TI MedicationRequest dgMP - Implementation Guide TI Common v1.5.0-ballot.1

Is Modifier false

Summary true

4. MedicationRequest.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.

Short Metadata about the resource

Control 0..1

Meta

Is Modifier false

Must Support true

Summary true

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

6. MedicationRequest.meta.id

Definition

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

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

8. MedicationRequest.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.

Short Additional 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.

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

Invariants ele-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())

This element introduces a set of slices on MedicationRequest.meta.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

10. MedicationRequest.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.

Short Version 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.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support true

Summary true

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

12. MedicationRequest.meta.lastUpdated

Definition

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

Short When 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.

Control 0..1

instant

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support true

Summary true

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

14. MedicationRequest.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.

Short Identifies 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.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

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

16. MedicationRequest.meta.profile

Definition

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

Short Profiles 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.

Control 0..*

Type canonical(StructureDefinition)

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

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

18. MedicationRequest.meta.security

Definition

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

Short Security 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.

Control 0..*
This element is affected by the following invariants: ele-1

Unless 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.

Coding

Is Modifier false

Summary true

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

20. MedicationRequest.meta.tag

Definition

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

Short Tags 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.

Control 0..*
This element is affected by the following invariants: ele-1

For 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".

Coding

Is Modifier false

Summary true

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

22. MedicationRequest.implicitRules

Definition

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

Short A 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.

Control 0..1

Is Modifier true 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 Value This primitive element may be present, or absent, or replaced by an extension

Summary true

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

24. MedicationRequest.language

Definition

The base language in which the resource is written.

Short Language 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).

Control 0..1

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

A human language.

Additional Bindings

Purpose

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

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

26. MedicationRequest.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.

Short Text 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.

Control 0..1

Narrative

Is Modifier false

Summary false

Alternate Names narrative, html, xhtml, display

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

28. MedicationRequest.contained

Definition

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

Short Contained, 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.

Control 0..*

Resource

Is Modifier false

Summary false

Alternate Names inline resources, anonymous resources, contained resources

30. MedicationRequest.extension

Definition

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.

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

This element introduces a set of slices on MedicationRequest.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

32. MedicationRequest.extension:context

Slice Name context

Definition

Extension for indicating the context.

Short Extension

Control 0..1

Type Extension(ContextExtension) (Extension Type: code)

Is Modifier false

Must Support true

Summary false

34. MedicationRequest.extension:multiplePrescription

Slice Name multiplePrescription

Definition

This FHIR Extension for multiple prescriptions adds details such as repetition count and time intervals for repeated medication orders to FHIR resources.

Short MultiplePrescription

Control 0..1

Type Extension(MultiplePrescription) (Complex Extension)

Is Modifier false

Must Support true

36. MedicationRequest.extension:multiplePrescription.id

Definition

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

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

38. MedicationRequest.extension:multiplePrescription.extension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier false

Summary false

This element introduces a set of slices on MedicationRequest.extension.extension. The slices areUnordered and Closed, and can be differentiated using the following discriminators:

value @ url

40. MedicationRequest.extension:multiplePrescription.extension:indicator

Slice Name indicator

Definition

An Extension

Short Extension

Control 0..1

Is Modifier false

Must Support true

Summary false

42. MedicationRequest.extension:multiplePrescription.extension:indicator.id

Definition

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

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

44. MedicationRequest.extension:multiplePrescription.extension:indicator.extension

Definition

An Extension

Short Extension

Control 0..0

Is Modifier false

Summary false

This element introduces a set of slices on MedicationRequest.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

46. MedicationRequest.extension:multiplePrescription.extension:indicator.url

Definition

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

Short identifies 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.

Control 1..1

XML Format In the XML format, this property is represented as an attribute.

Fixed Value indicator

48. MedicationRequest.extension:multiplePrescription.extension:indicator.value[x]

Definition

Indicator of whether the current prescription is part of a multiple prescription

true - the current prescription is part of a multiple prescription false - the current prescription is not part of a multiple prescription

Short Multiple Prescription Indicator

Control 1..1
This element is affected by the following invariants: ele-1

[x] Note SeeChoice of Data Typesfor further information about how to use [x]

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support true

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

50. MedicationRequest.extension:multiplePrescription.extension:counter

Slice Name counter

Definition

An Extension

Short Extension

Control 0..1

Is Modifier false

Must Support true

Summary false

52. MedicationRequest.extension:multiplePrescription.extension:counter.id

Definition

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

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

54. MedicationRequest.extension:multiplePrescription.extension:counter.extension

Definition

An Extension

Short Extension

Control 0..0

Is Modifier false

Summary false

This element introduces a set of slices on MedicationRequest.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

56. MedicationRequest.extension:multiplePrescription.extension:counter.url

Definition

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

Short identifies the meaning of the extension

Comments

Control 1..1

XML Format In the XML format, this property is represented as an attribute.

Fixed Value counter

58. MedicationRequest.extension:multiplePrescription.extension:counter.value[x]

Definition

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

Short Value of extension

Control 1..1
This element is affected by the following invariants: ele-1

Ratio

[x] Note SeeChoice of Data Typesfor further information about how to use [x]

Is Modifier false

Must Support true

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

60. MedicationRequest.extension:multiplePrescription.extension:counter.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.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

62. MedicationRequest.extension:multiplePrescription.extension:counter.value[x].extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

This element introduces a set of slices on MedicationRequest.extension.extension.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

64. MedicationRequest.extension:multiplePrescription.extension:counter.value[x].numerator

Definition

The value of the numerator.

Short Numerator value

Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Control 1..1
This element is affected by the following invariants: ele-1

Quantity

Is Modifier false

Must Support true

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
qty-3: If a code for the unit is present, the system SHALL also be present (code.empty() or system.exists())

66. MedicationRequest.extension:multiplePrescription.extension:counter.value[x].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.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

68. MedicationRequest.extension:multiplePrescription.extension:counter.value[x].numerator.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

This element introduces a set of slices on MedicationRequest.extension.extension.value[x].numerator.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

70. MedicationRequest.extension:multiplePrescription.extension:counter.value[x].numerator.value

Definition

The field serves to indicate which number in a series of multiple prescriptions it is. Example: "2" in "2 out of 4"

Short Multiple Prescription Counter

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).

Control 1..1

decimal

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support true

Summary true

Requirements

Precision is handled implicitly in almost all cases of measurement.

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

72. MedicationRequest.extension:multiplePrescription.extension:counter.value[x].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

Control 0..0

The 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.

Is Modifier true 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 Value This primitive element may be present, or absent, or replaced by an extension

Summary true

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 Missing If there is no comparator, then there is no modification of the value

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

74. MedicationRequest.extension:multiplePrescription.extension:counter.value[x].numerator.unit

Definition

A human-readable form of the unit.

Short Unit representation

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Control 0..0

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

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

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

76. MedicationRequest.extension:multiplePrescription.extension:counter.value[x].numerator.system

Definition

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

Short System that defines coded unit form

Comments

see http://en.wikipedia.org/wiki/Uniform_resource_identifier

Control 0..0
This element is affected by the following invariants: qty-3

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

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

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

78. MedicationRequest.extension:multiplePrescription.extension:counter.value[x].numerator.code

Definition

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

Short Coded 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.

Control 0..0

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

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.

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

80. MedicationRequest.extension:multiplePrescription.extension:counter.value[x].denominator

Definition

The value of the denominator.

Short Denominator value

Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Control 1..1
This element is affected by the following invariants: ele-1

Quantity

Is Modifier false

Must Support true

Summary true

82. MedicationRequest.extension:multiplePrescription.extension:counter.value[x].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.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

84. MedicationRequest.extension:multiplePrescription.extension:counter.value[x].denominator.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

This element introduces a set of slices on MedicationRequest.extension.extension.value[x].denominator.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

86. MedicationRequest.extension:multiplePrescription.extension:counter.value[x].denominator.value

Definition

The field serves to indicate the length of this series. Example: "4" in "2 out of 4"

Short Denominator of Multiple Prescription Series

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).

Control 1..1

decimal

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support true

Summary true

Requirements

Precision is handled implicitly in almost all cases of measurement.

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

88. MedicationRequest.extension:multiplePrescription.extension:counter.value[x].denominator.comparator

Definition

Short < | <= | >= | > - how to understand the value

Control 0..0

The 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.

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

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 Missing If there is no comparator, then there is no modification of the value

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

90. MedicationRequest.extension:multiplePrescription.extension:counter.value[x].denominator.unit

Definition

A human-readable form of the unit.

Short Unit representation

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Control 0..0

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

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

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

92. MedicationRequest.extension:multiplePrescription.extension:counter.value[x].denominator.system

Definition

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

Short System that defines coded unit form

Comments

see http://en.wikipedia.org/wiki/Uniform_resource_identifier

Control 0..0
This element is affected by the following invariants: qty-3

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

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

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

94. MedicationRequest.extension:multiplePrescription.extension:counter.value[x].denominator.code

Definition

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

Short Coded 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.

Control 0..0

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

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.

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

96. MedicationRequest.extension:multiplePrescription.extension:period

Slice Name period

Definition

An Extension

Short Extension

Control 0..1

Is Modifier false

Must Support true

Summary false

98. MedicationRequest.extension:multiplePrescription.extension:period.id

Definition

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

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

100. MedicationRequest.extension:multiplePrescription.extension:period.extension

Definition

An Extension

Short Extension

Control 0..0

Is Modifier false

Summary false

This element introduces a set of slices on MedicationRequest.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

102. MedicationRequest.extension:multiplePrescription.extension:period.url

Definition

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

Short identifies the meaning of the extension

Comments

Control 1..1

XML Format In the XML format, this property is represented as an attribute.

Fixed Value period

104. MedicationRequest.extension:multiplePrescription.extension:period.value[x]

Definition

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

Short Value of extension

Control 1..1
This element is affected by the following invariants: ele-1

[x] Note SeeChoice of Data Typesfor further information about how to use [x]

Is Modifier false

Must Support true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
-limitationDateStart: Limitation of the date format to 10 characters YYYY-MM-DD (start.toString().length()=10)
-limitationDateEnd: Limitation of the date format to 10 characters YYYY-MM-DD (end.exists().not() or end.toString().length()=10)

106. MedicationRequest.extension:multiplePrescription.extension:period.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.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

108. MedicationRequest.extension:multiplePrescription.extension:period.value[x].extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

This element introduces a set of slices on MedicationRequest.extension.extension.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

110. MedicationRequest.extension:multiplePrescription.extension:period.value[x].start

Definition

Date from which the partial prescription of the multiple prescription can be redeemed

Short Start Date of the Prescription Redemption Period

Comments

If the low element is missing, the meaning is that the low boundary is not known.

Control 1..1
This element is affected by the following invariants: per-1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support true

Summary true

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

112. MedicationRequest.extension:multiplePrescription.extension:period.value[x].end

Definition

Date of the last redemption day for the partial prescription within the multiple prescription series. The issuer may specify a redemption period different from the one outlined in the Medicinal Products Prescription Ordinance (AMVV)

Short End Date of the Prescription Redemption Period

Comments

The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.

Control 0..1
This element is affected by the following invariants: per-1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support true

Summary true

Meaning if Missing If the end of the period is missing, it means that the period is ongoing

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

114. MedicationRequest.extension:multiplePrescription.extension:id

Slice Name id

Definition

An Extension

Short Extension

Control 0..1

Is Modifier false

Must Support true

Summary false

116. MedicationRequest.extension:multiplePrescription.extension:id.id

Definition

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

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

118. MedicationRequest.extension:multiplePrescription.extension:id.extension

Definition

An Extension

Short Extension

Control 0..0

Is Modifier false

Summary false

This element introduces a set of slices on MedicationRequest.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

120. MedicationRequest.extension:multiplePrescription.extension:id.url

Definition

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

Short identifies the meaning of the extension

Comments

Control 1..1

XML Format In the XML format, this property is represented as an attribute.

Fixed Value id

122. MedicationRequest.extension:multiplePrescription.extension:id.value[x]

Definition

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

Short Value of extension

Control 1..1
This element is affected by the following invariants: ele-1

[x] Note SeeChoice of Data Typesfor further information about how to use [x]

Is Modifier false

Must Support true

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

124. MedicationRequest.extension:multiplePrescription.extension:id.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.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

126. MedicationRequest.extension:multiplePrescription.extension:id.value[x].extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

This element introduces a set of slices on MedicationRequest.extension.extension.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

128. MedicationRequest.extension:multiplePrescription.extension:id.value[x].use

Definition

The purpose of this identifier.

Short usual | official | temp | secondary | old (If known)

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Control 0..0

The codes SHALL be taken from IdentifierUse
(required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

Identifies the purpose for this identifier, if known .

Is Modifier true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

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

130. MedicationRequest.extension:multiplePrescription.extension:id.value[x].type

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Short Description of identifier

Comments

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

Control 0..0
This element is affected by the following invariants: ele-1

Unless not suitable, these codes SHALL be taken from Identifier Type Codes
(extensible to http://hl7.org/fhir/ValueSet/identifier-type|4.0.1)

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Is Modifier false

Summary true

Requirements

Allows users to make use of identifiers when the identifier system is not known.

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

132. MedicationRequest.extension:multiplePrescription.extension:id.value[x].system

Definition

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

Short Specification as UUID

Comments

Identifier.system is always case sensitive.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support true

Summary true

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Fixed Value urn:ietf:rfc:3986

Example General: http://www.acme.com/identifiers/patient

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

134. MedicationRequest.extension:multiplePrescription.extension:id.value[x].value

Definition

A unique ID that is identical across all partial prescriptions of a multiple prescription.

Short Multiple Prescription ID

Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support true

Summary true

Example General: 123456

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

136. MedicationRequest.extension:multiplePrescription.extension:id.value[x].period

Definition

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

Short Time period when id is/was valid for use

Comments

A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").

Period is not used for a duration (a measure of elapsed time). See Duration.

Control 0..0
This element is affected by the following invariants: ele-1

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
per-1: If present, start SHALL have a lower value than end (start.hasValue().not() or end.hasValue().not() or (start <= end))

138. MedicationRequest.extension:multiplePrescription.extension:id.value[x].assigner

Definition

Organization that issued/manages the identifier.

Short Organization that issued id (may be just text)

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Control 0..0
This element is affected by the following invariants: ele-1

Type Reference(Organization)

Is Modifier false

Summary true

Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))

140. MedicationRequest.extension:multiplePrescription.url

Definition

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

Short identifies the meaning of the extension

Comments

Control 1..1

XML Format In the XML format, this property is represented as an attribute.

Fixed Value https://gematik.de/fhir/epa-medication/StructureDefinition/multiple-prescription-extension

142. MedicationRequest.extension:multiplePrescription.value[x]

Definition

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

Short Value of extension

Control 0..0
This element is affected by the following invariants: ele-1

Type Choice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

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

144. MedicationRequest.extension:isBvg

Slice Name isBvg

Definition

Indicator of whether this regulation is made in reference to the 'Bundesentschädigungsgesetz' or the 'Bundesversorgungsgesetz'.

Short Extension

Control 0..1

Type Extension(IndicatorBVGExtension) (Extension Type: boolean)

Is Modifier false

Must Support true

Summary false

146. MedicationRequest.extension:isSer

Slice Name isSer

Definition

Kennzeichnung, ob diese Verordnung mit Bezug zum Sozialen Entschädigungsrecht nach SGB XIV (SER) erfolgt

Short Extension

Control 0..1

Type Extension(IndicatorSERExtension) (Extension Type: boolean)

Is Modifier false

Must Support true

Summary false

148. MedicationRequest.extension:prescriberID

Slice Name prescriberID

Definition

Verschreiber-ID, welche bei der Verordnung bestimmter Präparate anzugeben ist, damit die Apotheke das Rezept beliefern darf.

Short Extension

Control 0..1

Type Extension(PrescriberIDExtension) (Extension Type: Identifier)

Is Modifier false

Must Support true

Summary false

150. MedicationRequest.extension:prescriberID.id

Definition

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

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

152. MedicationRequest.extension:prescriberID.extension

Definition

An Extension

Short Extension

Control 0..0

Is Modifier false

Summary false

This element introduces a set of slices on MedicationRequest.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

154. MedicationRequest.extension:prescriberID.url

Definition

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

Short identifies the meaning of the extension

Comments

Control 1..1

XML Format In the XML format, this property is represented as an attribute.

Fixed Value https://gematik.de/fhir/epa-medication/StructureDefinition/prescriber-id-extension

156. MedicationRequest.extension:prescriberID.value[x]

Definition

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

Short Value of extension

Control 1..1
This element is affected by the following invariants: ele-1

[x] Note SeeChoice of Data Typesfor further information about how to use [x]

Is Modifier false

Must Support true

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

158. MedicationRequest.extension:prescriberID.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.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

160. MedicationRequest.extension:prescriberID.value[x].extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

This element introduces a set of slices on MedicationRequest.extension.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

162. MedicationRequest.extension:prescriberID.value[x].use

Definition

The purpose of this identifier.

Short usual | official | temp | secondary | old (If known)

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Control 0..0

The codes SHALL be taken from IdentifierUse
(required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

Identifies the purpose for this identifier, if known .

Is Modifier true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

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

164. MedicationRequest.extension:prescriberID.value[x].type

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Short Description of identifier

Comments

Control 0..0
This element is affected by the following invariants: ele-1

Unless not suitable, these codes SHALL be taken from Identifier Type Codes
(extensible to http://hl7.org/fhir/ValueSet/identifier-type|4.0.1)

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Is Modifier false

Summary true

Requirements

Allows users to make use of identifiers when the identifier system is not known.

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

166. MedicationRequest.extension:prescriberID.value[x].system

Definition

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

Short The namespace for the identifier value

Comments

Identifier.system is always case sensitive.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Example General: http://www.acme.com/identifiers/patient

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

168. MedicationRequest.extension:prescriberID.value[x].value

Definition

Verschreiber-ID, welche bei der Verordnung bestimmter Präparate anzugeben ist, damit die Apotheke das Rezept beliefern darf.

Short Verschreiber-ID

Comments

Control 1..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Example General: 123456

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

170. MedicationRequest.extension:prescriberID.value[x].period

Definition

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

Short Time period when id is/was valid for use

Comments

Period is not used for a duration (a measure of elapsed time). See Duration.

Control 0..0
This element is affected by the following invariants: ele-1

Is Modifier false

Summary true

172. MedicationRequest.extension:prescriberID.value[x].assigner

Definition

Organization that issued/manages the identifier.

Short Organization that issued id (may be just text)

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Control 0..0
This element is affected by the following invariants: ele-1

Type Reference(Organization)

Is Modifier false

Summary true

174. MedicationRequest.extension:patientID

Slice Name patientID

Definition

Patienten-ID, welche bei der Verordnung bestimmter Arzneimittel angegeben werden kann.

Short Extension

Control 0..1

Type Extension(PatientIDExtension) (Extension Type: Identifier)

Is Modifier false

Must Support true

Summary false

176. MedicationRequest.extension:narcotics

Slice Name narcotics

Definition

Abbildung der Angaben zur Verordnung eines Betäubungsmittels im Sinne des Betäubungsmittelgesetzes (BtMG)

Short Betäubungsmittel (BtM)

Control 0..1

Type Extension(NarcoticsExtension) (Complex Extension)

Is Modifier false

Must Support true

178. MedicationRequest.extension:narcotics.id

Definition

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

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

180. MedicationRequest.extension:narcotics.extension

Definition

An Extension

Short Extension

Control 0..*

Is Modifier false

Must Support true

Summary false

This element introduces a set of slices on MedicationRequest.extension.extension. The slices areUnordered and Closed, and can be differentiated using the following discriminators:

value @ url

182. MedicationRequest.extension:narcotics.extension:narcotics-markings

Slice Name narcotics-markings

Definition

An Extension

Short Extension

Control 0..1

Is Modifier false

Must Support true

Summary false

184. MedicationRequest.extension:narcotics.extension:narcotics-markings.id

Definition

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

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

186. MedicationRequest.extension:narcotics.extension:narcotics-markings.extension

Definition

An Extension

Short Extension

Control 0..0

Is Modifier false

Summary false

This element introduces a set of slices on MedicationRequest.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

188. MedicationRequest.extension:narcotics.extension:narcotics-markings.url

Definition

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

Short identifies the meaning of the extension

Comments

Control 1..1

XML Format In the XML format, this property is represented as an attribute.

Fixed Value narcotics-markings

190. MedicationRequest.extension:narcotics.extension:narcotics-markings.value[x]

Definition

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

Short Value of extension

Comments

Die KBV aktualisiert ihr "Schüsseltabellen"-Paket häufiger, als neue ePA-Versionen veröffentlicht werden. Allerdings übernehmen die E-Rezept-Clients und der E-Rezept-Fachdienst neue KBV-Paketversionen schnell nach deren Veröffentlichung und geben sie somit an den ePA-MedicationService weiter. Da der MedicationService möglicherweise an eine ältere Version des KBV-Pakets gebunden ist, würde er die weitergeleiteten E-Rezept-Daten ablehnen. Zukünftig wird der MedicationService in der Lage sein, auf die neuesten KBV-Paketversionen zu aktualisieren, ohne dass eine neue ePA-Version erforderlich ist. Da das E-Rezept tatsächlich die Codes gegen die neueste KBV-Paketversion prüft, wird der MedicationService keine "ungültigen" Codes erhalten, und die Clients können darauf vertrauen, dass die Daten des MedicationService mit der neuesten KBV-Paketversion übereinstimmen.

Control 0..1
This element is affected by the following invariants: ele-1

Binding The codes SHALL be taken from https://fhir.kbv.de/ValueSet/KBV_VS_SFHIR_KBV_NARCOTIC_LABEL
(required to https://fhir.kbv.de/ValueSet/KBV_VS_SFHIR_KBV_NARCOTIC_LABEL)

Coding

[x] Note SeeChoice of Data Typesfor further information about how to use [x]

Is Modifier false

Must Support true

Pattern Value { "system" : "https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_KBV_NARCOTIC_LABEL" }

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

192. MedicationRequest.extension:narcotics.extension:narcotics-markings.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.

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

194. MedicationRequest.extension:narcotics.extension:narcotics-markings.value[x].extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

This element introduces a set of slices on MedicationRequest.extension.extension.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

196. MedicationRequest.extension:narcotics.extension:narcotics-markings.value[x].system

Definition

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

Short Identity 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.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support true

Summary true

Requirements

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

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

198. MedicationRequest.extension:narcotics.extension:narcotics-markings.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.

Short Version 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.

Note This is a business version Id, not a resource version Id (see discussion)

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

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

200. MedicationRequest.extension:narcotics.extension:narcotics-markings.value[x].code

Definition

Kennzeichen nach § 9 Abs. 1 Nr. 6 BtMVV

Short Kennzeichen nach § 9 Abs. 1 Nr. 6 BtMVV

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support true

Summary true

Requirements

Need to refer to a particular code in the system.

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

202. MedicationRequest.extension:narcotics.extension:narcotics-markings.value[x].display

Definition

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

Short Representation defined by the system

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

Requirements

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

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

204. MedicationRequest.extension:narcotics.extension:narcotics-markings.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).

Short If 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.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

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.

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

206. MedicationRequest.extension:narcotics.extension:additional-information-substitutes

Slice Name additional-information-substitutes

Definition

An Extension

Short Extension

Control 0..1

Is Modifier false

Must Support true

Summary false

208. MedicationRequest.extension:narcotics.extension:additional-information-substitutes.id

Definition

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

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

210. MedicationRequest.extension:narcotics.extension:additional-information-substitutes.extension

Definition

An Extension

Short Extension

Control 0..0

Is Modifier false

Summary false

This element introduces a set of slices on MedicationRequest.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

212. MedicationRequest.extension:narcotics.extension:additional-information-substitutes.url

Definition

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

Short identifies the meaning of the extension

Comments

Control 1..1

XML Format In the XML format, this property is represented as an attribute.

Fixed Value additional-information-substitutes

214. MedicationRequest.extension:narcotics.extension:additional-information-substitutes.value[x]

Definition

Dieses Feld enthält ergänzende Angaben zu Reichdauer und Teilmengen des Substitutionsmittels, insbesondere Zeitpunkte, zu denen das Substitutionsmittel abgegeben bzw. verabreicht werden soll.

Short Ergänzende Angaben zu Substitutionsmittel

Control 0..1
This element is affected by the following invariants: ele-1

[x] Note SeeChoice of Data Typesfor further information about how to use [x]

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support true

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

216. MedicationRequest.extension:narcotics.url

Definition

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

Short identifies the meaning of the extension

Comments

Control 1..1

XML Format In the XML format, this property is represented as an attribute.

Fixed Value https://gematik.de/fhir/epa-medication/StructureDefinition/narcotics-extension

218. MedicationRequest.extension:narcotics.value[x]

Definition

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

Short Value of extension

Control 0..0
This element is affected by the following invariants: ele-1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

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

220. MedicationRequest.extension:teratogenic

Slice Name teratogenic

Definition

Abbildung der Angaben zur Verordnung eines teratogenen Arzneimittels (T-Rezept)

Short T-Rezept

Control 0..1

Type Extension(TeratogenicExtension) (Complex Extension)

Is Modifier false

Must Support true

222. MedicationRequest.extension:renderedDosageInstruction

Slice Name renderedDosageInstruction

Definition

Ein menschenlesbarer, vollständiger Text der Dosierungsanweisungen. Der Text wird aus den strukturierten Dosage-Elementen generiert und dient der patientensicheren Darstellung der Dosierung. Er soll die maschinenlesbaren Angaben konsistent wiedergeben und in einer für Patient:innen verständlichen Form bereitstellen.

Short Vollständige Darstellung der Dosierungsanweisungen (generiert aus den Dosage-Elementen).

Comments

Element MedicationRequest.renderedDosageInstruction has a context of MedicationRequest based on following the parent source element upwards and mapping to MedicationRequest. Element MedicationRequest.renderedDosageInstruction has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).

Control 0..1

Type Extension(R5: Full representation of the dosage instructions (new)) (Extension Type: markdown)

Is Modifier false

Must Support true

Summary false

224. MedicationRequest.extension:renderedDosageInstruction.id

Definition

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

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

226. MedicationRequest.extension:renderedDosageInstruction.extension

Definition

An Extension

Short Extension

Control 0..0

Is Modifier false

Summary false

This element introduces a set of slices on MedicationRequest.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

228. MedicationRequest.extension:renderedDosageInstruction.url

Definition

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

Short identifies the meaning of the extension

Comments

Control 1..1

XML Format In the XML format, this property is represented as an attribute.

Fixed Value http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationRequest.renderedDosageInstruction

230. MedicationRequest.extension:renderedDosageInstruction.value[x]

Definition

The full representation of the dose of the medication included in all dosage instructions. To be used when multiple dosage instructions are included to represent complex dosing such as increasing or tapering doses.

Short Full representation of the dosage instructions

Control 0..1
This element is affected by the following invariants: ele-1

markdown

[x] Note SeeChoice of Data Typesfor further information about how to use [x]

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support true

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

232. MedicationRequest.extension:generatedDosageInstructionsMeta

Slice Name generatedDosageInstructionsMeta

Definition

Diese Extension enthält zusätzliche Metadaten zu den automatisch generierten Dosierungsanweisungen, wie z.B. Informationen zur Generierung oder zum Ursprung der Daten.

Short Metadaten zu den generierten Dosierungsanweisungen

Control 0..1

Type Extension(Generated Dosage Instructions Meta) (Complex Extension)

Is Modifier false

Must Support true

234. MedicationRequest.modifierExtension

Definition

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

Short Extensions that cannot be ignored

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them

Summary false

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 Names extensions, user content

This element introduces a set of slices on MedicationRequest.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

236. MedicationRequest.identifier

Definition

Identifiers associated with this medication request that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server.

Short External ids for this request

Comments

This is a business identifier, not a resource identifier.

Note This is a business identifier, not a resource identifier (see discussion)

Control 0..*
This element is affected by the following invariants: ele-1

Is Modifier false

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

This element introduces a set of slices on MedicationRequest.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:

pattern @ $this

238. MedicationRequest.identifier:RxPrescriptionProcessIdentifier

Slice Name RxPrescriptionProcessIdentifier

Definition

Short External ids for this request

Comments

This is a business identifier, not a resource identifier.

Note This is a business identifier, not a resource identifier (see discussion)

Control 0..1
This element is affected by the following invariants: ele-1

Type Identifier(RxPrescriptionProcessIdentifier)

Is Modifier false

Pattern Value { "system" : "https://gematik.de/fhir/epa-medication/sid/rx-prescription-process-identifier" }

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

240. MedicationRequest.identifier:RxOriginatorProcessIdentifier

Slice Name RxOriginatorProcessIdentifier

Definition

Short External ids for this request

Comments

This is a business identifier, not a resource identifier.

Note This is a business identifier, not a resource identifier (see discussion)

Control 0..1
This element is affected by the following invariants: ele-1

Type Identifier(RxOriginatorProcessIdentifier)

Is Modifier false

Pattern Value { "system" : "https://gematik.de/fhir/epa-medication/sid/rx-originator-process-identifier" }

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

242. MedicationRequest.status

Definition

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

Short Status of Medication Request

Comments

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Control 1..1

Binding The codes SHALL be taken from https://gematik.de/fhir/terminology/ValueSet/ti-medication-request-status-vs
(required to https://gematik.de/fhir/terminology/ValueSet/ti-medication-request-status-vs)

Is Modifier true because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support true

Summary true

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

244. MedicationRequest.statusReason

Definition

Captures the reason for the current state of the MedicationRequest.

Short Reason for current status

Comments

This is generally only used for "exception" statuses such as "suspended" or "cancelled". The reason why the MedicationRequest was created at all is captured in reasonCode, not here.

Control 0..1
This element is affected by the following invariants: ele-1

For example codes, see medicationRequest Status Reason Codes
(example to http://hl7.org/fhir/ValueSet/medicationrequest-status-reason|4.0.1)

Identifies the reasons for a given status.

Is Modifier false

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

246. MedicationRequest.intent

Definition

e.g. when data is synchronized with the E-Rezept-Fachdienst, the 'filler-order' code should be used here.

Short filler-order

Comments

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

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

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

Control 1..1

The codes SHALL be taken from medicationRequest Intent
(required to http://hl7.org/fhir/ValueSet/medicationrequest-intent|4.0.1)

The kind of medication order.

Is Modifier true because This element changes the interpretation of all descriptive attributes. For example "the time the request is recommended to occur" vs. "the time the request is authorized to occur" or "who is recommended to perform the request" vs. "who is authorized to perform the request

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support true

Summary true

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

248. MedicationRequest.category

Definition

Indicates the type of medication request (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)).

Short Type of medication usage

Comments

The category can be used to include where the medication is expected to be consumed or other types of requests.

Control 0..*
This element is affected by the following invariants: ele-1

For example codes, see medicationRequest Category Codes
(example to http://hl7.org/fhir/ValueSet/medicationrequest-category|4.0.1)

A coded concept identifying the category of medication request. For example, where the medication is to be consumed or administered, or the type of medication treatment.

Is Modifier false

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

250. MedicationRequest.priority

Definition

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

Short routine | urgent | asap | stat

Control 0..1

The codes SHALL be taken from RequestPriority
(required to http://hl7.org/fhir/ValueSet/request-priority|4.0.1)

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

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

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

252. MedicationRequest.doNotPerform

Definition

If true indicates that the provider is asking for the medication request not to occur.

Short True if request is prohibiting action

Comments

If do not perform is not specified, the request is a positive request e.g. "do perform".

Control 0..1

Is Modifier true because This element is labeled as a modifier because this element negates the request to occur (ie, this is a request for the medication not to be ordered or prescribed, etc)

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

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

254. MedicationRequest.reported[x]

Definition

Indicates if this record was captured as a secondary 'reported' record rather than as an original primary source-of-truth record. It may also indicate the source of the report.

Short Reported rather than primary record

Control 0..1
This element is affected by the following invariants: ele-1

Type Choice of: boolean, Reference(Patient, Practitioner, PractitionerRole, RelatedPerson, Organization)

[x] Note SeeChoice of Data Typesfor further information about how to use [x]

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

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

256. MedicationRequest.medication[x]

Definition

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

Short Medication to be taken

Comments

If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the Medication resource is recommended. For example, if you require form or lot number or if the medication is compounded or extemporaneously prepared, then you must reference the Medication resource.

Control 1..1
This element is affected by the following invariants: ele-1

Type Reference(Medication)

[x] Note SeeChoice of Data Typesfor further information about how to use [x]

Is Modifier false

Must Support true

Summary true

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

258. MedicationRequest.subject

Definition

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

Short Who or group medication request is for

Comments

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

Control 1..1
This element is affected by the following invariants: ele-1

Type Reference(Patient)

Is Modifier false

Must Support true

Summary true

260. MedicationRequest.subject.id

Definition

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

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

262. MedicationRequest.subject.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

This element introduces a set of slices on MedicationRequest.subject.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

264. MedicationRequest.subject.reference

Definition

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

Short Literal 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.

Control 0..1
This element is affected by the following invariants: ref-1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

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

266. MedicationRequest.subject.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).

Short Type 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.

Control 0..1

Unless 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).

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

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

268. MedicationRequest.subject.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.

Short Logical 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).

Note This is a business identifier, not a resource identifier (see discussion)

Control 1..1
This element is affected by the following invariants: ele-1

Type Identifier(Identifier-Profil für die 10-stellige Krankenversichertennummer)

Is Modifier false

Must Support true

Summary true

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

270. MedicationRequest.subject.display

Definition

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

Short Text 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.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

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

272. MedicationRequest.encounter

Definition

The Encounter during which this [x] was created or to which the creation of this record is tightly associated.

Short Encounter created as part of encounter/admission/stay

Comments

This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter." If there is a need to link to episodes of care they will be handled with an extension.

Control 0..1
This element is affected by the following invariants: ele-1

Type Reference(Encounter)

Is Modifier false

274. MedicationRequest.supportingInformation

Definition

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

Short Information to support ordering of the medication

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Control 0..*
This element is affected by the following invariants: ele-1

Type Reference(Resource)

Is Modifier false

276. MedicationRequest.authoredOn

Definition

Issue Date of the Prescription

Short Issue Date

Control 1..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support true

Summary true

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

278. MedicationRequest.requester

Definition

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

Short Who/What requested the Request

Comments

Control 0..1
This element is affected by the following invariants: ele-1

Type Reference(Organization, Practitioner, PractitionerRole)

Is Modifier false

Must Support true

Must Support Types No must-support rules about the choice of types/profiles

Summary true

280. MedicationRequest.performer

Definition

The specified desired performer of the medication treatment (e.g. the performer of the medication administration).

Short Intended performer of administration

Comments

Control 0..1
This element is affected by the following invariants: ele-1

Type Reference(Practitioner, PractitionerRole, Organization, Patient, Device, RelatedPerson, CareTeam)

Is Modifier false

282. MedicationRequest.performerType

Definition

Indicates the type of performer of the administration of the medication.

Short Desired kind of performer of the medication administration

Comments

If specified without indicating a performer, this indicates that the performer must be of the specified type. If specified with a performer then it indicates the requirements of the performer if the designated performer is not available.

Control 0..1
This element is affected by the following invariants: ele-1

For example codes, see ProcedurePerformerRoleCodes
(example to http://hl7.org/fhir/ValueSet/performer-role|4.0.1)

Identifies the type of individual that is desired to administer the medication.

Is Modifier false

Summary true

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

284. MedicationRequest.recorder

Definition

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

Short Person who entered the request

Comments

Control 0..1
This element is affected by the following invariants: ele-1

Type Reference(Practitioner, PractitionerRole)

Is Modifier false

286. MedicationRequest.reasonCode

Definition

The reason or the indication for ordering or not ordering the medication.

Short Reason or indication for ordering or not ordering the medication

Comments

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

Control 0..*
This element is affected by the following invariants: ele-1

For example codes, see Condition/Problem/DiagnosisCodes
(example to http://hl7.org/fhir/ValueSet/condition-code|4.0.1)

A coded concept indicating why the medication was ordered.

Is Modifier false

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

288. MedicationRequest.reasonReference

Definition

Condition or observation that supports why the medication was ordered.

Short Condition or observation that supports why the prescription is being written

Comments

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

Control 0..*
This element is affected by the following invariants: ele-1

Type Reference(Condition, Observation)

Is Modifier false

290. MedicationRequest.instantiatesCanonical

Definition

The URL pointing to a protocol, guideline, orderset, or other definition that is adhered to in whole or in part by this MedicationRequest.

Short Instantiates FHIR protocol or definition

Comments

see Canonical References

Control 0..*

canonical

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

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

292. MedicationRequest.instantiatesUri

Definition

The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this MedicationRequest.

Short Instantiates external protocol or definition

Comments

see http://en.wikipedia.org/wiki/Uniform_resource_identifier

Control 0..*

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

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

294. MedicationRequest.basedOn

Definition

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

Short What request fulfills

Comments

Control 0..*
This element is affected by the following invariants: ele-1

Type Reference(CarePlan, MedicationRequest, ServiceRequest, ImmunizationRecommendation)

Is Modifier false

Must Support true

Must Support Types No must-support rules about the choice of types/profiles

Summary true

296. MedicationRequest.basedOn.id

Definition

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

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

298. MedicationRequest.basedOn.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

This element introduces a set of slices on MedicationRequest.basedOn.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

300. MedicationRequest.basedOn.reference

Definition

Short Literal reference, Relative, internal or absolute URL

Comments

Control 0..1
This element is affected by the following invariants: ref-1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support true

Summary true

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

302. MedicationRequest.basedOn.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.

Short Type the reference refers to (e.g. "Patient")

Comments

Control 0..1

Unless 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).

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

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

304. MedicationRequest.basedOn.identifier

Definition

Short Logical reference, when literal reference is not known

Comments

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

Note This is a business identifier, not a resource identifier (see discussion)

Control 0..1
This element is affected by the following invariants: ele-1

Type Identifier(Profil für den Identifikator eines eMP-Eintrags)

Is Modifier false

Must Support true

Summary true

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

306. MedicationRequest.basedOn.display

Definition

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

Short Text 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.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

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

308. MedicationRequest.groupIdentifier

Definition

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

Short Composite request this is part of

Control 0..1
This element is affected by the following invariants: ele-1

Is Modifier false

Summary true

Requirements

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

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

310. MedicationRequest.courseOfTherapyType

Definition

The description of the overall patte3rn of the administration of the medication to the patient.

Short Overall pattern of medication administration

Comments

This attribute should not be confused with the protocol of the medication.

Control 0..1
This element is affected by the following invariants: ele-1

For example codes, see medicationRequest Course of Therapy Codes
(example to http://hl7.org/fhir/ValueSet/medicationrequest-course-of-therapy|4.0.1)

Identifies the overall pattern of medication administratio.

Is Modifier false

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

312. MedicationRequest.insurance

Definition

Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be required for delivering the requested service.

Short Associated insurance coverage

Comments

Control 0..*
This element is affected by the following invariants: ele-1

Type Reference(Coverage, ClaimResponse)

Is Modifier false

314. MedicationRequest.note

Definition

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

Short Information about the prescription

Comments

For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).

Control 0..1
This element is affected by the following invariants: ele-1

Annotation

Is Modifier false

Must Support true

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

316. MedicationRequest.note.id

Definition

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

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

318. MedicationRequest.note.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

This element introduces a set of slices on MedicationRequest.note.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

320. MedicationRequest.note.author[x]

Definition

The individual responsible for making the annotation.

Short Individual responsible for the annotation

Comments

Organization is used when there's no need for specific attribution as to who made the comment.

Control 0..1
This element is affected by the following invariants: ele-1

Type Choice of: Reference(Practitioner, Patient, RelatedPerson, Organization), string

[x] Note SeeChoice of Data Typesfor further information about how to use [x]

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

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

322. MedicationRequest.note.time

Definition

Indicates when this particular annotation was made.

Short When the annotation was made

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

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

324. MedicationRequest.note.text

Definition

Instructions to the pharmacy that go beyond the dosage information

Short Dispensing Note

Comments

Systems are not required to have markdown support, so the text should be readable without markdown processing. The markdown syntax is GFM - see https://github.github.com/gfm/

Control 1..1

markdown

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support true

Summary true

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

326. MedicationRequest.dosageInstruction

Definition

Hier werden Informationen zur Dosierung angegeben.

Short Hier werden Informationen zur Dosierung angegeben.

Comments

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

Control 0..*

Type Dosage(Dosage dgMP)

Is Modifier false

Must Support true

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

328. MedicationRequest.dispenseRequest

Definition

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

Short Medication supply authorization

Control 0..1
This element is affected by the following invariants: ele-1

BackboneElement

Is Modifier false

Must Support true

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

330. MedicationRequest.dispenseRequest.id

Definition

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

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

332. MedicationRequest.dispenseRequest.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

This element introduces a set of slices on MedicationRequest.dispenseRequest.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

334. MedicationRequest.dispenseRequest.modifierExtension

Definition

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

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

336. MedicationRequest.dispenseRequest.initialFill

Definition

Indicates the quantity or duration for the first dispense of the medication.

Short First fill details

Comments

If populating this element, either the quantity or the duration must be included.

Control 0..1
This element is affected by the following invariants: ele-1

BackboneElement

Is Modifier false

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

338. MedicationRequest.dispenseRequest.initialFill.id

Definition

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

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

340. MedicationRequest.dispenseRequest.initialFill.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

This element introduces a set of slices on MedicationRequest.dispenseRequest.initialFill.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

342. MedicationRequest.dispenseRequest.initialFill.modifierExtension

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

344. MedicationRequest.dispenseRequest.initialFill.quantity

Definition

The amount or quantity to provide as part of the first dispense.

Short First fill quantity

Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Control 0..1
This element is affected by the following invariants: ele-1

Type Quantity(SimpleQuantity)

Is Modifier false

346. MedicationRequest.dispenseRequest.initialFill.duration

Definition

The length of time that the first dispense is expected to last.

Short First fill duration

Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Control 0..1

Duration

Is Modifier false

Invariants drt-1: There SHALL be a code if there is a value and it SHALL be an expression of time. If system is present, it SHALL be UCUM. (code.exists() implies ((system = %ucum) and value.exists()))
ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
qty-3: If a code for the unit is present, the system SHALL also be present (code.empty() or system.exists())

348. MedicationRequest.dispenseRequest.dispenseInterval

Definition

The minimum period of time that must occur between dispenses of the medication.

Short Minimum period of time between dispenses

Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Control 0..1

Duration

Is Modifier false

350. MedicationRequest.dispenseRequest.validityPeriod

Definition

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

Short Time period supply is authorized for

Comments

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

Control 0..1
This element is affected by the following invariants: ele-1

Is Modifier false

Requirements

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

352. MedicationRequest.dispenseRequest.numberOfRepeatsAllowed

Definition

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

Short Number of refills authorized

Comments

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

Control 0..1

unsignedInt

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary false

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

354. MedicationRequest.dispenseRequest.quantity

Definition

The amount that is to be dispensed for one fill.

Short Amount of medication to supply per dispense

Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Control 0..1
This element is affected by the following invariants: ele-1

Type Quantity(SimpleQuantity)

Is Modifier false

Must Support true

356. MedicationRequest.dispenseRequest.quantity.id

Definition

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

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

358. MedicationRequest.dispenseRequest.quantity.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

This element introduces a set of slices on MedicationRequest.dispenseRequest.quantity.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

360. MedicationRequest.dispenseRequest.quantity.value

Definition

Number of Prescribed Packages

Short Number of Prescribed Packages

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).

Control 1..1

decimal

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support true

Summary true

Requirements

Precision is handled implicitly in almost all cases of measurement.

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

362. MedicationRequest.dispenseRequest.quantity.comparator

Definition

Not allowed to be used in this context

Short < | <= | >= | > - how to understand the value

Control 0..0

The 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.

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Summary true

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 Missing If there is no comparator, then there is no modification of the value

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

364. MedicationRequest.dispenseRequest.quantity.unit

Definition

A human-readable form of the unit.

Short Unit representation

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support true

Summary true

Requirements

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

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

366. MedicationRequest.dispenseRequest.quantity.system

Definition

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

Short System that defines coded unit form

Control 0..1
This element is affected by the following invariants: qty-3

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support true

Summary true

Requirements

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

Pattern Value http://unitsofmeasure.org

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

368. MedicationRequest.dispenseRequest.quantity.code

Definition

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

Short Coded 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.

Control 0..1

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support true

Summary true

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.

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

370. MedicationRequest.dispenseRequest.expectedSupplyDuration

Definition

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

Short Number of days supply per dispense

Comments

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

Control 0..1

Duration

Is Modifier false

Must Support true

372. MedicationRequest.dispenseRequest.performer

Definition

Indicates the intended dispensing Organization specified by the prescriber.

Short Intended dispenser

Comments

Control 0..1
This element is affected by the following invariants: ele-1

Type Reference(Organization)

Is Modifier false

374. MedicationRequest.substitution

Definition

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

Short Any restrictions on medication substitution

Control 0..1
This element is affected by the following invariants: ele-1

BackboneElement

Is Modifier false

Must Support true

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

376. MedicationRequest.substitution.id

Definition

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

Short Unique id for inter-element referencing

Control 0..1

Is Modifier false

XML Format In the XML format, this property is represented as an attribute.

Summary false

378. MedicationRequest.substitution.extension

Definition

Short Additional content defined by implementations

Comments

Control 0..*

Is Modifier false

Summary false

Alternate Names extensions, user content

This element introduces a set of slices on MedicationRequest.substitution.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:

value @ url

380. MedicationRequest.substitution.modifierExtension

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions that cannot be ignored even if unrecognized

Comments

Control 0..*

Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

Summary true

Requirements

Alternate Names extensions, user content, modifiers

382. MedicationRequest.substitution.allowed[x]

Definition

True if the prescriber allows a different drug to be dispensed from what was prescribed.

Short Whether substitution is allowed or not

Comments

This element is labeled as a modifier because whether substitution is allow or not, it cannot be ignored.

Control 1..1
This element is affected by the following invariants: ele-1

[x] Note SeeChoice of Data Typesfor further information about how to use [x]

Is Modifier false

Primitive Value This primitive element may be present, or absent, or replaced by an extension

Must Support true

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

384. MedicationRequest.substitution.reason

Definition

Indicates the reason for the substitution, or why substitution must or must not be performed.

Short Why should (not) substitution be made

Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Control 0..1
This element is affected by the following invariants: ele-1

For example codes, see SubstanceAdminSubstitutionReason
(example to http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason)

A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.