97. Medication.form.coding:kbvDarreichungsform.system
                                Control1..?
                                Must Supporttrue
                                99. Medication.form.coding:kbvDarreichungsform.code
                                Control1..?
                                Must Supporttrue
                                101. Medication.form.coding:kbvDarreichungsform.display
                                Must Supporttrue
                                103. Medication.form.coding:ifaDarreichungsform
                                Slice NameifaDarreichungsform
                                Control0..1
                                BindingThe codes SHALL be taken from https://fhir.ifaffm.de/CodeSystem/IFA_DARREICHUNGSFORM
                                (required to https://fhir.ifaffm.de/CodeSystem/IFA_DARREICHUNGSFORM)
                                Must Supporttrue
                                Pattern Value{
                                  "system" : "https://fhir.ifaffm.de/CodeSystem/IFA_DARREICHUNGSFORM"
                                }
                                105. Medication.form.coding:ifaDarreichungsform.system
                                Control1..?
                                Must Supporttrue
                                107. Medication.form.coding:ifaDarreichungsform.code
                                Control1..?
                                Must Supporttrue
                                109. Medication.form.coding:ifaDarreichungsform.display
                                Must Supporttrue
                                111. Medication.form.text
                                Must Supporttrue
                                113. Medication.amount
                                Must Supporttrue
                                115. Medication.amount.numerator
                                BindingThe codes SHOULD be taken from UCUMCodes
                                (preferred to http://hl7.org/fhir/ValueSet/ucum-units)
                                Must Supporttrue
                                117. Medication.amount.numerator.extension:packagingSize
                                Slice NamepackagingSize
                                Control0..1
                                TypeExtension(MedicationPackagingSizeExtension) (Extension Type: string)
                                Must Supporttrue
                                119. Medication.amount.numerator.extension:totalQuantity
                                Slice NametotalQuantity
                                Control0..1
                                TypeExtension(MedicationTotalQuantityFormulationExtension) (Extension Type: string)
                                Must Supporttrue
                                121. Medication.amount.denominator
                                BindingThe codes SHOULD be taken from UCUMCodes
                                (preferred to http://hl7.org/fhir/ValueSet/ucum-units)
                                Must Supporttrue
                                123. Medication.amount.denominator.value
                                Must Supporttrue
                                125. Medication.amount.denominator.unit
                                Must Supporttrue
                                127. Medication.amount.denominator.system
                                Must Supporttrue
                                129. Medication.amount.denominator.code
                                Must Supporttrue
                                131. Medication.ingredient
                                ShortActive or inactive ingredients of the medication, including pharmaceutical substances as well as individual medicinal products in combination packs.
                                Must Supporttrue
                                133. Medication.ingredient.extension
                                SlicingThis element introduces a set of slices on Medication.ingredient.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • value @ url
                                • 135. Medication.ingredient.extension:darreichungsform
                                  Slice Namedarreichungsform
                                  Control0..1
                                  TypeExtension(MedicationIngredientDarreichungsformExtension) (Extension Type: string)
                                  137. Medication.ingredient.item[x]
                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                  Must Supporttrue
                                  SlicingThis element introduces a set of slices on Medication.ingredient.item[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • type @ $this
                                  • 139. Medication.ingredient.item[x]:itemCodeableConcept
                                    Slice NameitemCodeableConcept
                                    ShortEncoded description of the substance or component.
                                    Control0..1
                                    TypeCodeableConcept
                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                    Must Supporttrue
                                    141. Medication.ingredient.item[x]:itemCodeableConcept.coding
                                    Must Supporttrue
                                    SlicingThis element introduces a set of slices on Medication.ingredient.item[x].coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                    • value @ $this
                                    • 143. Medication.ingredient.item[x]:itemCodeableConcept.coding:ask
                                      Slice Nameask
                                      Control0..*
                                      Must Supporttrue
                                      Pattern Value{
                                        "system" : "http://fhir.de/CodeSystem/ask"
                                      }
                                      145. Medication.ingredient.item[x]:itemCodeableConcept.coding:ask.system
                                      Control1..?
                                      Must Supporttrue
                                      147. Medication.ingredient.item[x]:itemCodeableConcept.coding:ask.code
                                      Control1..?
                                      Must Supporttrue
                                      149. Medication.ingredient.item[x]:itemCodeableConcept.coding:ask.display
                                      Must Supporttrue
                                      151. Medication.ingredient.item[x]:itemCodeableConcept.coding:atc-de
                                      Slice Nameatc-de
                                      Control0..*
                                      Must Supporttrue
                                      Pattern Value{
                                        "system" : "http://fhir.de/CodeSystem/bfarm/atc"
                                      }
                                      153. Medication.ingredient.item[x]:itemCodeableConcept.coding:atc-de.system
                                      Control1..?
                                      Must Supporttrue
                                      155. Medication.ingredient.item[x]:itemCodeableConcept.coding:atc-de.version
                                      NoteThis is a business version Id, not a resource version Id (see discussion)
                                      Control1..?
                                      157. Medication.ingredient.item[x]:itemCodeableConcept.coding:atc-de.code
                                      Control1..?
                                      Must Supporttrue
                                      159. Medication.ingredient.item[x]:itemCodeableConcept.coding:atc-de.display
                                      Must Supporttrue
                                      161. Medication.ingredient.item[x]:itemCodeableConcept.coding:pzn
                                      Slice Namepzn
                                      Control0..*
                                      Must Supporttrue
                                      Pattern Value{
                                        "system" : "http://fhir.de/CodeSystem/ifa/pzn"
                                      }
                                      163. Medication.ingredient.item[x]:itemCodeableConcept.coding:pzn.system
                                      Control1..?
                                      Must Supporttrue
                                      165. Medication.ingredient.item[x]:itemCodeableConcept.coding:pzn.code
                                      Control1..?
                                      Must Supporttrue
                                      167. Medication.ingredient.item[x]:itemCodeableConcept.coding:pzn.display
                                      Must Supporttrue
                                      169. Medication.ingredient.item[x]:itemCodeableConcept.text
                                      Must Supporttrue
                                      171. Medication.ingredient.item[x]:itemReference
                                      Slice NameitemReference
                                      ShortEine Medication für ein pharmazeutisches Produkt innerhalb einer Kombipackung darf keine weiteren untergeordneten Medications enthalten.“
                                      Control0..0
                                      TypeReference(Medication)
                                      Must Supporttrue
                                      173. Medication.ingredient.isActive
                                      ShortIs it an active ingredient?
                                      175. Medication.ingredient.strength
                                      ShortStrength
                                      Must Supporttrue
                                      177. Medication.ingredient.strength.extension:amountText
                                      Slice NameamountText
                                      Control0..1
                                      TypeExtension(MedicationIngredientAmountExtensions) (Extension Type: string)
                                      179. Medication.ingredient.strength.numerator
                                      BindingThe codes SHOULD be taken from UCUMCodes
                                      (preferred to http://hl7.org/fhir/ValueSet/ucum-units)
                                      Must Supporttrue
                                      181. Medication.ingredient.strength.numerator.value
                                      Control1..?
                                      Must Supporttrue
                                      183. Medication.ingredient.strength.numerator.unit
                                      Must Supporttrue
                                      185. Medication.ingredient.strength.numerator.system
                                      Must Supporttrue
                                      187. Medication.ingredient.strength.numerator.code
                                      Must Supporttrue
                                      189. Medication.ingredient.strength.denominator
                                      BindingThe codes SHOULD be taken from UCUMCodes
                                      (preferred to http://hl7.org/fhir/ValueSet/ucum-units)
                                      Must Supporttrue
                                      191. Medication.ingredient.strength.denominator.value
                                      Control1..?
                                      Must Supporttrue
                                      193. Medication.ingredient.strength.denominator.unit
                                      Must Supporttrue
                                      195. Medication.ingredient.strength.denominator.system
                                      Must Supporttrue
                                      197. Medication.ingredient.strength.denominator.code
                                      Must Supporttrue

                                      Guidance on how to interpret the contents of this table can be foundhere

                                      0. Medication
                                      Definition

                                      This resource is primarily used for the identification and definition of a medication for the purposes of prescribing, dispensing, and administering a medication as well as for making statements about medication use.

                                      ShortDefinition of a Medication
                                      Control0..*
                                      Is Modifierfalse
                                      Summaryfalse
                                      Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                                      dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource 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())
                                      dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
                                      dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                                      dom-6: A resource should have narrative for robust management (text.`div`.exists())
                                      ti-med-1: Medication code, name, or ingredients must be specified (code.exists() or ingredient.exists())
                                      2. Medication.id
                                      Definition

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

                                      ShortLogical id of this artifact
                                      Comments

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

                                      Control0..1
                                      Typeid
                                      Is Modifierfalse
                                      Summarytrue
                                      4. Medication.meta
                                      Definition

                                      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.

                                      ShortMetadata about the resource
                                      Control0..1
                                      TypeMeta
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summarytrue
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      6. Medication.meta.id
                                      Definition

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

                                      ShortUnique id for inter-element referencing
                                      Control0..1
                                      Typestring
                                      Is Modifierfalse
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      Summaryfalse
                                      8. Medication.meta.extension
                                      Definition

                                      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.

                                      ShortAdditional content defined by implementations
                                      Comments

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

                                      Control0..*
                                      TypeExtension
                                      Is Modifierfalse
                                      Summaryfalse
                                      Alternate Namesextensions, user content
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      SlicingThis element introduces a set of slices on Medication.meta.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                      • value @ url
                                      • 10. Medication.meta.versionId
                                        Definition

                                        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.

                                        ShortVersion specific identifier
                                        Comments

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

                                        Control0..1
                                        Typeid
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Must Supporttrue
                                        Summarytrue
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        12. Medication.meta.lastUpdated
                                        Definition

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

                                        ShortWhen the resource version last changed
                                        Comments

                                        This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

                                        Control0..1
                                        Typeinstant
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Must Supporttrue
                                        Summarytrue
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        14. Medication.meta.source
                                        Definition

                                        A uri that identifies the source system of the resource. This provides a minimal amount of Provenance 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.

                                        ShortIdentifies where the resource comes from
                                        Comments

                                        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.

                                        Control0..1
                                        Typeuri
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        16. Medication.meta.profile
                                        Definition

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

                                        ShortProfiles this resource claims to conform to
                                        Comments

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

                                        Control0..*
                                        Typecanonical(StructureDefinition)
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        18. Medication.meta.security
                                        Definition

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

                                        ShortSecurity Labels applied to this resource
                                        Comments

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

                                        Control0..*
                                        BindingUnless not suitable, these codes SHALL be taken from All Security Labels
                                        (extensible to http://hl7.org/fhir/ValueSet/security-labels|4.0.1)

                                        Security Labels from the Healthcare Privacy and Security Classification System.

                                        TypeCoding
                                        Is Modifierfalse
                                        Summarytrue
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        20. Medication.meta.tag
                                        Definition

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

                                        ShortTags applied to this resource
                                        Comments

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

                                        Control0..*
                                        BindingFor example codes, see CommonTags
                                        (example to http://hl7.org/fhir/ValueSet/common-tags|4.0.1)

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

                                        TypeCoding
                                        Is Modifierfalse
                                        Summarytrue
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        22. Medication.implicitRules
                                        Definition

                                        A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

                                        ShortA set of rules under which this content was created
                                        Comments

                                        Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

                                        Control0..1
                                        Typeuri
                                        Is Modifiertrue because 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
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        24. Medication.language
                                        Definition

                                        The base language in which the resource is written.

                                        ShortLanguage of the resource content
                                        Comments

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

                                        Control0..1
                                        BindingThe codes SHOULD be taken from CommonLanguages
                                        (preferred to http://hl7.org/fhir/ValueSet/languages|4.0.1)

                                        A human language.

                                        Additional BindingsPurpose
                                        AllLanguagesMax Binding
                                        Typecode
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        26. Medication.text
                                        Definition

                                        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.

                                        ShortText summary of the resource, for human interpretation
                                        Comments

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

                                        Control0..1
                                        TypeNarrative
                                        Is Modifierfalse
                                        Summaryfalse
                                        Alternate Namesnarrative, html, xhtml, display
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        28. Medication.contained
                                        Definition

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

                                        ShortContained, inline Resources
                                        Comments

                                        This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

                                        Control0..0
                                        TypeResource
                                        Is Modifierfalse
                                        Summaryfalse
                                        Alternate Namesinline resources, anonymous resources, contained resources
                                        30. Medication.extension
                                        Definition

                                        An Extension

                                        ShortExtension
                                        Control0..*
                                        TypeExtension
                                        Is Modifierfalse
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        SlicingThis element introduces a set of slices on Medication.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                        • value @ url
                                        • 32. Medication.extension:context
                                          Slice Namecontext
                                          Definition

                                          Extension for indicating the context.

                                          ShortExtension
                                          Control0..1
                                          This element is affected by the following invariants: ele-1
                                          TypeExtension(ContextExtension) (Extension Type: code)
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          34. Medication.extension:rxPrescriptionProcessIdentifier
                                          Slice NamerxPrescriptionProcessIdentifier
                                          Definition

                                          This extension is used to track medication prescription transactions between the E-Rezept-Fachdienst and the ePA. The RxPrescriptionProcessIdentifier is generated by the ePA Medication Service and consists of the PrescriptionId and the authoredOn date of the operation parameters request. It ensures consistent referencing and management of medication-related resources across different systems.

                                          ShortExtension
                                          Control0..1
                                          This element is affected by the following invariants: ele-1
                                          TypeExtension(RxPrescriptionProcessIdentifierExtension) (Extension Type: Identifier(RxPrescriptionProcessIdentifier))
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          36. Medication.extension:isVaccine
                                          Slice NameisVaccine
                                          Definition

                                          Indicator of whether this is a vaccine.

                                          ShortExtension
                                          Control0..1
                                          This element is affected by the following invariants: ele-1
                                          TypeExtension(MedicationIsVaccineExtension) (Extension Type: boolean)
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          38. Medication.extension:drugCategory
                                          Slice NamedrugCategory
                                          Definition

                                          Extension for indicating the medication category.

                                          ShortExtension
                                          Control0..1
                                          This element is affected by the following invariants: ele-1
                                          TypeExtension(DrugCategoryExtension) (Extension Type: Coding)
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          40. Medication.extension:drugCategory.id
                                          Definition

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

                                          ShortUnique id for inter-element referencing
                                          Control0..1
                                          Typestring
                                          Is Modifierfalse
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          Summaryfalse
                                          42. Medication.extension:drugCategory.extension
                                          Definition

                                          An Extension

                                          ShortExtension
                                          Control0..0
                                          TypeExtension
                                          Is Modifierfalse
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          SlicingThis element introduces a set of slices on Medication.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                          • value @ url
                                          • 44. Medication.extension:drugCategory.url
                                            Definition

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

                                            Shortidentifies the meaning of the extension
                                            Comments

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

                                            Control1..1
                                            Typeuri
                                            Is Modifierfalse
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            Summaryfalse
                                            Fixed Valuehttps://gematik.de/fhir/epa-medication/StructureDefinition/drug-category-extension
                                            46. Medication.extension:drugCategory.value[x]
                                            Definition

                                            Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                            ShortValue of extension
                                            Control1..1
                                            BindingThe codes SHALL be taken from https://gematik.de/fhir/terminology/ValueSet/ti-drug-category-vs
                                            (required to https://gematik.de/fhir/terminology/ValueSet/ti-drug-category-vs)
                                            TypeCoding
                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                            Is Modifierfalse
                                            Must Supporttrue
                                            Summaryfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            48. Medication.extension:drugCategory.value[x].id
                                            Definition

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

                                            ShortUnique id for inter-element referencing
                                            Control0..1
                                            Typestring
                                            Is Modifierfalse
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            Summaryfalse
                                            50. Medication.extension:drugCategory.value[x].extension
                                            Definition

                                            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.

                                            ShortAdditional content defined by implementations
                                            Comments

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

                                            Control0..*
                                            TypeExtension
                                            Is Modifierfalse
                                            Summaryfalse
                                            Alternate Namesextensions, user content
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            SlicingThis element introduces a set of slices on Medication.extension.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                            • value @ url
                                            • 52. Medication.extension:drugCategory.value[x].system
                                              Definition

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

                                              ShortIdentity of the terminology system
                                              Comments

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

                                              Control1..1
                                              Typeuri
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Must Supporttrue
                                              Summarytrue
                                              Requirements

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

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              54. Medication.extension:drugCategory.value[x].version
                                              Definition

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

                                              ShortVersion of the system - if relevant
                                              Comments

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

                                              NoteThis is a business version Id, not a resource version Id (see discussion)
                                              Control0..1
                                              Typestring
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Summarytrue
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              56. Medication.extension:drugCategory.value[x].code
                                              Definition

                                              Drug Category

                                              ShortCategory
                                              Control1..1
                                              Typecode
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Must Supporttrue
                                              Summarytrue
                                              Requirements

                                              Need to refer to a particular code in the system.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              58. Medication.extension:drugCategory.value[x].display
                                              Definition

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

                                              ShortRepresentation defined by the system
                                              Control0..1
                                              Typestring
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Summarytrue
                                              Requirements

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

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              60. Medication.extension:drugCategory.value[x].userSelected
                                              Definition

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

                                              ShortIf this coding was chosen directly by the user
                                              Comments

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

                                              Control0..1
                                              Typeboolean
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Summarytrue
                                              Requirements

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

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              62. Medication.extension:normSizeCode
                                              Slice NamenormSizeCode
                                              Definition

                                              Description of the therapy-appropriate package size (e.g., N1)

                                              ShortPackage size according to N-designation
                                              Control0..1
                                              This element is affected by the following invariants: ele-1
                                              TypeExtension(ExtensionNormgroesseDeBasis) (Extension Type: code)
                                              Is Modifierfalse
                                              Must Supporttrue
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                              64. Medication.extension:normSizeCode.id
                                              Definition

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

                                              ShortUnique id for inter-element referencing
                                              Control0..1
                                              Typestring
                                              Is Modifierfalse
                                              XML FormatIn the XML format, this property is represented as an attribute.
                                              Summaryfalse
                                              66. Medication.extension:normSizeCode.extension
                                              Definition

                                              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.

                                              ShortAdditional content defined by implementations
                                              Comments

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

                                              Control0..0
                                              TypeExtension
                                              Is Modifierfalse
                                              Summaryfalse
                                              Alternate Namesextensions, user content
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                              SlicingThis element introduces a set of slices on Medication.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                              • value @ url
                                              • 68. Medication.extension:normSizeCode.url
                                                Definition

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

                                                Shortidentifies the meaning of the extension
                                                Comments

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

                                                Control1..1
                                                Typeuri
                                                Is Modifierfalse
                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                Summaryfalse
                                                Fixed Valuehttp://fhir.de/StructureDefinition/normgroesse
                                                70. Medication.extension:normSizeCode.value[x]
                                                Definition

                                                Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                ShortValue of extension
                                                Control0..1
                                                BindingThe codes SHALL be taken from https://fhir.kbv.de/ValueSet/KBV_VS_SFHIR_KBV_NORMGROESSE
                                                (required to https://fhir.kbv.de/ValueSet/KBV_VS_SFHIR_KBV_NORMGROESSE)
                                                Typecode
                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summaryfalse
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                72. Medication.extension:packaging
                                                Slice Namepackaging
                                                Definition

                                                Information on the packaging of a formulation.

                                                ShortExtension
                                                Control0..1
                                                This element is affected by the following invariants: ele-1
                                                TypeExtension(MedicationFormulationPackagingExtension) (Extension Type: string)
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summaryfalse
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                74. Medication.extension:manufacturingInstructions
                                                Slice NamemanufacturingInstructions
                                                Definition

                                                Manufacturing instructions regarding the preparation of a formulation (Subscriptio).

                                                ShortExtension
                                                Control0..1
                                                This element is affected by the following invariants: ele-1
                                                TypeExtension(MedicationManufacturingInstructionsExtension) (Extension Type: string)
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summaryfalse
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                76. Medication.extension:type
                                                Slice Nametype
                                                Definition

                                                Extension for EPAMedication types

                                                ShortMedication Type
                                                Control0..1
                                                This element is affected by the following invariants: ele-1
                                                TypeExtension(Medication Type) (Extension Type: Coding)
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summaryfalse
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                78. Medication.extension:type.id
                                                Definition

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

                                                ShortUnique id for inter-element referencing
                                                Control0..1
                                                Typestring
                                                Is Modifierfalse
                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                Summaryfalse
                                                80. Medication.extension:type.extension
                                                Definition

                                                An Extension

                                                ShortExtension
                                                Control0..0
                                                TypeExtension
                                                Is Modifierfalse
                                                Summaryfalse
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                SlicingThis element introduces a set of slices on Medication.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                • value @ url
                                                • 82. Medication.extension:type.url
                                                  Definition

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

                                                  Shortidentifies the meaning of the extension
                                                  Comments

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

                                                  Control1..1
                                                  Typeuri
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  Summaryfalse
                                                  Fixed Valuehttps://gematik.de/fhir/epa-medication/StructureDefinition/epa-medication-type-extension
                                                  84. Medication.extension:type.value[x]
                                                  Definition

                                                  Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                  ShortValue of extension
                                                  Control1..1
                                                  BindingThe codes SHALL be taken from https://gematik.de/fhir/terminology/ValueSet/ti-medication-type-pharmaceutical-product-vs
                                                  (required to https://gematik.de/fhir/terminology/ValueSet/ti-medication-type-pharmaceutical-product-vs)
                                                  TypeCoding
                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  86. Medication.extension:type.value[x].id
                                                  Definition

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

                                                  ShortUnique id for inter-element referencing
                                                  Control0..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  Summaryfalse
                                                  88. Medication.extension:type.value[x].extension
                                                  Definition

                                                  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.

                                                  ShortAdditional content defined by implementations
                                                  Comments

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

                                                  Control0..*
                                                  TypeExtension
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Alternate Namesextensions, user content
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                  SlicingThis element introduces a set of slices on Medication.extension.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                  • value @ url
                                                  • 90. Medication.extension:type.value[x].system
                                                    Definition

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

                                                    ShortIdentity of the terminology system
                                                    Comments

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

                                                    Control0..1
                                                    Typeuri
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Must Supporttrue
                                                    Summarytrue
                                                    Requirements

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

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    92. Medication.extension:type.value[x].version
                                                    Definition

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

                                                    ShortVersion of the system - if relevant
                                                    Comments

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

                                                    NoteThis is a business version Id, not a resource version Id (see discussion)
                                                    Control0..1
                                                    Typestring
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Must Supporttrue
                                                    Summarytrue
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    94. Medication.extension:type.value[x].code
                                                    Definition

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

                                                    ShortSymbol in syntax defined by the system
                                                    Control0..1
                                                    Typecode
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Must Supporttrue
                                                    Summarytrue
                                                    Requirements

                                                    Need to refer to a particular code in the system.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    96. Medication.extension:type.value[x].display
                                                    Definition

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

                                                    ShortRepresentation defined by the system
                                                    Control0..1
                                                    Typestring
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Must Supporttrue
                                                    Summarytrue
                                                    Requirements

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

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    98. Medication.extension:type.value[x].userSelected
                                                    Definition

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

                                                    ShortIf this coding was chosen directly by the user
                                                    Comments

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

                                                    Control0..1
                                                    Typeboolean
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summarytrue
                                                    Requirements

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

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    100. Medication.modifierExtension
                                                    Definition

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

                                                    ShortExtensions that cannot be ignored
                                                    Comments

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

                                                    Control0..*
                                                    TypeExtension
                                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                                                    Summaryfalse
                                                    Requirements

                                                    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.

                                                    Alternate Namesextensions, user content
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    102. Medication.identifier
                                                    Definition

                                                    Business identifier for this medication.

                                                    ShortBusiness identifier for this medication
                                                    Comments

                                                    The serial number could be included as an identifier.

                                                    NoteThis is a business identifier, not a resource identifier (see discussion)
                                                    Control0..*
                                                    TypeIdentifier
                                                    Is Modifierfalse
                                                    Summarytrue
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    SlicingThis element introduces a set of slices on Medication.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                    • value @ $this
                                                    • 104. Medication.identifier:RxOriginatorProcessIdentifier
                                                      Slice NameRxOriginatorProcessIdentifier
                                                      Definition

                                                      Business identifier for this medication.

                                                      ShortBusiness identifier for this medication
                                                      Comments

                                                      The serial number could be included as an identifier.

                                                      NoteThis is a business identifier, not a resource identifier (see discussion)
                                                      Control0..1
                                                      TypeIdentifier(RxOriginatorProcessIdentifier)
                                                      Is Modifierfalse
                                                      Summarytrue
                                                      Pattern Value{
                                                        "system" : "https://gematik.de/fhir/epa-medication/sid/rx-originator-process-identifier"
                                                      }
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      106. Medication.code
                                                      Definition

                                                      A code (or set of codes) that specify this medication, or a textual description if no code is available. Usage note: This could be a standard medication code such as a code from RxNorm, SNOMED CT, IDMP etc. It could also be a national or local formulary code, optionally with translations to other code systems.

                                                      ShortMedication in coded form or as free text if necessary
                                                      Comments

                                                      Depending on the context of use, the code that was actually selected by the user (prescriber, dispenser, etc.) will have the coding.userSelected set to true. As described in the coding datatype: "A coding may be marked as a "userSelected" if a user selected the particular coded value in a user interface (e.g. the user selects an item in a pick-list). If a user selected coding exists, it is the preferred choice for performing translations etc. Other codes can only be literal translations to alternative code systems, or codes at a lower level of granularity (e.g. a generic code for a vendor-specific primary one).

                                                      Control0..1
                                                      BindingFor example codes, see SNOMEDCTMedicationCodes
                                                      (example to http://hl7.org/fhir/ValueSet/medication-codes|4.0.1)

                                                      A coded concept that defines the type of a medication.

                                                      TypeCodeableConcept
                                                      Is Modifierfalse
                                                      Must Supporttrue
                                                      Summarytrue
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      108. Medication.code.id
                                                      Definition

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

                                                      ShortUnique id for inter-element referencing
                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                      Summaryfalse
                                                      110. Medication.code.extension
                                                      Definition

                                                      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.

                                                      ShortAdditional content defined by implementations
                                                      Comments

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

                                                      Control0..*
                                                      TypeExtension
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Alternate Namesextensions, user content
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                      SlicingThis element introduces a set of slices on Medication.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                      • value @ url
                                                      • 112. Medication.code.coding
                                                        Definition

                                                        A reference to a code defined by a terminology system.

                                                        ShortCode defined by a terminology system
                                                        Comments

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

                                                        Control0..*
                                                        TypeCoding
                                                        Is Modifierfalse
                                                        Must Supporttrue
                                                        Summarytrue
                                                        Requirements

                                                        Allows for alternative encodings within a code system, and translations to other code systems.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        SlicingThis element introduces a set of slices on Medication.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                        • value @ $this
                                                        • 114. Medication.code.coding:pzn
                                                          Slice Namepzn
                                                          Definition

                                                          A reference to a code defined by a terminology system.

                                                          ShortCode defined by a terminology system
                                                          Comments

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

                                                          Control0..0
                                                          TypeCoding
                                                          Is Modifierfalse
                                                          Must Supporttrue
                                                          Summarytrue
                                                          Requirements

                                                          Allows for alternative encodings within a code system, and translations to other code systems.

                                                          Pattern Value{
                                                            "system" : "http://fhir.de/CodeSystem/ifa/pzn"
                                                          }
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          123. Medication.code.coding:atc-de
                                                          Slice Nameatc-de
                                                          Definition

                                                          A reference to a code defined by a terminology system.

                                                          ShortCode defined by a terminology system
                                                          Comments

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

                                                          Control0..*
                                                          TypeCoding
                                                          Is Modifierfalse
                                                          Must Supporttrue
                                                          Summarytrue
                                                          Requirements

                                                          Allows for alternative encodings within a code system, and translations to other code systems.

                                                          Pattern Value{
                                                            "system" : "http://fhir.de/CodeSystem/bfarm/atc"
                                                          }
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          125. Medication.code.coding:atc-de.id
                                                          Definition

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

                                                          ShortUnique id for inter-element referencing
                                                          Control0..1
                                                          Typestring
                                                          Is Modifierfalse
                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                          Summaryfalse
                                                          127. Medication.code.coding:atc-de.extension
                                                          Definition

                                                          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.

                                                          ShortAdditional content defined by implementations
                                                          Comments

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

                                                          Control0..*
                                                          TypeExtension
                                                          Is Modifierfalse
                                                          Summaryfalse
                                                          Alternate Namesextensions, user content
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                          SlicingThis element introduces a set of slices on Medication.code.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                          • value @ url
                                                          • 129. Medication.code.coding:atc-de.system
                                                            Definition

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

                                                            ShortIdentity of the terminology system
                                                            Comments

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

                                                            Control1..1
                                                            Typeuri
                                                            Is Modifierfalse
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Must Supporttrue
                                                            Summarytrue
                                                            Requirements

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

                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            131. Medication.code.coding:atc-de.version
                                                            Definition

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

                                                            ShortVersion of the system - if relevant
                                                            Comments

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

                                                            NoteThis is a business version Id, not a resource version Id (see discussion)
                                                            Control1..1
                                                            Typestring
                                                            Is Modifierfalse
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Summarytrue
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            133. Medication.code.coding:atc-de.code
                                                            Definition

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

                                                            ShortSymbol in syntax defined by the system
                                                            Control1..1
                                                            Typecode
                                                            Is Modifierfalse
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Must Supporttrue
                                                            Summarytrue
                                                            Requirements

                                                            Need to refer to a particular code in the system.

                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            135. Medication.code.coding:atc-de.display
                                                            Definition

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

                                                            ShortRepresentation defined by the system
                                                            Control0..1
                                                            Typestring
                                                            Is Modifierfalse
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Must Supporttrue
                                                            Summarytrue
                                                            Requirements

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

                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            137. Medication.code.coding:atc-de.userSelected
                                                            Definition

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

                                                            ShortIf this coding was chosen directly by the user
                                                            Comments

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

                                                            Control0..1
                                                            Typeboolean
                                                            Is Modifierfalse
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Summarytrue
                                                            Requirements

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

                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            139. Medication.code.coding:ask
                                                            Slice Nameask
                                                            Definition

                                                            A reference to a code defined by a terminology system.

                                                            ShortCode defined by a terminology system
                                                            Comments

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

                                                            Control0..*
                                                            TypeCoding
                                                            Is Modifierfalse
                                                            Must Supporttrue
                                                            Summarytrue
                                                            Requirements

                                                            Allows for alternative encodings within a code system, and translations to other code systems.

                                                            Pattern Value{
                                                              "system" : "http://fhir.de/CodeSystem/ask"
                                                            }
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            141. Medication.code.coding:ask.id
                                                            Definition

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

                                                            ShortUnique id for inter-element referencing
                                                            Control0..1
                                                            Typestring
                                                            Is Modifierfalse
                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                            Summaryfalse
                                                            143. Medication.code.coding:ask.extension
                                                            Definition

                                                            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.

                                                            ShortAdditional content defined by implementations
                                                            Comments

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

                                                            Control0..*
                                                            TypeExtension
                                                            Is Modifierfalse
                                                            Summaryfalse
                                                            Alternate Namesextensions, user content
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                            SlicingThis element introduces a set of slices on Medication.code.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                            • value @ url
                                                            • 145. Medication.code.coding:ask.system
                                                              Definition

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

                                                              ShortIdentity of the terminology system
                                                              Comments

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

                                                              Control1..1
                                                              Typeuri
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Must Supporttrue
                                                              Summarytrue
                                                              Requirements

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

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              147. Medication.code.coding:ask.version
                                                              Definition

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

                                                              ShortVersion of the system - if relevant
                                                              Comments

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

                                                              NoteThis is a business version Id, not a resource version Id (see discussion)
                                                              Control0..1
                                                              Typestring
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Summarytrue
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              149. Medication.code.coding:ask.code
                                                              Definition

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

                                                              ShortSymbol in syntax defined by the system
                                                              Control1..1
                                                              Typecode
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Must Supporttrue
                                                              Summarytrue
                                                              Requirements

                                                              Need to refer to a particular code in the system.

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              151. Medication.code.coding:ask.display
                                                              Definition

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

                                                              ShortRepresentation defined by the system
                                                              Control0..1
                                                              Typestring
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Must Supporttrue
                                                              Summarytrue
                                                              Requirements

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

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              153. Medication.code.coding:ask.userSelected
                                                              Definition

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

                                                              ShortIf this coding was chosen directly by the user
                                                              Comments

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

                                                              Control0..1
                                                              Typeboolean
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Summarytrue
                                                              Requirements

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

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              155. Medication.code.text
                                                              Definition

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

                                                              ShortPlain text representation of the concept
                                                              Comments

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

                                                              Control0..1
                                                              Typestring
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Must Supporttrue
                                                              Summarytrue
                                                              Requirements

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

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              157. Medication.status
                                                              Definition

                                                              A code to indicate if the medication is in active use.

                                                              ShortStatus of Medication Information
                                                              Comments

                                                              This status is intended to identify if the medication in a local system is in active use within a drug database or inventory. For example, a pharmacy system may create a new drug file record for a compounded product "ABC Hospital Special Cream" with an active status. At some point in the future, it may be determined that the drug record was created with an error and the status is changed to "entered in error". This status is not intended to specify if a medication is part of a particular formulary. It is possible that the drug record may be referenced by multiple formularies or catalogues and each of those entries would have a separate status.

                                                              Control0..1
                                                              BindingThe codes SHALL be taken from Medication Status Codes
                                                              (required to http://hl7.org/fhir/ValueSet/medication-status|4.0.1)

                                                              A coded concept defining if the medication is in active use.

                                                              Typecode
                                                              Is Modifiertrue because This element changes the interpretation of all descriptive attributes.
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Must Supporttrue
                                                              Summarytrue
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              159. Medication.manufacturer
                                                              Definition

                                                              Describes the details of the manufacturer of the medication product. This is not intended to represent the distributor of a medication product.

                                                              ShortManufacturer of the Medication
                                                              Comments

                                                              Here, the actual manufacturer of the medication can be named, primarily in the case of active ingredient mixtures (compounding prescriptions), such as the hospital pharmacy. It is important to note that the licensing organization, as mentioned in the PZN (Pharmaceutical Central Number) data, is not considered the manufacturer.

                                                              Control0..1
                                                              TypeReference(Organization)
                                                              Is Modifierfalse
                                                              Must Supporttrue
                                                              Summarytrue
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              161. Medication.manufacturer.id
                                                              Definition

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

                                                              ShortUnique id for inter-element referencing
                                                              Control0..1
                                                              Typestring
                                                              Is Modifierfalse
                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                              Summaryfalse
                                                              163. Medication.manufacturer.extension
                                                              Definition

                                                              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.

                                                              ShortAdditional content defined by implementations
                                                              Comments

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

                                                              Control0..*
                                                              TypeExtension
                                                              Is Modifierfalse
                                                              Summaryfalse
                                                              Alternate Namesextensions, user content
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                              SlicingThis element introduces a set of slices on Medication.manufacturer.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                              • value @ url
                                                              • 165. Medication.manufacturer.reference
                                                                Definition

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

                                                                ShortLiteral reference, Relative, internal or absolute URL
                                                                Comments

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

                                                                Control0..1
                                                                This element is affected by the following invariants: ref-1
                                                                Typestring
                                                                Is Modifierfalse
                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                Summarytrue
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                167. Medication.manufacturer.type
                                                                Definition

                                                                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).

                                                                ShortType the reference refers to (e.g. "Patient")
                                                                Comments

                                                                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.

                                                                Control0..1
                                                                BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                                                (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

                                                                Aa resource (or, for logical models, the URI of the logical model).

                                                                Typeuri
                                                                Is Modifierfalse
                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                Summarytrue
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                169. Medication.manufacturer.identifier
                                                                Definition

                                                                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.

                                                                ShortLogical reference, when literal reference is not known
                                                                Comments

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

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

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

                                                                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).

                                                                NoteThis is a business identifier, not a resource identifier (see discussion)
                                                                Control0..1
                                                                TypeIdentifier
                                                                Is Modifierfalse
                                                                Summarytrue
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                171. Medication.manufacturer.display
                                                                Definition

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

                                                                ShortText alternative for the resource
                                                                Comments

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

                                                                Control1..1
                                                                Typestring
                                                                Is Modifierfalse
                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                Must Supporttrue
                                                                Summarytrue
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                173. Medication.form
                                                                Definition

                                                                Describes the form of the item. Powder; tablets; capsule.

                                                                ShortForm of Dispensing
                                                                Comments

                                                                When Medication is referenced from MedicationRequest, this is the ordered form. When Medication is referenced within MedicationDispense, this is the dispensed form. When Medication is referenced within MedicationAdministration, this is administered form.

                                                                Control0..1
                                                                BindingFor example codes, see SNOMEDCTFormCodes
                                                                (example to http://hl7.org/fhir/ValueSet/medication-form-codes|4.0.1)

                                                                A coded concept defining the form of a medication.

                                                                TypeCodeableConcept
                                                                Is Modifierfalse
                                                                Must Supporttrue
                                                                Summaryfalse
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                175. Medication.form.id
                                                                Definition

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

                                                                ShortUnique id for inter-element referencing
                                                                Control0..1
                                                                Typestring
                                                                Is Modifierfalse
                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                Summaryfalse
                                                                177. Medication.form.extension
                                                                Definition

                                                                An Extension

                                                                ShortExtension
                                                                Control0..*
                                                                TypeExtension
                                                                Is Modifierfalse
                                                                Must Supporttrue
                                                                Summaryfalse
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                SlicingThis element introduces a set of slices on Medication.form.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                • value @ url
                                                                • 179. Medication.form.extension:dataAbsentReason
                                                                  Slice NamedataAbsentReason
                                                                  Definition

                                                                  Provides a reason why the expected value or elements in the element that is extended are missing.

                                                                  Shortunknown | asked | temp | notasked | masked | unsupported | astext | error
                                                                  Control0..1
                                                                  TypeExtension(Data Absent Reason) (Extension Type: code)
                                                                  Is Modifierfalse
                                                                  Must Supporttrue
                                                                  Summaryfalse
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                  181. Medication.form.coding
                                                                  Definition

                                                                  A reference to a code defined by a terminology system.

                                                                  ShortCode defined by a terminology system
                                                                  Comments

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

                                                                  Control0..*
                                                                  TypeCoding
                                                                  Is Modifierfalse
                                                                  Must Supporttrue
                                                                  Summarytrue
                                                                  Requirements

                                                                  Allows for alternative encodings within a code system, and translations to other code systems.

                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  SlicingThis element introduces a set of slices on Medication.form.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                  • value @ $this
                                                                  • 183. Medication.form.coding:kbvDarreichungsform
                                                                    Slice NamekbvDarreichungsform
                                                                    Definition

                                                                    A reference to a code defined by a terminology system.

                                                                    ShortCode defined by a terminology system
                                                                    Comments

                                                                    KBV updates its "Schüsseltabellen" package more often than ePA versions get released. However, the eRezept clients and eRezept service take over new KBV package versions quickly after release and thus hands them over to the ePA Medication Service. Since the Medication Service is potentially fixed onto an older version of the KBV package, it would reject the forwarded eRezept data. In the future, the Medication Service will be enabled to update to the latest KBV package versions without the need for a new ePA release. Since the eRezept does check the codes against the latest KBV package version, the Medication Service will not receive any "invalid" codes and clients can rely on the Medication Service data conforming to the latest KBV package.

                                                                    Control0..1
                                                                    BindingThe codes SHALL be taken from https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_KBV_DARREICHUNGSFORM
                                                                    (required to https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_KBV_DARREICHUNGSFORM)
                                                                    TypeCoding
                                                                    Is Modifierfalse
                                                                    Must Supporttrue
                                                                    Summarytrue
                                                                    Requirements

                                                                    Allows for alternative encodings within a code system, and translations to other code systems.

                                                                    Pattern Value{
                                                                      "system" : "https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_KBV_DARREICHUNGSFORM"
                                                                    }
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    185. Medication.form.coding:kbvDarreichungsform.id
                                                                    Definition

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

                                                                    ShortUnique id for inter-element referencing
                                                                    Control0..1
                                                                    Typestring
                                                                    Is Modifierfalse
                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                    Summaryfalse
                                                                    187. Medication.form.coding:kbvDarreichungsform.extension
                                                                    Definition

                                                                    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.

                                                                    ShortAdditional content defined by implementations
                                                                    Comments

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

                                                                    Control0..*
                                                                    TypeExtension
                                                                    Is Modifierfalse
                                                                    Summaryfalse
                                                                    Alternate Namesextensions, user content
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                    SlicingThis element introduces a set of slices on Medication.form.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                    • value @ url
                                                                    • 189. Medication.form.coding:kbvDarreichungsform.system
                                                                      Definition

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

                                                                      ShortIdentity of the terminology system
                                                                      Comments

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

                                                                      Control1..1
                                                                      Typeuri
                                                                      Is Modifierfalse
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      Must Supporttrue
                                                                      Summarytrue
                                                                      Requirements

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

                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      191. Medication.form.coding:kbvDarreichungsform.version
                                                                      Definition

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

                                                                      ShortVersion of the system - if relevant
                                                                      Comments

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

                                                                      NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                      Control0..1
                                                                      Typestring
                                                                      Is Modifierfalse
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      Summarytrue
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      193. Medication.form.coding:kbvDarreichungsform.code
                                                                      Definition

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

                                                                      ShortSymbol in syntax defined by the system
                                                                      Control1..1
                                                                      Typecode
                                                                      Is Modifierfalse
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      Must Supporttrue
                                                                      Summarytrue
                                                                      Requirements

                                                                      Need to refer to a particular code in the system.

                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      195. Medication.form.coding:kbvDarreichungsform.display
                                                                      Definition

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

                                                                      ShortRepresentation defined by the system
                                                                      Control0..1
                                                                      Typestring
                                                                      Is Modifierfalse
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      Must Supporttrue
                                                                      Summarytrue
                                                                      Requirements

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

                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      197. Medication.form.coding:kbvDarreichungsform.userSelected
                                                                      Definition

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

                                                                      ShortIf this coding was chosen directly by the user
                                                                      Comments

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

                                                                      Control0..1
                                                                      Typeboolean
                                                                      Is Modifierfalse
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      Summarytrue
                                                                      Requirements

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

                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      199. Medication.form.coding:ifaDarreichungsform
                                                                      Slice NameifaDarreichungsform
                                                                      Definition

                                                                      A reference to a code defined by a terminology system.

                                                                      ShortCode defined by a terminology system
                                                                      Comments

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

                                                                      Control0..1
                                                                      BindingThe codes SHALL be taken from https://fhir.ifaffm.de/CodeSystem/IFA_DARREICHUNGSFORM
                                                                      (required to https://fhir.ifaffm.de/CodeSystem/IFA_DARREICHUNGSFORM)
                                                                      TypeCoding
                                                                      Is Modifierfalse
                                                                      Must Supporttrue
                                                                      Summarytrue
                                                                      Requirements

                                                                      Allows for alternative encodings within a code system, and translations to other code systems.

                                                                      Pattern Value{
                                                                        "system" : "https://fhir.ifaffm.de/CodeSystem/IFA_DARREICHUNGSFORM"
                                                                      }
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      201. Medication.form.coding:ifaDarreichungsform.id
                                                                      Definition

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

                                                                      ShortUnique id for inter-element referencing
                                                                      Control0..1
                                                                      Typestring
                                                                      Is Modifierfalse
                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                      Summaryfalse
                                                                      203. Medication.form.coding:ifaDarreichungsform.extension
                                                                      Definition

                                                                      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.

                                                                      ShortAdditional content defined by implementations
                                                                      Comments

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

                                                                      Control0..*
                                                                      TypeExtension
                                                                      Is Modifierfalse
                                                                      Summaryfalse
                                                                      Alternate Namesextensions, user content
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                      SlicingThis element introduces a set of slices on Medication.form.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                      • value @ url
                                                                      • 205. Medication.form.coding:ifaDarreichungsform.system
                                                                        Definition

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

                                                                        ShortIdentity of the terminology system
                                                                        Comments

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

                                                                        Control1..1
                                                                        Typeuri
                                                                        Is Modifierfalse
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Must Supporttrue
                                                                        Summarytrue
                                                                        Requirements

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

                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        207. Medication.form.coding:ifaDarreichungsform.version
                                                                        Definition

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

                                                                        ShortVersion of the system - if relevant
                                                                        Comments

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

                                                                        NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                        Control0..1
                                                                        Typestring
                                                                        Is Modifierfalse
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Summarytrue
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        209. Medication.form.coding:ifaDarreichungsform.code
                                                                        Definition

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

                                                                        ShortSymbol in syntax defined by the system
                                                                        Control1..1
                                                                        Typecode
                                                                        Is Modifierfalse
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Must Supporttrue
                                                                        Summarytrue
                                                                        Requirements

                                                                        Need to refer to a particular code in the system.

                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        211. Medication.form.coding:ifaDarreichungsform.display
                                                                        Definition

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

                                                                        ShortRepresentation defined by the system
                                                                        Control0..1
                                                                        Typestring
                                                                        Is Modifierfalse
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Must Supporttrue
                                                                        Summarytrue
                                                                        Requirements

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

                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        213. Medication.form.coding:ifaDarreichungsform.userSelected
                                                                        Definition

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

                                                                        ShortIf this coding was chosen directly by the user
                                                                        Comments

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

                                                                        Control0..1
                                                                        Typeboolean
                                                                        Is Modifierfalse
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Summarytrue
                                                                        Requirements

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

                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        215. Medication.form.text
                                                                        Definition

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

                                                                        ShortPlain text representation of the concept
                                                                        Comments

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

                                                                        Control0..1
                                                                        Typestring
                                                                        Is Modifierfalse
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Must Supporttrue
                                                                        Summarytrue
                                                                        Requirements

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

                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        217. Medication.amount
                                                                        Definition

                                                                        Specific amount of the drug in the packaged product. For example, when specifying a product that has the same strength (For example, Insulin glargine 100 unit per mL solution for injection), this attribute provides additional clarification of the package amount (For example, 3 mL, 10mL, etc.).

                                                                        ShortAmount of drug in package
                                                                        Control0..1
                                                                        TypeRatio
                                                                        Is Modifierfalse
                                                                        Must Supporttrue
                                                                        Summarytrue
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        219. Medication.amount.id
                                                                        Definition

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

                                                                        ShortUnique id for inter-element referencing
                                                                        Control0..1
                                                                        Typestring
                                                                        Is Modifierfalse
                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                        Summaryfalse
                                                                        221. Medication.amount.extension
                                                                        Definition

                                                                        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.

                                                                        ShortAdditional content defined by implementations
                                                                        Comments

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

                                                                        Control0..*
                                                                        TypeExtension
                                                                        Is Modifierfalse
                                                                        Summaryfalse
                                                                        Alternate Namesextensions, user content
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                        SlicingThis element introduces a set of slices on Medication.amount.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                        • value @ url
                                                                        • 223. Medication.amount.numerator
                                                                          Definition

                                                                          The value of the numerator.

                                                                          ShortNumerator value
                                                                          Control0..1
                                                                          BindingThe codes SHOULD be taken from UCUMCodes
                                                                          (preferred to http://hl7.org/fhir/ValueSet/ucum-units)
                                                                          TypeQuantity
                                                                          Is Modifierfalse
                                                                          Must Supporttrue
                                                                          Summarytrue
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          225. Medication.amount.numerator.id
                                                                          Definition

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

                                                                          ShortUnique id for inter-element referencing
                                                                          Control0..1
                                                                          Typestring
                                                                          Is Modifierfalse
                                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                                          Summaryfalse
                                                                          227. Medication.amount.numerator.extension
                                                                          Definition

                                                                          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.

                                                                          ShortAdditional content defined by implementations
                                                                          Comments

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

                                                                          Control0..*
                                                                          TypeExtension
                                                                          Is Modifierfalse
                                                                          Summaryfalse
                                                                          Alternate Namesextensions, user content
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                          SlicingThis element introduces a set of slices on Medication.amount.numerator.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                          • value @ url
                                                                          • 229. Medication.amount.numerator.extension:packagingSize
                                                                            Slice NamepackagingSize
                                                                            Definition

                                                                            Specification of the package size according to divided quantity (e.g., 100, 2x25), only appears in conjunction with "unit" (e.g., 100 Stück).

                                                                            ShortExtension
                                                                            Control0..1
                                                                            TypeExtension(MedicationPackagingSizeExtension) (Extension Type: string)
                                                                            Is Modifierfalse
                                                                            Must Supporttrue
                                                                            Summaryfalse
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                            231. Medication.amount.numerator.extension:totalQuantity
                                                                            Slice NametotalQuantity
                                                                            Definition

                                                                            Total quantity of the formulation (without the unit).

                                                                            ShortExtension
                                                                            Control0..1
                                                                            TypeExtension(MedicationTotalQuantityFormulationExtension) (Extension Type: string)
                                                                            Is Modifierfalse
                                                                            Must Supporttrue
                                                                            Summaryfalse
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                            233. Medication.amount.numerator.value
                                                                            Definition

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

                                                                            ShortNumerical value (with implicit precision)
                                                                            Comments

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

                                                                            Control0..1
                                                                            Typedecimal
                                                                            Is Modifierfalse
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            Summarytrue
                                                                            Requirements

                                                                            Precision is handled implicitly in almost all cases of measurement.

                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            235. Medication.amount.numerator.comparator
                                                                            Definition

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

                                                                            Short< | <= | >= | > - how to understand the value
                                                                            Control0..1
                                                                            BindingThe codes SHALL be taken from QuantityComparator
                                                                            (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                                            How the Quantity should be understood and represented.

                                                                            Typecode
                                                                            Is Modifiertrue because 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
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            Summarytrue
                                                                            Requirements

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

                                                                            Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            237. Medication.amount.numerator.unit
                                                                            Definition

                                                                            A human-readable form of the unit.

                                                                            ShortUnit representation
                                                                            Control0..1
                                                                            Typestring
                                                                            Is Modifierfalse
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            Summarytrue
                                                                            Requirements

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

                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            239. Medication.amount.numerator.system
                                                                            Definition

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

                                                                            ShortSystem that defines coded unit form
                                                                            Control0..1
                                                                            This element is affected by the following invariants: qty-3
                                                                            Typeuri
                                                                            Is Modifierfalse
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            Summarytrue
                                                                            Requirements

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

                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            241. Medication.amount.numerator.code
                                                                            Definition

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

                                                                            ShortCoded form of the unit
                                                                            Comments

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

                                                                            Control0..1
                                                                            Typecode
                                                                            Is Modifierfalse
                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                            Summarytrue
                                                                            Requirements

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

                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            243. Medication.amount.denominator
                                                                            Definition

                                                                            The value of the denominator.

                                                                            ShortDenominator value
                                                                            Control0..1
                                                                            BindingThe codes SHOULD be taken from UCUMCodes
                                                                            (preferred to http://hl7.org/fhir/ValueSet/ucum-units)
                                                                            TypeQuantity
                                                                            Is Modifierfalse
                                                                            Must Supporttrue
                                                                            Summarytrue
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            245. Medication.amount.denominator.id
                                                                            Definition

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

                                                                            ShortUnique id for inter-element referencing
                                                                            Control0..1
                                                                            Typestring
                                                                            Is Modifierfalse
                                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                                            Summaryfalse
                                                                            247. Medication.amount.denominator.extension
                                                                            Definition

                                                                            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.

                                                                            ShortAdditional content defined by implementations
                                                                            Comments

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

                                                                            Control0..*
                                                                            TypeExtension
                                                                            Is Modifierfalse
                                                                            Summaryfalse
                                                                            Alternate Namesextensions, user content
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                            SlicingThis element introduces a set of slices on Medication.amount.denominator.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                            • value @ url
                                                                            • 249. Medication.amount.denominator.value
                                                                              Definition

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

                                                                              ShortNumerical value (with implicit precision)
                                                                              Comments

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

                                                                              Control0..1
                                                                              Typedecimal
                                                                              Is Modifierfalse
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              Must Supporttrue
                                                                              Summarytrue
                                                                              Requirements

                                                                              Precision is handled implicitly in almost all cases of measurement.

                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              251. Medication.amount.denominator.comparator
                                                                              Definition

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

                                                                              Short< | <= | >= | > - how to understand the value
                                                                              Control0..1
                                                                              BindingThe codes SHALL be taken from QuantityComparator
                                                                              (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                                              How the Quantity should be understood and represented.

                                                                              Typecode
                                                                              Is Modifiertrue because 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
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              Summarytrue
                                                                              Requirements

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

                                                                              Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              253. Medication.amount.denominator.unit
                                                                              Definition

                                                                              A human-readable form of the unit.

                                                                              ShortUnit representation
                                                                              Control0..1
                                                                              Typestring
                                                                              Is Modifierfalse
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              Must Supporttrue
                                                                              Summarytrue
                                                                              Requirements

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

                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              255. Medication.amount.denominator.system
                                                                              Definition

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

                                                                              ShortSystem that defines coded unit form
                                                                              Control0..1
                                                                              This element is affected by the following invariants: qty-3
                                                                              Typeuri
                                                                              Is Modifierfalse
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              Must Supporttrue
                                                                              Summarytrue
                                                                              Requirements

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

                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              257. Medication.amount.denominator.code
                                                                              Definition

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

                                                                              ShortCoded form of the unit
                                                                              Comments

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

                                                                              Control0..1
                                                                              Typecode
                                                                              Is Modifierfalse
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              Must Supporttrue
                                                                              Summarytrue
                                                                              Requirements

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

                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              259. Medication.ingredient
                                                                              Definition

                                                                              Identifies a particular constituent of interest in the product.

                                                                              ShortActive or inactive ingredients of the medication, including pharmaceutical substances as well as individual medicinal products in combination packs.
                                                                              Comments

                                                                              The ingredients need not be a complete list. If an ingredient is not specified, this does not indicate whether an ingredient is present or absent. If an ingredient is specified it does not mean that all ingredients are specified. It is possible to specify both inactive and active ingredients.

                                                                              Control0..*
                                                                              TypeBackboneElement
                                                                              Is Modifierfalse
                                                                              Must Supporttrue
                                                                              Summaryfalse
                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              261. Medication.ingredient.id
                                                                              Definition

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

                                                                              ShortUnique id for inter-element referencing
                                                                              Control0..1
                                                                              Typestring
                                                                              Is Modifierfalse
                                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                                              Summaryfalse
                                                                              263. Medication.ingredient.extension
                                                                              Definition

                                                                              An Extension

                                                                              ShortExtension
                                                                              Control0..*
                                                                              TypeExtension
                                                                              Is Modifierfalse
                                                                              Summaryfalse
                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                              SlicingThis element introduces a set of slices on Medication.ingredient.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                              • value @ url
                                                                              • 265. Medication.ingredient.extension:darreichungsform
                                                                                Slice Namedarreichungsform
                                                                                Definition

                                                                                Dosage form of an ingredient in a formulation.

                                                                                ShortExtension
                                                                                Control0..1
                                                                                This element is affected by the following invariants: ele-1
                                                                                TypeExtension(MedicationIngredientDarreichungsformExtension) (Extension Type: string)
                                                                                Is Modifierfalse
                                                                                Summaryfalse
                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                267. Medication.ingredient.modifierExtension
                                                                                Definition

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

                                                                                ShortExtensions that cannot be ignored even if unrecognized
                                                                                Comments

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

                                                                                Control0..*
                                                                                TypeExtension
                                                                                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                                Summarytrue
                                                                                Requirements

                                                                                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.

                                                                                Alternate Namesextensions, user content, modifiers
                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                269. Medication.ingredient.item[x]
                                                                                Definition

                                                                                The actual ingredient - either a substance (simple ingredient) or another medication of a medication.

                                                                                ShortThe actual ingredient or content
                                                                                Control1..1
                                                                                TypeCodeableConcept
                                                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                Is Modifierfalse
                                                                                Must Supporttrue
                                                                                Summaryfalse
                                                                                Requirements

                                                                                The ingredient may reference a substance (for example, amoxicillin) or another medication (for example in the case of a compounded product, Glaxal Base).

                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                SlicingThis element introduces a set of slices on Medication.ingredient.item[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                                                • type @ $this
                                                                                • 271. Medication.ingredient.item[x]:itemCodeableConcept
                                                                                  Slice NameitemCodeableConcept
                                                                                  Definition

                                                                                  The actual ingredient - either a substance (simple ingredient) or another medication of a medication.

                                                                                  ShortEncoded description of the substance or component.
                                                                                  Control0..1
                                                                                  TypeCodeableConcept
                                                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                                  Is Modifierfalse
                                                                                  Must Supporttrue
                                                                                  Summaryfalse
                                                                                  Requirements

                                                                                  The ingredient may reference a substance (for example, amoxicillin) or another medication (for example in the case of a compounded product, Glaxal Base).

                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  273. Medication.ingredient.item[x]:itemCodeableConcept.id
                                                                                  Definition

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

                                                                                  ShortUnique id for inter-element referencing
                                                                                  Control0..1
                                                                                  Typestring
                                                                                  Is Modifierfalse
                                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                                  Summaryfalse
                                                                                  275. Medication.ingredient.item[x]:itemCodeableConcept.extension
                                                                                  Definition

                                                                                  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.

                                                                                  ShortAdditional content defined by implementations
                                                                                  Comments

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

                                                                                  Control0..*
                                                                                  TypeExtension
                                                                                  Is Modifierfalse
                                                                                  Summaryfalse
                                                                                  Alternate Namesextensions, user content
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                  SlicingThis element introduces a set of slices on Medication.ingredient.item[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                  • value @ url
                                                                                  • 277. Medication.ingredient.item[x]:itemCodeableConcept.coding
                                                                                    Definition

                                                                                    A reference to a code defined by a terminology system.

                                                                                    ShortCode defined by a terminology system
                                                                                    Comments

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

                                                                                    Control0..*
                                                                                    TypeCoding
                                                                                    Is Modifierfalse
                                                                                    Must Supporttrue
                                                                                    Summarytrue
                                                                                    Requirements

                                                                                    Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                    SlicingThis element introduces a set of slices on Medication.ingredient.item[x].coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                    • value @ $this
                                                                                    • 279. Medication.ingredient.item[x]:itemCodeableConcept.coding:ask
                                                                                      Slice Nameask
                                                                                      Definition

                                                                                      A reference to a code defined by a terminology system.

                                                                                      ShortCode defined by a terminology system
                                                                                      Comments

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

                                                                                      Control0..*
                                                                                      TypeCoding
                                                                                      Is Modifierfalse
                                                                                      Must Supporttrue
                                                                                      Summarytrue
                                                                                      Requirements

                                                                                      Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                      Pattern Value{
                                                                                        "system" : "http://fhir.de/CodeSystem/ask"
                                                                                      }
                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      281. Medication.ingredient.item[x]:itemCodeableConcept.coding:ask.id
                                                                                      Definition

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

                                                                                      ShortUnique id for inter-element referencing
                                                                                      Control0..1
                                                                                      Typestring
                                                                                      Is Modifierfalse
                                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                                      Summaryfalse
                                                                                      283. Medication.ingredient.item[x]:itemCodeableConcept.coding:ask.extension
                                                                                      Definition

                                                                                      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.

                                                                                      ShortAdditional content defined by implementations
                                                                                      Comments

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

                                                                                      Control0..*
                                                                                      TypeExtension
                                                                                      Is Modifierfalse
                                                                                      Summaryfalse
                                                                                      Alternate Namesextensions, user content
                                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                      SlicingThis element introduces a set of slices on Medication.ingredient.item[x].coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                      • value @ url
                                                                                      • 285. Medication.ingredient.item[x]:itemCodeableConcept.coding:ask.system
                                                                                        Definition

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

                                                                                        ShortIdentity of the terminology system
                                                                                        Comments

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

                                                                                        Control1..1
                                                                                        Typeuri
                                                                                        Is Modifierfalse
                                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                        Must Supporttrue
                                                                                        Summarytrue
                                                                                        Requirements

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

                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        287. Medication.ingredient.item[x]:itemCodeableConcept.coding:ask.version
                                                                                        Definition

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

                                                                                        ShortVersion of the system - if relevant
                                                                                        Comments

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

                                                                                        NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                        Control0..1
                                                                                        Typestring
                                                                                        Is Modifierfalse
                                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                        Summarytrue
                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        289. Medication.ingredient.item[x]:itemCodeableConcept.coding:ask.code
                                                                                        Definition

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

                                                                                        ShortSymbol in syntax defined by the system
                                                                                        Control1..1
                                                                                        Typecode
                                                                                        Is Modifierfalse
                                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                        Must Supporttrue
                                                                                        Summarytrue
                                                                                        Requirements

                                                                                        Need to refer to a particular code in the system.

                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        291. Medication.ingredient.item[x]:itemCodeableConcept.coding:ask.display
                                                                                        Definition

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

                                                                                        ShortRepresentation defined by the system
                                                                                        Control0..1
                                                                                        Typestring
                                                                                        Is Modifierfalse
                                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                        Must Supporttrue
                                                                                        Summarytrue
                                                                                        Requirements

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

                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        293. Medication.ingredient.item[x]:itemCodeableConcept.coding:ask.userSelected
                                                                                        Definition

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

                                                                                        ShortIf this coding was chosen directly by the user
                                                                                        Comments

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

                                                                                        Control0..1
                                                                                        Typeboolean
                                                                                        Is Modifierfalse
                                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                        Summarytrue
                                                                                        Requirements

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

                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        295. Medication.ingredient.item[x]:itemCodeableConcept.coding:atc-de
                                                                                        Slice Nameatc-de
                                                                                        Definition

                                                                                        A reference to a code defined by a terminology system.

                                                                                        ShortCode defined by a terminology system
                                                                                        Comments

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

                                                                                        Control0..*
                                                                                        TypeCoding
                                                                                        Is Modifierfalse
                                                                                        Must Supporttrue
                                                                                        Summarytrue
                                                                                        Requirements

                                                                                        Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                        Pattern Value{
                                                                                          "system" : "http://fhir.de/CodeSystem/bfarm/atc"
                                                                                        }
                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        297. Medication.ingredient.item[x]:itemCodeableConcept.coding:atc-de.id
                                                                                        Definition

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

                                                                                        ShortUnique id for inter-element referencing
                                                                                        Control0..1
                                                                                        Typestring
                                                                                        Is Modifierfalse
                                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                                        Summaryfalse
                                                                                        299. Medication.ingredient.item[x]:itemCodeableConcept.coding:atc-de.extension
                                                                                        Definition

                                                                                        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.

                                                                                        ShortAdditional content defined by implementations
                                                                                        Comments

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

                                                                                        Control0..*
                                                                                        TypeExtension
                                                                                        Is Modifierfalse
                                                                                        Summaryfalse
                                                                                        Alternate Namesextensions, user content
                                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                        SlicingThis element introduces a set of slices on Medication.ingredient.item[x].coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                        • value @ url
                                                                                        • 301. Medication.ingredient.item[x]:itemCodeableConcept.coding:atc-de.system
                                                                                          Definition

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

                                                                                          ShortIdentity of the terminology system
                                                                                          Comments

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

                                                                                          Control1..1
                                                                                          Typeuri
                                                                                          Is Modifierfalse
                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                          Must Supporttrue
                                                                                          Summarytrue
                                                                                          Requirements

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

                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          303. Medication.ingredient.item[x]:itemCodeableConcept.coding:atc-de.version
                                                                                          Definition

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

                                                                                          ShortVersion of the system - if relevant
                                                                                          Comments

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

                                                                                          NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                          Control1..1
                                                                                          Typestring
                                                                                          Is Modifierfalse
                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                          Summarytrue
                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          305. Medication.ingredient.item[x]:itemCodeableConcept.coding:atc-de.code
                                                                                          Definition

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

                                                                                          ShortSymbol in syntax defined by the system
                                                                                          Control1..1
                                                                                          Typecode
                                                                                          Is Modifierfalse
                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                          Must Supporttrue
                                                                                          Summarytrue
                                                                                          Requirements

                                                                                          Need to refer to a particular code in the system.

                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          307. Medication.ingredient.item[x]:itemCodeableConcept.coding:atc-de.display
                                                                                          Definition

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

                                                                                          ShortRepresentation defined by the system
                                                                                          Control0..1
                                                                                          Typestring
                                                                                          Is Modifierfalse
                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                          Must Supporttrue
                                                                                          Summarytrue
                                                                                          Requirements

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

                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          309. Medication.ingredient.item[x]:itemCodeableConcept.coding:atc-de.userSelected
                                                                                          Definition

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

                                                                                          ShortIf this coding was chosen directly by the user
                                                                                          Comments

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

                                                                                          Control0..1
                                                                                          Typeboolean
                                                                                          Is Modifierfalse
                                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                          Summarytrue
                                                                                          Requirements

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

                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          311. Medication.ingredient.item[x]:itemCodeableConcept.coding:pzn
                                                                                          Slice Namepzn
                                                                                          Definition

                                                                                          A reference to a code defined by a terminology system.

                                                                                          ShortCode defined by a terminology system
                                                                                          Comments

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

                                                                                          Control0..*
                                                                                          TypeCoding
                                                                                          Is Modifierfalse
                                                                                          Must Supporttrue
                                                                                          Summarytrue
                                                                                          Requirements

                                                                                          Allows for alternative encodings within a code system, and translations to other code systems.

                                                                                          Pattern Value{
                                                                                            "system" : "http://fhir.de/CodeSystem/ifa/pzn"
                                                                                          }
                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          313. Medication.ingredient.item[x]:itemCodeableConcept.coding:pzn.id
                                                                                          Definition

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

                                                                                          ShortUnique id for inter-element referencing
                                                                                          Control0..1
                                                                                          Typestring
                                                                                          Is Modifierfalse
                                                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                                                          Summaryfalse
                                                                                          315. Medication.ingredient.item[x]:itemCodeableConcept.coding:pzn.extension
                                                                                          Definition

                                                                                          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.

                                                                                          ShortAdditional content defined by implementations
                                                                                          Comments

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

                                                                                          Control0..*
                                                                                          TypeExtension
                                                                                          Is Modifierfalse
                                                                                          Summaryfalse
                                                                                          Alternate Namesextensions, user content
                                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                          SlicingThis element introduces a set of slices on Medication.ingredient.item[x].coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                          • value @ url
                                                                                          • 317. Medication.ingredient.item[x]:itemCodeableConcept.coding:pzn.system
                                                                                            Definition

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

                                                                                            ShortIdentity of the terminology system
                                                                                            Comments

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

                                                                                            Control1..1
                                                                                            Typeuri
                                                                                            Is Modifierfalse
                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                            Must Supporttrue
                                                                                            Summarytrue
                                                                                            Requirements

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

                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                            319. Medication.ingredient.item[x]:itemCodeableConcept.coding:pzn.version
                                                                                            Definition

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

                                                                                            ShortVersion of the system - if relevant
                                                                                            Comments

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

                                                                                            NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                                            Control0..1
                                                                                            Typestring
                                                                                            Is Modifierfalse
                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                            Summarytrue
                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                            321. Medication.ingredient.item[x]:itemCodeableConcept.coding:pzn.code
                                                                                            Definition

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

                                                                                            ShortSymbol in syntax defined by the system
                                                                                            Control1..1
                                                                                            Typecode
                                                                                            Is Modifierfalse
                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                            Must Supporttrue
                                                                                            Summarytrue
                                                                                            Requirements

                                                                                            Need to refer to a particular code in the system.

                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                            323. Medication.ingredient.item[x]:itemCodeableConcept.coding:pzn.display
                                                                                            Definition

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

                                                                                            ShortRepresentation defined by the system
                                                                                            Control0..1
                                                                                            Typestring
                                                                                            Is Modifierfalse
                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                            Must Supporttrue
                                                                                            Summarytrue
                                                                                            Requirements

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

                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                            325. Medication.ingredient.item[x]:itemCodeableConcept.coding:pzn.userSelected
                                                                                            Definition

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

                                                                                            ShortIf this coding was chosen directly by the user
                                                                                            Comments

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

                                                                                            Control0..1
                                                                                            Typeboolean
                                                                                            Is Modifierfalse
                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                            Summarytrue
                                                                                            Requirements

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

                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                            327. Medication.ingredient.item[x]:itemCodeableConcept.text
                                                                                            Definition

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

                                                                                            ShortPlain text representation of the concept
                                                                                            Comments

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

                                                                                            Control0..1
                                                                                            Typestring
                                                                                            Is Modifierfalse
                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                            Must Supporttrue
                                                                                            Summarytrue
                                                                                            Requirements

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

                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                            329. Medication.ingredient.item[x]:itemReference
                                                                                            Slice NameitemReference
                                                                                            Definition

                                                                                            The actual ingredient - either a substance (simple ingredient) or another medication of a medication.

                                                                                            ShortEine Medication für ein pharmazeutisches Produkt innerhalb einer Kombipackung darf keine weiteren untergeordneten Medications enthalten.“
                                                                                            Control0..0
                                                                                            TypeReference(Medication)
                                                                                            Is Modifierfalse
                                                                                            Must Supporttrue
                                                                                            Summaryfalse
                                                                                            Requirements

                                                                                            The ingredient may reference a substance (for example, amoxicillin) or another medication (for example in the case of a compounded product, Glaxal Base).

                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                            331. Medication.ingredient.isActive
                                                                                            Definition

                                                                                            Indication of whether this ingredient affects the therapeutic action of the drug.

                                                                                            ShortIs it an active ingredient?
                                                                                            Control0..1
                                                                                            Typeboolean
                                                                                            Is Modifierfalse
                                                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                            Summaryfalse
                                                                                            Requirements

                                                                                            True indicates that the ingredient affects the therapeutic action of the drug (i.e. active). False indicates that the ingredient does not affect the therapeutic action of the drug (i.e. inactive).

                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                            333. Medication.ingredient.strength
                                                                                            Definition

                                                                                            Specifies how many (or how much) of the items there are in this Medication. For example, 250 mg per tablet. This is expressed as a ratio where the numerator is 250mg and the denominator is 1 tablet.

                                                                                            ShortStrength
                                                                                            Control0..1
                                                                                            TypeRatio
                                                                                            Is Modifierfalse
                                                                                            Must Supporttrue
                                                                                            Summaryfalse
                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                            335. Medication.ingredient.strength.id
                                                                                            Definition

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

                                                                                            ShortUnique id for inter-element referencing
                                                                                            Control0..1
                                                                                            Typestring
                                                                                            Is Modifierfalse
                                                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                                                            Summaryfalse
                                                                                            337. Medication.ingredient.strength.extension
                                                                                            Definition

                                                                                            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.

                                                                                            ShortAdditional content defined by implementations
                                                                                            Comments

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

                                                                                            Control0..*
                                                                                            TypeExtension
                                                                                            Is Modifierfalse
                                                                                            Summaryfalse
                                                                                            Alternate Namesextensions, user content
                                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                            SlicingThis element introduces a set of slices on Medication.ingredient.strength.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                            • value @ url
                                                                                            • 339. Medication.ingredient.strength.extension:amountText
                                                                                              Slice NameamountText
                                                                                              Definition

                                                                                              Free-text amount of the ingredient for classical Latin notations such as "ad 100.0" or "quantum satis," including the unit.

                                                                                              ShortExtension
                                                                                              Control0..1
                                                                                              TypeExtension(MedicationIngredientAmountExtensions) (Extension Type: string)
                                                                                              Is Modifierfalse
                                                                                              Summaryfalse
                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                              341. Medication.ingredient.strength.numerator
                                                                                              Definition

                                                                                              The value of the numerator.

                                                                                              ShortNumerator value
                                                                                              Control0..1
                                                                                              BindingThe codes SHOULD be taken from UCUMCodes
                                                                                              (preferred to http://hl7.org/fhir/ValueSet/ucum-units)
                                                                                              TypeQuantity
                                                                                              Is Modifierfalse
                                                                                              Must Supporttrue
                                                                                              Summarytrue
                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                              343. Medication.ingredient.strength.numerator.id
                                                                                              Definition

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

                                                                                              ShortUnique id for inter-element referencing
                                                                                              Control0..1
                                                                                              Typestring
                                                                                              Is Modifierfalse
                                                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                                                              Summaryfalse
                                                                                              345. Medication.ingredient.strength.numerator.extension
                                                                                              Definition

                                                                                              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.

                                                                                              ShortAdditional content defined by implementations
                                                                                              Comments

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

                                                                                              Control0..*
                                                                                              TypeExtension
                                                                                              Is Modifierfalse
                                                                                              Summaryfalse
                                                                                              Alternate Namesextensions, user content
                                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                              SlicingThis element introduces a set of slices on Medication.ingredient.strength.numerator.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                              • value @ url
                                                                                              • 347. Medication.ingredient.strength.numerator.value
                                                                                                Definition

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

                                                                                                ShortNumerical value (with implicit precision)
                                                                                                Comments

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

                                                                                                Control1..1
                                                                                                Typedecimal
                                                                                                Is Modifierfalse
                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                Must Supporttrue
                                                                                                Summarytrue
                                                                                                Requirements

                                                                                                Precision is handled implicitly in almost all cases of measurement.

                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                349. Medication.ingredient.strength.numerator.comparator
                                                                                                Definition

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

                                                                                                Short< | <= | >= | > - how to understand the value
                                                                                                Control0..1
                                                                                                BindingThe codes SHALL be taken from QuantityComparator
                                                                                                (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                                                                How the Quantity should be understood and represented.

                                                                                                Typecode
                                                                                                Is Modifiertrue because 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
                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                Summarytrue
                                                                                                Requirements

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

                                                                                                Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                351. Medication.ingredient.strength.numerator.unit
                                                                                                Definition

                                                                                                A human-readable form of the unit.

                                                                                                ShortUnit representation
                                                                                                Control0..1
                                                                                                Typestring
                                                                                                Is Modifierfalse
                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                Must Supporttrue
                                                                                                Summarytrue
                                                                                                Requirements

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

                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                353. Medication.ingredient.strength.numerator.system
                                                                                                Definition

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

                                                                                                ShortSystem that defines coded unit form
                                                                                                Control0..1
                                                                                                This element is affected by the following invariants: qty-3
                                                                                                Typeuri
                                                                                                Is Modifierfalse
                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                Must Supporttrue
                                                                                                Summarytrue
                                                                                                Requirements

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

                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                355. Medication.ingredient.strength.numerator.code
                                                                                                Definition

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

                                                                                                ShortCoded form of the unit
                                                                                                Comments

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

                                                                                                Control0..1
                                                                                                Typecode
                                                                                                Is Modifierfalse
                                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                Must Supporttrue
                                                                                                Summarytrue
                                                                                                Requirements

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

                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                357. Medication.ingredient.strength.denominator
                                                                                                Definition

                                                                                                The value of the denominator.

                                                                                                ShortDenominator value
                                                                                                Control0..1
                                                                                                BindingThe codes SHOULD be taken from UCUMCodes
                                                                                                (preferred to http://hl7.org/fhir/ValueSet/ucum-units)
                                                                                                TypeQuantity
                                                                                                Is Modifierfalse
                                                                                                Must Supporttrue
                                                                                                Summarytrue
                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                359. Medication.ingredient.strength.denominator.id
                                                                                                Definition

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

                                                                                                ShortUnique id for inter-element referencing
                                                                                                Control0..1
                                                                                                Typestring
                                                                                                Is Modifierfalse
                                                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                Summaryfalse
                                                                                                361. Medication.ingredient.strength.denominator.extension
                                                                                                Definition

                                                                                                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.

                                                                                                ShortAdditional content defined by implementations
                                                                                                Comments

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

                                                                                                Control0..*
                                                                                                TypeExtension
                                                                                                Is Modifierfalse
                                                                                                Summaryfalse
                                                                                                Alternate Namesextensions, user content
                                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                SlicingThis element introduces a set of slices on Medication.ingredient.strength.denominator.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                                                • value @ url
                                                                                                • 363. Medication.ingredient.strength.denominator.value
                                                                                                  Definition

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

                                                                                                  ShortNumerical value (with implicit precision)
                                                                                                  Comments

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

                                                                                                  Control1..1
                                                                                                  Typedecimal
                                                                                                  Is Modifierfalse
                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                  Must Supporttrue
                                                                                                  Summarytrue
                                                                                                  Requirements

                                                                                                  Precision is handled implicitly in almost all cases of measurement.

                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                  365. Medication.ingredient.strength.denominator.comparator
                                                                                                  Definition

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

                                                                                                  Short< | <= | >= | > - how to understand the value
                                                                                                  Control0..1
                                                                                                  BindingThe codes SHALL be taken from QuantityComparator
                                                                                                  (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                                                                  How the Quantity should be understood and represented.

                                                                                                  Typecode
                                                                                                  Is Modifiertrue because 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
                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                  Summarytrue
                                                                                                  Requirements

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

                                                                                                  Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                  367. Medication.ingredient.strength.denominator.unit
                                                                                                  Definition

                                                                                                  A human-readable form of the unit.

                                                                                                  ShortUnit representation
                                                                                                  Control0..1
                                                                                                  Typestring
                                                                                                  Is Modifierfalse
                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                  Must Supporttrue
                                                                                                  Summarytrue
                                                                                                  Requirements

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

                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                  369. Medication.ingredient.strength.denominator.system
                                                                                                  Definition

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

                                                                                                  ShortSystem that defines coded unit form
                                                                                                  Control0..1
                                                                                                  This element is affected by the following invariants: qty-3
                                                                                                  Typeuri
                                                                                                  Is Modifierfalse
                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                  Must Supporttrue
                                                                                                  Summarytrue
                                                                                                  Requirements

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

                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                  371. Medication.ingredient.strength.denominator.code
                                                                                                  Definition

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

                                                                                                  ShortCoded form of the unit
                                                                                                  Comments

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

                                                                                                  Control0..1
                                                                                                  Typecode
                                                                                                  Is Modifierfalse
                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                  Must Supporttrue
                                                                                                  Summarytrue
                                                                                                  Requirements

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

                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                  373. Medication.batch
                                                                                                  Definition

                                                                                                  Information that only applies to packages (not products).

                                                                                                  ShortDetails about packaged medications
                                                                                                  Control0..1
                                                                                                  TypeBackboneElement
                                                                                                  Is Modifierfalse
                                                                                                  Summaryfalse
                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                  375. Medication.batch.id
                                                                                                  Definition

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

                                                                                                  ShortUnique id for inter-element referencing
                                                                                                  Control0..1
                                                                                                  Typestring
                                                                                                  Is Modifierfalse
                                                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                                                  Summaryfalse
                                                                                                  377. Medication.batch.extension
                                                                                                  Definition

                                                                                                  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.

                                                                                                  ShortAdditional content defined by implementations
                                                                                                  Comments

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

                                                                                                  Control0..*
                                                                                                  TypeExtension
                                                                                                  Is Modifierfalse
                                                                                                  Summaryfalse
                                                                                                  Alternate Namesextensions, user content
                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                  379. Medication.batch.modifierExtension
                                                                                                  Definition

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

                                                                                                  ShortExtensions that cannot be ignored even if unrecognized
                                                                                                  Comments

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

                                                                                                  Control0..*
                                                                                                  TypeExtension
                                                                                                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                                                  Summarytrue
                                                                                                  Requirements

                                                                                                  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.

                                                                                                  Alternate Namesextensions, user content, modifiers
                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                                                  381. Medication.batch.lotNumber
                                                                                                  Definition

                                                                                                  The assigned lot number of a batch of the specified product.

                                                                                                  ShortIdentifier assigned to batch
                                                                                                  Control0..1
                                                                                                  Typestring
                                                                                                  Is Modifierfalse
                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                  Summaryfalse
                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                                                  383. Medication.batch.expirationDate
                                                                                                  Definition

                                                                                                  When this specific batch of product will expire.

                                                                                                  ShortWhen batch will expire
                                                                                                  Control0..1
                                                                                                  TypedateTime
                                                                                                  Is Modifierfalse
                                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                                  Summaryfalse
                                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))