Release 4
This page is part of the FHIR Specification (v4.0.1: R4 - Mixed Normative and STU ). This is the current published version in it's permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

11.2 Resource MedicationAdministration - Content

Pharmacy Work Group Maturity Level : 2   Trial Use Security Category : Patient Compartments : Device , Encounter , Patient , Practitioner , RelatedPerson

Describes the event of a patient consuming or otherwise being administered a medication. This may be as simple as swallowing a tablet or it may be a long running infusion. Related resources tie this event to the authorizing prescription, and the specific encounter between patient and health care practitioner.

This resource covers the administration of all medications and vaccines. Please refer to the Immunization Resource/Profile for the treatment of vaccines. It will principally be used within care settings (including inpatient) to record the capture of medication administrations, including self-administrations of oral medications, injections, intra-venous adjustments, etc. It can also be used in outpatient settings to record allergy shots and other non-immunization administrations. In some cases, it might be used for home-health reporting, such as recording self-administered or even device-administered insulin.

MedicationAdministration is an event resource from a FHIR workflow perspective - see Workflow Event

The Medication domain includes a number of related resources

MedicationRequest An order for both supply of the medication and the instructions for administration of the medicine to a patient.
MedicationDispense Provision of a supply of a medication with the intention that it is subsequently consumed by a patient (usually in response to a prescription).
MedicationAdministration When a patient actually consumes a medicine, or it is otherwise administered to them
MedicationStatement MedicationUsage This is a record of a medication being taken by a patient or that a medication has been given to a patient, where the record is the result of a report from the patient or another clinician. A medication statement is not a part of the prescribe->dispense->administer sequence but is a report that such a sequence (or at least a part of it) did take place, resulting in a belief that the patient has received a particular medication.

MedicationAdministration is intended for tracking the administration of non-vaccine medications. Administration of vaccines is intended to be handled using the Immunization resource. Some systems treat immunizations in the same way as any other medication administration. Such systems SHOULD use an immunization resource to represent these. If systems need to use a MedicationAdministration resource to capture vaccinations for workflow or other reasons, they SHOULD also create and expose an equivalent Immunization instance.

This resource is referenced by AdverseEvent , ChargeItem , itself, MedicationStatement MedicationUsage , Observation and Procedure .

This resource implements the Event pattern.

Structure

medicationCodeableConcept CodeableConcept medicationReference Reference ( Medication ) reasonCode 0..* CodeableConcept Reason administration performed Reason Medication Given Codes ( Example )
Name Flags Card. Type Description & Constraints doco
. . MedicationAdministration TU DomainResource Administration of medication to a patient
Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier 0..* Identifier External identifier
. . instantiates . instantiatesCanonical Σ 0..* canonical ( PlanDefinition | ActivityDefinition ) Instantiates protocol or definition
... instantiatesUri Σ 0..* uri Instantiates external protocol or definition
. . . partOf Σ 0..* Reference ( MedicationAdministration | Procedure ) Part of referenced event
. . . status ?! Σ 1..1 code in-progress | not-done | on-hold | completed | entered-in-error | stopped | unknown
Medication administration status codes ( Required )
. . . statusReason 0..* CodeableConcept Reason administration not performed
SNOMED CT Reason Medication Not Given Codes ( Example )
. . . category 0..1 0..* CodeableConcept Type of medication usage administration
Medication administration category location codes ( Preferred Example )
. . medication[x] . medication Σ 1..1 CodeableReference ( Medication ) What was administered
SNOMED CT Medication Codes ( Example )
. . . subject Σ 1..1 Reference ( Patient | Group ) Who received medication
. . . context encounter 0..1 Reference ( Encounter | EpisodeOfCare ) Encounter or Episode of Care administered as part of
. . . supportingInformation 0..* Reference ( Any ) Additional information to support administration
. . . effective[x] occurence[x] Σ 1..1 Start and end time of administration
. . . . effectiveDateTime occurenceDateTime dateTime
. . . . effectivePeriod occurencePeriod Period
. . . recorded Σ 0..1 dateTime When the MedicationAdministration was first captured in the subject's record
... performer Σ 0..* BackboneElement Who performed the medication administration and what they did
. . . . function 0..1 CodeableConcept Type of performance
Medication administration performer function codes ( Example )
. . . . actor Σ 1..1 Reference ( Practitioner | PractitionerRole | Patient | RelatedPerson | Device ) Who performed the medication administration
. . . reasonReference reason 0..* Reference CodeableReference ( Condition | Observation | DiagnosticReport ) Condition Concept, condition or observation that supports why the medication was administered
Reason Medication Given Codes ( Example )
. . . request 0..1 Reference ( MedicationRequest ) Request administration performed against
. . . device 0..* Reference ( Device ) Device used to administer
. . . note 0..* Annotation Information about the administration
. . . dosage I 0..1 BackboneElement Details of how medication was taken
+ Rule: SHALL have at least one of dosage.dose or dosage.rate[x]
. . . . text 0..1 string Free text dosage instructions e.g. SIG
. . . . site 0..1 CodeableConcept Body site administered to
SNOMED CT Anatomical Structure for Administration Site Codes ( Example )
. . . . route 0..1 CodeableConcept Path of substance into body
SNOMED CT Route Codes ( Example )
. . . . method 0..1 CodeableConcept How drug was administered
SNOMED CT Administration Method Codes ( Example )
. . . . dose 0..1 SimpleQuantity Amount of medication per dose
. . . . rate[x] 0..1 Dose quantity per unit of time
. . . . . rateRatio Ratio
. . . . . rateQuantity SimpleQuantity
. . . eventHistory 0..* Reference ( Provenance ) A list of events of interest in the lifecycle

doco Documentation for this format

UML Diagram ( Legend )

MedicationAdministration ( DomainResource ) Identifiers associated with this Medication Administration that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server identifier : Identifier [0..*] A protocol, guideline, orderset, or other definition that was adhered to in whole or in part by this event instantiates instantiatesCanonical : canonical [0..*] « PlanDefinition | ActivityDefinition » The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this MedicationAdministration instantiatesUri : uri [0..*] A plan that is fulfilled in whole or in part by this MedicationDispense basedOn : Reference [0..*] « CarePlan » A larger event of which this particular event is a component or step partOf : Reference [0..*] « MedicationAdministration | Procedure » Will generally be set to show that the administration has been completed. For some long running administrations such as infusions, it is possible for an administration to be started but not completed or it may be paused while some other process is under way (this element modifies the meaning of other elements) status : code [1..1] « A set of codes indicating the current status of a MedicationAdministration. (Strength=Required) MedicationAdministration Stat... ! » A code indicating why the administration was not performed statusReason : CodeableConcept [0..*] « A set of codes indicating the reason why the MedicationAdministration is negated. (Strength=Example) SNOMEDCTReasonMedicationNotGi... ?? » Indicates where the The type of medication is expected to administration (for example, drug classification like ATC, where meds would be consumed or administered administered, legal category of the medication) category : CodeableConcept [0..1] [0..*] « A coded concept describing where the medication administered is expected to occur. (Strength=Preferred) (Strength=Example) MedicationAdministration Cate... Loca... ? ?? » Identifies the medication that was administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications medication[x] medication : Type DataType [1..1] « CodeableConcept | Reference ( Medication ); ; Codes identifying substance or product that can be administered. (Strength=Example) SNOMEDCTMedicationCodes ?? » The person or animal or group receiving the medication subject : Reference [1..1] « Patient | Group » The visit, admission, or other contact between patient and health care provider during which the medication administration was performed context encounter : Reference [0..1] « Encounter | EpisodeOfCare » Additional information (for example, patient height and weight) that supports the administration of the medication medication. This attribute can be used to provide documentation of specific characteristics of the patient present at the time of administration. For example, if the dose says "give "x" if the heartrate exceeds "y"", then the heart rate can be included using this attribute supportingInformation : Reference [0..*] « Any » A specific date/time or interval of time during which the administration took place (or did not take place, when the 'notGiven' attribute is true). place). For many administrations, such as swallowing a tablet the use of dateTime is more appropriate effective[x] occurence[x] : Type DataType [1..1] « dateTime | Period » A code indicating why The date the medication was given reasonCode : CodeableConcept [0..*] « A set occurrence of codes indicating the reason why the MedicationAdministration was made. (Strength=Example) first captured in the record - potentially significantly after the occurrence of the event ReasonMedicationGivenCodes recorded ?? » : dateTime [0..1] A code, Condition or observation that supports why the medication was administered reasonReference reason : Reference DataType [0..*] « Condition | Observation | DiagnosticReport ; A set of codes indicating the reason why the MedicationAdministration was made. (Strength=Example) DiagnosticReport ReasonMedicationGivenCodes ?? » The original request, instruction or authority to perform the administration request : Reference [0..1] « MedicationRequest » The device used in administering the medication to the patient. For example, a particular infusion pump device : Reference [0..*] « Device » Extra information about the medication administration that is not conveyed by the other attributes note : Annotation [0..*] A summary of the events of interest that have occurred, such as when the administration was verified eventHistory : Reference [0..*] « Provenance » Performer Distinguishes the type of involvement of the performer in the medication administration function : CodeableConcept [0..1] « A code describing the role an individual played in administering the medication. (Strength=Example) MedicationAdministration Perf... ?? » Indicates who or what performed the medication administration actor : Reference [1..1] « Practitioner | PractitionerRole | Patient | RelatedPerson | Device » Dosage Free text dosage can be used for cases where the dosage administered is too complex to code. When coded dosage is present, the free text dosage may still be present for display to humans. The dosage instructions should reflect the dosage of the medication that was administered text : string [0..1] A coded specification of the anatomic site where the medication first entered the body. For example, "left arm" site : CodeableConcept [0..1] « A coded concept describing the site location the medicine enters into or onto the body. (Strength=Example) SNOMEDCTAnatomicalStructureFo... ?? » A code specifying the route or physiological path of administration of a therapeutic agent into or onto the patient. For example, topical, intravenous, etc route : CodeableConcept [0..1] « A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject. (Strength=Example) SNOMEDCTRouteCodes ?? » A coded value indicating the method by which the medication is intended to be or was introduced into or on the body. This attribute will most often NOT be populated. It is most commonly used for injections. For example, Slow Push, Deep IV method : CodeableConcept [0..1] « A coded concept describing the technique by which the medicine is administered. (Strength=Example) SNOMEDCTAdministrationMethodC... ?? » The amount of the medication given at one administration event. Use this value when the administration is essentially an instantaneous event such as a swallowing a tablet or giving an injection dose : Quantity ( SimpleQuantity ) [0..1] Identifies the speed with which the medication was or will be introduced into the patient. Typically, the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time, e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours rate[x] : Type DataType [0..1] « Ratio | Quantity ( SimpleQuantity ) » Indicates who or what performed the medication administration and how they were involved performer [0..*] Describes the medication dosage information details e.g. dose, rate, site, route, etc dosage [0..1]

XML Template

<MedicationAdministration xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier External identifier --></identifier>
 <

 <instantiatesCanonical><!-- 0..* canonical(ActivityDefinition|PlanDefinition) Instantiates protocol or definition --></instantiatesCanonical>
 <instantiatesUri value="[uri]"/><!-- 0..* Instantiates external protocol or definition -->
 <basedOn><!-- 0..* Reference(CarePlan) Plan that is fulfilled by this dispense --></basedOn>

 <partOf><!-- 0..* Reference(MedicationAdministration|Procedure) Part of referenced event --></partOf>
 <status value="[code]"/><!-- 1..1 in-progress | not-done | on-hold | completed | entered-in-error | stopped | unknown -->
 <statusReason><!-- 0..* CodeableConcept Reason administration not performed --></statusReason>
 <</category>
 <</medication[x]>
 <</subject>
 <</context>
 <</supportingInformation>
 <</effective[x]>

 <category><!-- 0..* CodeableConcept Type of medication administration --></category>
 <medication><!-- 1..1 CodeableReference(Medication) What was administered --></medication>
 <subject><!-- 1..1 Reference(Group|Patient) Who received medication --></subject>
 <encounter><!-- 0..1 Reference(Encounter) Encounter administered as part of --></encounter>
 <supportingInformation><!-- 0..* Reference(Any) Additional information to support administration --></supportingInformation>
 <occurence[x]><!-- 1..1 dateTime|Period Start and end time of administration --></occurence[x]>
 <recorded value="[dateTime]"/><!-- 0..1 When the MedicationAdministration was first captured in the subject's record -->

 <performer>  <!-- 0..* Who performed the medication administration and what they did -->
  <function><!-- 0..1 CodeableConcept Type of performance --></function>
  <|
    </actor>

  <actor><!-- 1..1 Reference(Device|Patient|Practitioner|PractitionerRole|
    RelatedPerson) Who performed the medication administration --></actor>
 </performer>
 <</reasonCode>
 <</reasonReference>

 <reason><!-- 0..* CodeableReference(Condition|DiagnosticReport|Observation) Concept, condition or observation that supports why the medication was administered --></reason>

 <request><!-- 0..1 Reference(MedicationRequest) Request administration performed against --></request>
 <device><!-- 0..* Reference(Device) Device used to administer --></device>
 <note><!-- 0..* Annotation Information about the administration --></note>
 <dosage>  <!-- 0..1 Details of how medication was taken -->
  <text value="[string]"/><!-- 0..1 Free text dosage instructions e.g. SIG -->
  <site><!-- 0..1 CodeableConcept Body site administered to --></site>
  <route><!-- 0..1 CodeableConcept Path of substance into body --></route>
  <method><!-- 0..1 CodeableConcept How drug was administered --></method>
  <dose><!-- 0..1 Quantity(SimpleQuantity) Amount of medication per dose --></dose>
  <rate[x]><!-- 0..1 Ratio|Quantity(SimpleQuantity) Dose quantity per unit of time --></rate[x]>
 </dosage>
 <eventHistory><!-- 0..* Reference(Provenance) A list of events of interest in the lifecycle --></eventHistory>
</MedicationAdministration>

JSON Template

{doco
  "resourceType" : "MedicationAdministration",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External identifier
  "

  "instantiatesCanonical" : [{ canonical(ActivityDefinition|PlanDefinition) }], // Instantiates protocol or definition
  "instantiatesUri" : ["<uri>"], // Instantiates external protocol or definition
  "basedOn" : [{ Reference(CarePlan) }], // Plan that is fulfilled by this dispense

  "partOf" : [{ Reference(MedicationAdministration|Procedure) }], // Part of referenced event
  "status" : "<code>", // R!  in-progress | not-done | on-hold | completed | entered-in-error | stopped | unknown
  "statusReason" : [{ CodeableConcept }], // Reason administration not performed
  "
  
  " },
  " },
  "
  "
  "
  
  ">",
  " },

  "category" : [{ CodeableConcept }], // Type of medication administration
  "medication" : { CodeableReference(Medication) }, // R!  What was administered
  "subject" : { Reference(Group|Patient) }, // R!  Who received medication
  "encounter" : { Reference(Encounter) }, // Encounter administered as part of
  "supportingInformation" : [{ Reference(Any) }], // Additional information to support administration
  // occurence[x]: Start and end time of administration. One of these 2:
  "occurenceDateTime" : "<dateTime>",
  "occurencePeriod" : { Period },
  "recorded" : "<dateTime>", // When the MedicationAdministration was first captured in the subject's record

  "performer" : [{ // Who performed the medication administration and what they did
    "function" : { CodeableConcept }, // Type of performance
    "|
    

    "actor" : { Reference(Device|Patient|Practitioner|PractitionerRole|
    RelatedPerson) } // R!  Who performed the medication administration
  }],
  "
  "

  "reason" : [{ CodeableReference(Condition|DiagnosticReport|Observation) }], // Concept, condition or observation that supports why the medication was administered

  "request" : { Reference(MedicationRequest) }, // Request administration performed against
  "device" : [{ Reference(Device) }], // Device used to administer
  "note" : [{ Annotation }], // Information about the administration
  "dosage" : { // Details of how medication was taken
    "text" : "<string>", // Free text dosage instructions e.g. SIG
    "site" : { CodeableConcept }, // Body site administered to
    "route" : { CodeableConcept }, // Path of substance into body
    "method" : { CodeableConcept }, // How drug was administered
    "dose" : { Quantity(SimpleQuantity) }, // Amount of medication per dose
    // rate[x]: Dose quantity per unit of time. One of these 2:
    "rateRatio" : { Ratio }
    "rateQuantity" : { Quantity(SimpleQuantity) }
  },
  "eventHistory" : [{ Reference(Provenance) }] // A list of events of interest in the lifecycle
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco
[ a fhir:MedicationAdministration;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root
  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:MedicationAdministration.identifier [ Identifier ], ... ; # 0..* External identifier
  fhir:

  fhir:MedicationAdministration.instantiatesCanonical [ canonical(ActivityDefinition|PlanDefinition) ], ... ; # 0..* Instantiates protocol or definition
  fhir:MedicationAdministration.instantiatesUri [ uri ], ... ; # 0..* Instantiates external protocol or definition
  fhir:MedicationAdministration.basedOn [ Reference(CarePlan) ], ... ; # 0..* Plan that is fulfilled by this dispense

  fhir:MedicationAdministration.partOf [ Reference(MedicationAdministration|Procedure) ], ... ; # 0..* Part of referenced event
  fhir:MedicationAdministration.status [ code ]; # 1..1 in-progress | not-done | on-hold | completed | entered-in-error | stopped | unknown
  fhir:MedicationAdministration.statusReason [ CodeableConcept ], ... ; # 0..* Reason administration not performed
  fhir:
  # . One of these 2
    fhir: ]
    fhir:) ]
  fhir:
  fhir:
  fhir:
  # . One of these 2
    fhir: ]
    fhir: ]

  fhir:MedicationAdministration.category [ CodeableConcept ], ... ; # 0..* Type of medication administration
  fhir:MedicationAdministration.medication [ CodeableReference(Medication) ]; # 1..1 What was administered
  fhir:MedicationAdministration.subject [ Reference(Group|Patient) ]; # 1..1 Who received medication
  fhir:MedicationAdministration.encounter [ Reference(Encounter) ]; # 0..1 Encounter administered as part of
  fhir:MedicationAdministration.supportingInformation [ Reference(Any) ], ... ; # 0..* Additional information to support administration
  # MedicationAdministration.occurence[x] : 1..1 Start and end time of administration. One of these 2
    fhir:MedicationAdministration.occurenceDateTime [ dateTime ]
    fhir:MedicationAdministration.occurencePeriod [ Period ]
  fhir:MedicationAdministration.recorded [ dateTime ]; # 0..1 When the MedicationAdministration was first captured in the subject's record

  fhir:MedicationAdministration.performer [ # 0..* Who performed the medication administration and what they did
    fhir:MedicationAdministration.performer.function [ CodeableConcept ]; # 0..1 Type of performance
    fhir:

    fhir:MedicationAdministration.performer.actor [ Reference(Device|Patient|Practitioner|PractitionerRole|RelatedPerson) ]; # 1..1 Who performed the medication administration

  ], ...;
  fhir:
  fhir:

  fhir:MedicationAdministration.reason [ CodeableReference(Condition|DiagnosticReport|Observation) ], ... ; # 0..* Concept, condition or observation that supports why the medication was administered

  fhir:MedicationAdministration.request [ Reference(MedicationRequest) ]; # 0..1 Request administration performed against
  fhir:MedicationAdministration.device [ Reference(Device) ], ... ; # 0..* Device used to administer
  fhir:MedicationAdministration.note [ Annotation ], ... ; # 0..* Information about the administration
  fhir:MedicationAdministration.dosage [ # 0..1 Details of how medication was taken
    fhir:MedicationAdministration.dosage.text [ string ]; # 0..1 Free text dosage instructions e.g. SIG
    fhir:MedicationAdministration.dosage.site [ CodeableConcept ]; # 0..1 Body site administered to
    fhir:MedicationAdministration.dosage.route [ CodeableConcept ]; # 0..1 Path of substance into body
    fhir:MedicationAdministration.dosage.method [ CodeableConcept ]; # 0..1 How drug was administered
    fhir:MedicationAdministration.dosage.dose [ Quantity(SimpleQuantity) ]; # 0..1 Amount of medication per dose
    # MedicationAdministration.dosage.rate[x] : 0..1 Dose quantity per unit of time. One of these 2
      fhir:MedicationAdministration.dosage.rateRatio [ Ratio ]
      fhir:MedicationAdministration.dosage.rateSimpleQuantity [ Quantity(SimpleQuantity) ]
  ];
  fhir:MedicationAdministration.eventHistory [ Reference(Provenance) ], ... ; # 0..* A list of events of interest in the lifecycle
]

Changes since R3

MedicationAdministration
MedicationAdministration.instantiates MedicationAdministration.instantiatesCanonical
  • Added Element
MedicationAdministration.instantiatesUri
  • Added Element
MedicationAdministration.basedOn
  • Added Element
MedicationAdministration.status
  • Change value set from http://hl7.org/fhir/ValueSet/medication-admin-status http://hl7.org/fhir/ValueSet/medication-admin-status|4.0.0 to http://hl7.org/fhir/ValueSet/medication-admin-status|4.0.1 http://hl7.org/fhir/ValueSet/medication-admin-status|4.2.0
MedicationAdministration.category
  • Max Cardinality changed from 1 to *
MedicationAdministration.statusReason MedicationAdministration.medication
  • Added Mandatory Element
MedicationAdministration.performer.function MedicationAdministration.encounter
  • Added Element
MedicationAdministration.performer.actor MedicationAdministration.occurence[x]
  • Type Reference: Added Target Type PractitionerRole Mandatory Element
MedicationAdministration.reasonReference MedicationAdministration.recorded
  • Type Reference: Added Target Type DiagnosticReport Element
MedicationAdministration.request MedicationAdministration.reason
  • Added Element
MedicationAdministration.dosage.rate[x]
  • Add Type Quantity()
  • Remove Type Quantity()
MedicationAdministration.definition MedicationAdministration.instantiates
  • deleted
MedicationAdministration.performer.onBehalfOf MedicationAdministration.medication[x]
  • deleted
MedicationAdministration.notGiven MedicationAdministration.context
  • deleted
MedicationAdministration.reasonNotGiven MedicationAdministration.effective[x]
  • deleted
MedicationAdministration.prescription MedicationAdministration.reasonCode
  • deleted
MedicationAdministration.reasonReference
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

See R3 <--> R4 Conversion Maps (status = 14 tests that all execute ok. 4 fail round-trip testing and 14 r3 resources are invalid (0 errors). )

Structure

medicationCodeableConcept CodeableConcept medicationReference Reference ( Medication ) reasonCode 0..* CodeableConcept Reason administration performed Reason Medication Given Codes ( Example )
Name Flags Card. Type Description & Constraints doco
. . MedicationAdministration TU DomainResource Administration of medication to a patient
Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier 0..* Identifier External identifier
. . instantiates . instantiatesCanonical Σ 0..* canonical ( PlanDefinition | ActivityDefinition ) Instantiates protocol or definition
... instantiatesUri Σ 0..* uri Instantiates external protocol or definition
. . . partOf Σ 0..* Reference ( MedicationAdministration | Procedure ) Part of referenced event
. . . status ?! Σ 1..1 code in-progress | not-done | on-hold | completed | entered-in-error | stopped | unknown
Medication administration status codes ( Required )
. . . statusReason 0..* CodeableConcept Reason administration not performed
SNOMED CT Reason Medication Not Given Codes ( Example )
. . . category 0..1 0..* CodeableConcept Type of medication usage administration
Medication administration category location codes ( Preferred Example )
. . medication[x] . medication Σ 1..1 CodeableReference ( Medication ) What was administered
SNOMED CT Medication Codes ( Example )
. . . subject Σ 1..1 Reference ( Patient | Group ) Who received medication
. . . context encounter 0..1 Reference ( Encounter | EpisodeOfCare ) Encounter or Episode of Care administered as part of
. . . supportingInformation 0..* Reference ( Any ) Additional information to support administration
. . . effective[x] occurence[x] Σ 1..1 Start and end time of administration
. . . . effectiveDateTime occurenceDateTime dateTime
. . . . effectivePeriod occurencePeriod Period
. . . recorded Σ 0..1 dateTime When the MedicationAdministration was first captured in the subject's record
... performer Σ 0..* BackboneElement Who performed the medication administration and what they did
. . . . function 0..1 CodeableConcept Type of performance
Medication administration performer function codes ( Example )
. . . . actor Σ 1..1 Reference ( Practitioner | PractitionerRole | Patient | RelatedPerson | Device ) Who performed the medication administration
. . . reasonReference reason 0..* Reference CodeableReference ( Condition | Observation | DiagnosticReport ) Condition Concept, condition or observation that supports why the medication was administered
Reason Medication Given Codes ( Example )
. . . request 0..1 Reference ( MedicationRequest ) Request administration performed against
. . . device 0..* Reference ( Device ) Device used to administer
. . . note 0..* Annotation Information about the administration
. . . dosage I 0..1 BackboneElement Details of how medication was taken
+ Rule: SHALL have at least one of dosage.dose or dosage.rate[x]
. . . . text 0..1 string Free text dosage instructions e.g. SIG
. . . . site 0..1 CodeableConcept Body site administered to
SNOMED CT Anatomical Structure for Administration Site Codes ( Example )
. . . . route 0..1 CodeableConcept Path of substance into body
SNOMED CT Route Codes ( Example )
. . . . method 0..1 CodeableConcept How drug was administered
SNOMED CT Administration Method Codes ( Example )
. . . . dose 0..1 SimpleQuantity Amount of medication per dose
. . . . rate[x] 0..1 Dose quantity per unit of time
. . . . . rateRatio Ratio
. . . . . rateQuantity SimpleQuantity
. . . eventHistory 0..* Reference ( Provenance ) A list of events of interest in the lifecycle

doco Documentation for this format

UML Diagram ( Legend )

MedicationAdministration ( DomainResource ) Identifiers associated with this Medication Administration that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server identifier : Identifier [0..*] A protocol, guideline, orderset, or other definition that was adhered to in whole or in part by this event instantiates instantiatesCanonical : canonical [0..*] « PlanDefinition | ActivityDefinition » The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this MedicationAdministration instantiatesUri : uri [0..*] A plan that is fulfilled in whole or in part by this MedicationDispense basedOn : Reference [0..*] « CarePlan » A larger event of which this particular event is a component or step partOf : Reference [0..*] « MedicationAdministration | Procedure » Will generally be set to show that the administration has been completed. For some long running administrations such as infusions, it is possible for an administration to be started but not completed or it may be paused while some other process is under way (this element modifies the meaning of other elements) status : code [1..1] « A set of codes indicating the current status of a MedicationAdministration. (Strength=Required) MedicationAdministration Stat... ! » A code indicating why the administration was not performed statusReason : CodeableConcept [0..*] « A set of codes indicating the reason why the MedicationAdministration is negated. (Strength=Example) SNOMEDCTReasonMedicationNotGi... ?? » Indicates where the The type of medication is expected to administration (for example, drug classification like ATC, where meds would be consumed or administered administered, legal category of the medication) category : CodeableConcept [0..1] [0..*] « A coded concept describing where the medication administered is expected to occur. (Strength=Preferred) (Strength=Example) MedicationAdministration Cate... Loca... ? ?? » Identifies the medication that was administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications medication[x] medication : Type DataType [1..1] « CodeableConcept | Reference ( Medication ); ; Codes identifying substance or product that can be administered. (Strength=Example) SNOMEDCTMedicationCodes ?? » The person or animal or group receiving the medication subject : Reference [1..1] « Patient | Group » The visit, admission, or other contact between patient and health care provider during which the medication administration was performed context encounter : Reference [0..1] « Encounter | EpisodeOfCare » Additional information (for example, patient height and weight) that supports the administration of the medication medication. This attribute can be used to provide documentation of specific characteristics of the patient present at the time of administration. For example, if the dose says "give "x" if the heartrate exceeds "y"", then the heart rate can be included using this attribute supportingInformation : Reference [0..*] « Any » A specific date/time or interval of time during which the administration took place (or did not take place, when the 'notGiven' attribute is true). place). For many administrations, such as swallowing a tablet the use of dateTime is more appropriate effective[x] occurence[x] : Type DataType [1..1] « dateTime | Period » A code indicating why The date the medication was given reasonCode : CodeableConcept [0..*] « A set occurrence of codes indicating the reason why the MedicationAdministration was made. (Strength=Example) first captured in the record - potentially significantly after the occurrence of the event ReasonMedicationGivenCodes recorded ?? » : dateTime [0..1] A code, Condition or observation that supports why the medication was administered reasonReference reason : Reference DataType [0..*] « Condition | Observation | DiagnosticReport ; A set of codes indicating the reason why the MedicationAdministration was made. (Strength=Example) DiagnosticReport ReasonMedicationGivenCodes ?? » The original request, instruction or authority to perform the administration request : Reference [0..1] « MedicationRequest » The device used in administering the medication to the patient. For example, a particular infusion pump device : Reference [0..*] « Device » Extra information about the medication administration that is not conveyed by the other attributes note : Annotation [0..*] A summary of the events of interest that have occurred, such as when the administration was verified eventHistory : Reference [0..*] « Provenance » Performer Distinguishes the type of involvement of the performer in the medication administration function : CodeableConcept [0..1] « A code describing the role an individual played in administering the medication. (Strength=Example) MedicationAdministration Perf... ?? » Indicates who or what performed the medication administration actor : Reference [1..1] « Practitioner | PractitionerRole | Patient | RelatedPerson | Device » Dosage Free text dosage can be used for cases where the dosage administered is too complex to code. When coded dosage is present, the free text dosage may still be present for display to humans. The dosage instructions should reflect the dosage of the medication that was administered text : string [0..1] A coded specification of the anatomic site where the medication first entered the body. For example, "left arm" site : CodeableConcept [0..1] « A coded concept describing the site location the medicine enters into or onto the body. (Strength=Example) SNOMEDCTAnatomicalStructureFo... ?? » A code specifying the route or physiological path of administration of a therapeutic agent into or onto the patient. For example, topical, intravenous, etc route : CodeableConcept [0..1] « A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject. (Strength=Example) SNOMEDCTRouteCodes ?? » A coded value indicating the method by which the medication is intended to be or was introduced into or on the body. This attribute will most often NOT be populated. It is most commonly used for injections. For example, Slow Push, Deep IV method : CodeableConcept [0..1] « A coded concept describing the technique by which the medicine is administered. (Strength=Example) SNOMEDCTAdministrationMethodC... ?? » The amount of the medication given at one administration event. Use this value when the administration is essentially an instantaneous event such as a swallowing a tablet or giving an injection dose : Quantity ( SimpleQuantity ) [0..1] Identifies the speed with which the medication was or will be introduced into the patient. Typically, the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time, e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours rate[x] : Type DataType [0..1] « Ratio | Quantity ( SimpleQuantity ) » Indicates who or what performed the medication administration and how they were involved performer [0..*] Describes the medication dosage information details e.g. dose, rate, site, route, etc dosage [0..1]

XML Template

<MedicationAdministration xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier External identifier --></identifier>
 <

 <instantiatesCanonical><!-- 0..* canonical(ActivityDefinition|PlanDefinition) Instantiates protocol or definition --></instantiatesCanonical>
 <instantiatesUri value="[uri]"/><!-- 0..* Instantiates external protocol or definition -->
 <basedOn><!-- 0..* Reference(CarePlan) Plan that is fulfilled by this dispense --></basedOn>

 <partOf><!-- 0..* Reference(MedicationAdministration|Procedure) Part of referenced event --></partOf>
 <status value="[code]"/><!-- 1..1 in-progress | not-done | on-hold | completed | entered-in-error | stopped | unknown -->
 <statusReason><!-- 0..* CodeableConcept Reason administration not performed --></statusReason>
 <</category>
 <</medication[x]>
 <</subject>
 <</context>
 <</supportingInformation>
 <</effective[x]>

 <category><!-- 0..* CodeableConcept Type of medication administration --></category>
 <medication><!-- 1..1 CodeableReference(Medication) What was administered --></medication>
 <subject><!-- 1..1 Reference(Group|Patient) Who received medication --></subject>
 <encounter><!-- 0..1 Reference(Encounter) Encounter administered as part of --></encounter>
 <supportingInformation><!-- 0..* Reference(Any) Additional information to support administration --></supportingInformation>
 <occurence[x]><!-- 1..1 dateTime|Period Start and end time of administration --></occurence[x]>
 <recorded value="[dateTime]"/><!-- 0..1 When the MedicationAdministration was first captured in the subject's record -->

 <performer>  <!-- 0..* Who performed the medication administration and what they did -->
  <function><!-- 0..1 CodeableConcept Type of performance --></function>
  <|
    </actor>

  <actor><!-- 1..1 Reference(Device|Patient|Practitioner|PractitionerRole|
    RelatedPerson) Who performed the medication administration --></actor>
 </performer>
 <</reasonCode>
 <</reasonReference>

 <reason><!-- 0..* CodeableReference(Condition|DiagnosticReport|Observation) Concept, condition or observation that supports why the medication was administered --></reason>

 <request><!-- 0..1 Reference(MedicationRequest) Request administration performed against --></request>
 <device><!-- 0..* Reference(Device) Device used to administer --></device>
 <note><!-- 0..* Annotation Information about the administration --></note>
 <dosage>  <!-- 0..1 Details of how medication was taken -->
  <text value="[string]"/><!-- 0..1 Free text dosage instructions e.g. SIG -->
  <site><!-- 0..1 CodeableConcept Body site administered to --></site>
  <route><!-- 0..1 CodeableConcept Path of substance into body --></route>
  <method><!-- 0..1 CodeableConcept How drug was administered --></method>
  <dose><!-- 0..1 Quantity(SimpleQuantity) Amount of medication per dose --></dose>
  <rate[x]><!-- 0..1 Ratio|Quantity(SimpleQuantity) Dose quantity per unit of time --></rate[x]>
 </dosage>
 <eventHistory><!-- 0..* Reference(Provenance) A list of events of interest in the lifecycle --></eventHistory>
</MedicationAdministration>

JSON Template

{doco
  "resourceType" : "MedicationAdministration",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External identifier
  "

  "instantiatesCanonical" : [{ canonical(ActivityDefinition|PlanDefinition) }], // Instantiates protocol or definition
  "instantiatesUri" : ["<uri>"], // Instantiates external protocol or definition
  "basedOn" : [{ Reference(CarePlan) }], // Plan that is fulfilled by this dispense

  "partOf" : [{ Reference(MedicationAdministration|Procedure) }], // Part of referenced event
  "status" : "<code>", // R!  in-progress | not-done | on-hold | completed | entered-in-error | stopped | unknown
  "statusReason" : [{ CodeableConcept }], // Reason administration not performed
  "
  
  " },
  " },
  "
  "
  "
  
  ">",
  " },

  "category" : [{ CodeableConcept }], // Type of medication administration
  "medication" : { CodeableReference(Medication) }, // R!  What was administered
  "subject" : { Reference(Group|Patient) }, // R!  Who received medication
  "encounter" : { Reference(Encounter) }, // Encounter administered as part of
  "supportingInformation" : [{ Reference(Any) }], // Additional information to support administration
  // occurence[x]: Start and end time of administration. One of these 2:
  "occurenceDateTime" : "<dateTime>",
  "occurencePeriod" : { Period },
  "recorded" : "<dateTime>", // When the MedicationAdministration was first captured in the subject's record

  "performer" : [{ // Who performed the medication administration and what they did
    "function" : { CodeableConcept }, // Type of performance
    "|
    

    "actor" : { Reference(Device|Patient|Practitioner|PractitionerRole|
    RelatedPerson) } // R!  Who performed the medication administration
  }],
  "
  "

  "reason" : [{ CodeableReference(Condition|DiagnosticReport|Observation) }], // Concept, condition or observation that supports why the medication was administered

  "request" : { Reference(MedicationRequest) }, // Request administration performed against
  "device" : [{ Reference(Device) }], // Device used to administer
  "note" : [{ Annotation }], // Information about the administration
  "dosage" : { // Details of how medication was taken
    "text" : "<string>", // Free text dosage instructions e.g. SIG
    "site" : { CodeableConcept }, // Body site administered to
    "route" : { CodeableConcept }, // Path of substance into body
    "method" : { CodeableConcept }, // How drug was administered
    "dose" : { Quantity(SimpleQuantity) }, // Amount of medication per dose
    // rate[x]: Dose quantity per unit of time. One of these 2:
    "rateRatio" : { Ratio }
    "rateQuantity" : { Quantity(SimpleQuantity) }
  },
  "eventHistory" : [{ Reference(Provenance) }] // A list of events of interest in the lifecycle
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco
[ a fhir:MedicationAdministration;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root
  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:MedicationAdministration.identifier [ Identifier ], ... ; # 0..* External identifier
  fhir:

  fhir:MedicationAdministration.instantiatesCanonical [ canonical(ActivityDefinition|PlanDefinition) ], ... ; # 0..* Instantiates protocol or definition
  fhir:MedicationAdministration.instantiatesUri [ uri ], ... ; # 0..* Instantiates external protocol or definition
  fhir:MedicationAdministration.basedOn [ Reference(CarePlan) ], ... ; # 0..* Plan that is fulfilled by this dispense

  fhir:MedicationAdministration.partOf [ Reference(MedicationAdministration|Procedure) ], ... ; # 0..* Part of referenced event
  fhir:MedicationAdministration.status [ code ]; # 1..1 in-progress | not-done | on-hold | completed | entered-in-error | stopped | unknown
  fhir:MedicationAdministration.statusReason [ CodeableConcept ], ... ; # 0..* Reason administration not performed
  fhir:
  # . One of these 2
    fhir: ]
    fhir:) ]
  fhir:
  fhir:
  fhir:
  # . One of these 2
    fhir: ]
    fhir: ]

  fhir:MedicationAdministration.category [ CodeableConcept ], ... ; # 0..* Type of medication administration
  fhir:MedicationAdministration.medication [ CodeableReference(Medication) ]; # 1..1 What was administered
  fhir:MedicationAdministration.subject [ Reference(Group|Patient) ]; # 1..1 Who received medication
  fhir:MedicationAdministration.encounter [ Reference(Encounter) ]; # 0..1 Encounter administered as part of
  fhir:MedicationAdministration.supportingInformation [ Reference(Any) ], ... ; # 0..* Additional information to support administration
  # MedicationAdministration.occurence[x] : 1..1 Start and end time of administration. One of these 2
    fhir:MedicationAdministration.occurenceDateTime [ dateTime ]
    fhir:MedicationAdministration.occurencePeriod [ Period ]
  fhir:MedicationAdministration.recorded [ dateTime ]; # 0..1 When the MedicationAdministration was first captured in the subject's record

  fhir:MedicationAdministration.performer [ # 0..* Who performed the medication administration and what they did
    fhir:MedicationAdministration.performer.function [ CodeableConcept ]; # 0..1 Type of performance
    fhir:

    fhir:MedicationAdministration.performer.actor [ Reference(Device|Patient|Practitioner|PractitionerRole|RelatedPerson) ]; # 1..1 Who performed the medication administration

  ], ...;
  fhir:
  fhir:

  fhir:MedicationAdministration.reason [ CodeableReference(Condition|DiagnosticReport|Observation) ], ... ; # 0..* Concept, condition or observation that supports why the medication was administered

  fhir:MedicationAdministration.request [ Reference(MedicationRequest) ]; # 0..1 Request administration performed against
  fhir:MedicationAdministration.device [ Reference(Device) ], ... ; # 0..* Device used to administer
  fhir:MedicationAdministration.note [ Annotation ], ... ; # 0..* Information about the administration
  fhir:MedicationAdministration.dosage [ # 0..1 Details of how medication was taken
    fhir:MedicationAdministration.dosage.text [ string ]; # 0..1 Free text dosage instructions e.g. SIG
    fhir:MedicationAdministration.dosage.site [ CodeableConcept ]; # 0..1 Body site administered to
    fhir:MedicationAdministration.dosage.route [ CodeableConcept ]; # 0..1 Path of substance into body
    fhir:MedicationAdministration.dosage.method [ CodeableConcept ]; # 0..1 How drug was administered
    fhir:MedicationAdministration.dosage.dose [ Quantity(SimpleQuantity) ]; # 0..1 Amount of medication per dose
    # MedicationAdministration.dosage.rate[x] : 0..1 Dose quantity per unit of time. One of these 2
      fhir:MedicationAdministration.dosage.rateRatio [ Ratio ]
      fhir:MedicationAdministration.dosage.rateSimpleQuantity [ Quantity(SimpleQuantity) ]
  ];
  fhir:MedicationAdministration.eventHistory [ Reference(Provenance) ], ... ; # 0..* A list of events of interest in the lifecycle
]

Changes since Release 3

MedicationAdministration
MedicationAdministration.instantiates MedicationAdministration.instantiatesCanonical
  • Added Element
MedicationAdministration.instantiatesUri
  • Added Element
MedicationAdministration.basedOn
  • Added Element
MedicationAdministration.status
  • Change value set from http://hl7.org/fhir/ValueSet/medication-admin-status http://hl7.org/fhir/ValueSet/medication-admin-status|4.0.0 to http://hl7.org/fhir/ValueSet/medication-admin-status|4.0.1 http://hl7.org/fhir/ValueSet/medication-admin-status|4.2.0
MedicationAdministration.category
  • Max Cardinality changed from 1 to *
MedicationAdministration.statusReason MedicationAdministration.medication
  • Added Mandatory Element
MedicationAdministration.performer.function MedicationAdministration.encounter
  • Added Element
MedicationAdministration.performer.actor MedicationAdministration.occurence[x]
  • Type Reference: Added Target Type PractitionerRole Mandatory Element
MedicationAdministration.reasonReference MedicationAdministration.recorded
  • Type Reference: Added Target Type DiagnosticReport Element
MedicationAdministration.request MedicationAdministration.reason
  • Added Element
MedicationAdministration.dosage.rate[x]
  • Add Type Quantity()
  • Remove Type Quantity()
MedicationAdministration.definition MedicationAdministration.instantiates
  • deleted
MedicationAdministration.performer.onBehalfOf MedicationAdministration.medication[x]
  • deleted
MedicationAdministration.notGiven MedicationAdministration.context
  • deleted
MedicationAdministration.reasonNotGiven MedicationAdministration.effective[x]
  • deleted
MedicationAdministration.prescription MedicationAdministration.reasonCode
  • deleted
MedicationAdministration.reasonReference
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

See R3 <--> R4 Conversion Maps (status = 14 tests that all execute ok. 4 fail round-trip testing and 14 r3 resources are invalid (0 errors). )

 

See the Profiles & Extensions and the alternate definitions: Master Definition XML + JSON , XML Schema / Schematron + JSON Schema , ShEx (for Turtle ) + see the extensions , the spreadsheet version & the dependency analysis a

Path Definition Type Reference
MedicationAdministration.status A set of codes indicating the current status of a MedicationAdministration. Required MedicationAdministration Status Codes
MedicationAdministration.statusReason A set of codes indicating the reason why the MedicationAdministration is negated. Example SNOMEDCTReasonMedicationNotGivenCodes
MedicationAdministration.category A coded concept describing where the medication administered is expected to occur. Preferred Example MedicationAdministration Category Location Codes
MedicationAdministration.medication[x] MedicationAdministration.medication Codes identifying substance or product that can be administered. Example SNOMEDCTMedicationCodes
MedicationAdministration.performer.function A code describing the role an individual played in administering the medication. Example MedicationAdministration Performer Function Codes
MedicationAdministration.reasonCode MedicationAdministration.reason A set of codes indicating the reason why the MedicationAdministration was made. Example ReasonMedicationGivenCodes
MedicationAdministration.dosage.site A coded concept describing the site location the medicine enters into or onto the body. Example SNOMEDCTAnatomicalStructureForAdministrationSiteCodes
MedicationAdministration.dosage.route A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject. Example SNOMEDCTRouteCodes
MedicationAdministration.dosage.method A coded concept describing the technique by which the medicine is administered. Example SNOMEDCTAdministrationMethodCodes

id Level Location Description Expression
mad-1 Rule MedicationAdministration.dosage SHALL have at least one of dosage.dose or dosage.rate[x] dose.exists() or rate.exists()
Issue Comments
Medication Resource A medication will typically be referred to by means of a code drawn from a suitable medication terminology. However, on occasion a product will be required for which the "recipe" must be specified. This implies a requirement to deal with a choice of either a code or a much more complete resource.
Currently that resource has not been created.
Contrast Media Is this resource adequate for administering contrast media to a patient?
Author (accountability) Authorship (and any other accountability) is assumed to be dealt with by the standard FHIR methods.

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name Type Description Expression In Common
code D token Return administrations of this medication code (MedicationAdministration.medication as CodeableConcept) MedicationAdministration.medication.concept 13 Resources
context date reference date Return administrations that share this encounter or episode of care Date administration happened (or did not happen) MedicationAdministration.context ( EpisodeOfCare , Encounter ) MedicationAdministration.occurence 3 Resources
device reference Return administrations with this administration device identity MedicationAdministration.device
( Device )
effective-time encounter date reference Date administration happened (or did not happen) Return administrations that share this encounter MedicationAdministration.effective MedicationAdministration.encounter
( Encounter )
1 Resources
identifier token Return administrations with this external identifier MedicationAdministration.identifier 30 Resources
medication D reference Return administrations of this medication resource reference (MedicationAdministration.medication as Reference) ( Medication ) MedicationAdministration.medication.reference 3 Resources
patient reference The identity of a patient to list administrations for MedicationAdministration.subject.where(resolve() is Patient)
( Patient )
33 Resources
performer reference The identity of the individual who administered the medication MedicationAdministration.performer.actor
( Practitioner , Device , Patient , PractitionerRole , RelatedPerson )
reason-given D reference Reference to a resource (by instance) MedicationAdministration.reason.reference
reason-given-code D token Reasons for administering the medication MedicationAdministration.reasonCode MedicationAdministration.reason.concept
reason-not-given token Reasons for not administering the medication MedicationAdministration.statusReason
request reference The identity of a request to list administrations from MedicationAdministration.request
( MedicationRequest )
status N token MedicationAdministration event status (for example one of active/paused/completed/nullified) MedicationAdministration.status 3 Resources
subject reference The identity of the individual or group to list administrations for MedicationAdministration.subject
( Group , Patient )