Release 4 5 Preview #2
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Pharmacy Work Group Maturity Level : 3   Trial Use Security Category : Patient Compartments : Encounter , Patient , Practitioner

Detailed Descriptions for the elements in the MedicationRequest resource.

MedicationRequest
Element Id MedicationRequest
Definition

An order or request for both supply of the medication and the instructions for administration of the medication to a patient. The resource is called "MedicationRequest" rather than "MedicationPrescription" or "MedicationOrder" to generalize the use across inpatient and outpatient settings, including care plans, etc., and to harmonize with workflow patterns.

Cardinality 0..*
Type DomainResource
Alternate Names Prescription; Order
MedicationRequest.identifier
Element Id 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.

Note This is a business identifier, not a resource identifier (see discussion )
Cardinality 0..*
Type Identifier
Comments

This is a business identifier, not a resource identifier.

MedicationRequest.status
Element Id MedicationRequest.status
Definition

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

Cardinality 1..1
Terminology Binding Medicationrequest status ( Required )
Type code
Is Modifier true (Reason: 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)
Summary true
Comments

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

Clinical decision support systems should take the status into account when determining which medications to include in their algorithms.

MedicationRequest.statusReason
Element Id MedicationRequest.statusReason
Definition

Captures the reason for the current state of the MedicationRequest.

Cardinality 0..1
Terminology Binding Medication request status reason codes ( Example )
Type CodeableConcept
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.

MedicationRequest.intent
Element Id MedicationRequest.intent
Definition

Whether the request is a proposal, plan, or an original order.

Cardinality 1..1
Terminology Binding Medication request intent ( Required )
Type code
Is Modifier true (Reason: 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)
Summary true
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.

MedicationRequest.category
Element Id MedicationRequest.category
Definition

Indicates the type grouping or category of medication request (for example, drug classification like ATC, where the medication is expected to meds would be consumed or administered (i.e. inpatient or outpatient)). administered, legal category of the medication.).

Cardinality 0..*
Terminology Binding Medication request category administration location codes ( Example )
Type CodeableConcept
Comments

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

MedicationRequest.priority
Element Id MedicationRequest.priority
Definition

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

Cardinality 0..1
Terminology Binding Request priority ( Required )
Type code
Summary true
MedicationRequest.doNotPerform
Element Id MedicationRequest.doNotPerform
Definition

If true true, indicates that the provider is asking for the medication request patient to either stop taking or to not start taking the specified medication. For example, the patient is taking an existing medication and the provider is changing their medication. They want to occur. create two seperate requests: one to stop using the current medication and another to start the new medication.

Cardinality 0..1
Type boolean
Is Modifier true (Reason: 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))
Summary true
Comments

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

MedicationRequest.reported[x] MedicationRequest.reported
Element Id MedicationRequest.reported[x] MedicationRequest.reported
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.

Cardinality 0..1
Type boolean |
Summary true
MedicationRequest.informationSource
Element Id MedicationRequest.informationSource
Definition

The person or organization who provided the information about this request, if the source is someone other than the requestor. This is often used when the MedicationRequest is reported by another person.

Cardinality 0..1
Type Reference ( Patient | Practitioner | PractitionerRole | RelatedPerson | Organization )
[x] Note See Choice of Data Types Patterns for further information about how to use [x] Summary Reference(Patient,Practitioner,PractitionerRole,RelatedPerson,Organization): Common patterns = Participant true
MedicationRequest.medication[x] MedicationRequest.medication
Element Id MedicationRequest.medication[x] MedicationRequest.medication
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.

Cardinality 1..1
Terminology Binding SNOMED CT Medication Codes ( Example )
Type CodeableConcept | Reference CodeableReference ( Medication )
[x] Note See Choice of Data Types for further information about how to use [x] Summary true
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.

MedicationRequest.subject
Element Id MedicationRequest.subject
Definition

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

Cardinality 1..1
Type Reference ( Patient | Group )
Patterns Reference(Patient,Group): Common patterns = Participant
Summary true
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.

MedicationRequest.encounter
Element Id MedicationRequest.encounter
Definition

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

Cardinality 0..1
Type Reference ( Encounter )
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.

MedicationRequest.supportingInformation
Element Id MedicationRequest.supportingInformation
Definition

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

Cardinality 0..*
Type Reference ( Any )
Comments

This attribute can be used to reference a MedicationUsage about the patients' medication use.

MedicationRequest.authoredOn
Element Id MedicationRequest.authoredOn
Definition

The date (and perhaps time) when the prescription was initially written or authored on.

Cardinality 0..1
Type dateTime
Summary true
MedicationRequest.requester
Element Id MedicationRequest.requester
Definition

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

Cardinality 0..1
Type Reference ( Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device )
Patterns Reference(Practitioner,PractitionerRole,Organization,Patient,RelatedPerson,Device): Common patterns = Participant
Summary true
MedicationRequest.performer
Element Id MedicationRequest.performer
Definition

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

Cardinality 0..1
Type Reference ( Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam | HealthcareService )
Patterns Reference(Practitioner,PractitionerRole,Organization,Patient,Device,RelatedPerson,CareTeam,HealthcareService): Common patterns = Participant
MedicationRequest.performerType
Element Id MedicationRequest.performerType
Definition

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

Cardinality 0..1
Terminology Binding Procedure Performer Role Codes ( Example )
Type CodeableConcept
Summary true
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.

MedicationRequest.recorder
Element Id 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.

Cardinality 0..1
Type Reference ( Practitioner | PractitionerRole )
Patterns Reference(Practitioner,PractitionerRole): Common patterns = Participant
MedicationRequest.reasonCode MedicationRequest.reason
Element Id MedicationRequest.reasonCode MedicationRequest.reason
Definition

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

Cardinality 0..*
Terminology Binding Condition/Problem/Diagnosis Codes ( Example )
Type CodeableConcept CodeableReference ( Condition | Observation )
Patterns CodeableReference(Condition,Observation): Common patterns = Event
Comments

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

MedicationRequest.reasonReference Element Id MedicationRequest.reasonReference Definition Condition or observation that supports why the medication was ordered. Cardinality 0..* Type Reference ( Condition | Observation ) 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. MedicationRequest.instantiatesCanonical
Element Id 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.

Cardinality 0..*
Type canonical ( PlanDefinition | ActivityDefinition )
Summary true
MedicationRequest.instantiatesUri
Element Id 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.

Cardinality 0..*
Type uri
Summary true
MedicationRequest.basedOn
Element Id MedicationRequest.basedOn
Definition

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

Cardinality 0..*
Type Reference ( CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation )
Patterns Reference(CarePlan,MedicationRequest,ServiceRequest,ImmunizationRecommendation): Common patterns = Request
Summary true
MedicationRequest.groupIdentifier
Element Id 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.

Cardinality 0..1
Type Identifier
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.

Summary true
MedicationRequest.courseOfTherapyType
Element Id MedicationRequest.courseOfTherapyType
Definition

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

Cardinality 0..1
Terminology Binding Medication request course of therapy codes ( Example )
Type CodeableConcept
Comments

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

MedicationRequest.insurance
Element Id MedicationRequest.insurance
Definition

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

Cardinality 0..*
Type Reference ( Coverage | ClaimResponse )
Patterns Reference(Coverage,ClaimResponse): Common patterns = Event
MedicationRequest.note
Element Id MedicationRequest.note
Definition

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

Cardinality 0..*
Type Annotation
MedicationRequest.renderedDosageInstruction
Element Id MedicationRequest.renderedDosageInstruction
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.

Cardinality 0..1
Type string
Requirements

The content of the renderedDosageInstructions must not be different than the dose represented in the dosageInstruction content.

MedicationRequest.dosageInstruction
Element Id MedicationRequest.dosageInstruction
Definition

Indicates how the medication is to be used by the patient.

Cardinality 0..*
Type Dosage
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.

MedicationRequest.dispenseRequest
Element Id 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.

Cardinality 0..1
MedicationRequest.dispenseRequest.initialFill
Element Id MedicationRequest.dispenseRequest.initialFill
Definition

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

Cardinality 0..1
Comments

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

MedicationRequest.dispenseRequest.initialFill.quantity
Element Id MedicationRequest.dispenseRequest.initialFill.quantity
Definition

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

Cardinality 0..1
Type SimpleQuantity
MedicationRequest.dispenseRequest.initialFill.duration
Element Id MedicationRequest.dispenseRequest.initialFill.duration
Definition

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

Cardinality 0..1
Type Duration
MedicationRequest.dispenseRequest.dispenseInterval
Element Id MedicationRequest.dispenseRequest.dispenseInterval
Definition

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

Cardinality 0..1
Type Duration
MedicationRequest.dispenseRequest.validityPeriod
Element Id MedicationRequest.dispenseRequest.validityPeriod
Definition

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

Cardinality 0..1
Type Period
Requirements

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

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.

MedicationRequest.dispenseRequest.numberOfRepeatsAllowed
Element Id 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.

Cardinality 0..1
Type unsignedInt
Comments

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

MedicationRequest.dispenseRequest.quantity
Element Id MedicationRequest.dispenseRequest.quantity
Definition

The amount that is to be dispensed for one fill.

Cardinality 0..1
Type SimpleQuantity
MedicationRequest.dispenseRequest.expectedSupplyDuration
Element Id 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.

Cardinality 0..1
Type Duration
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.

MedicationRequest.dispenseRequest.performer MedicationRequest.dispenseRequest.dispenser
Element Id MedicationRequest.dispenseRequest.performer MedicationRequest.dispenseRequest.dispenser
Definition

Indicates the intended dispensing performing Organization that will dispense the medication as specified by the prescriber.

Cardinality 0..1
Type Reference ( Organization )
MedicationRequest.substitution
Element Id 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.

Cardinality 0..1
MedicationRequest.substitution.allowed[x]
Element Id MedicationRequest.substitution.allowed[x]
Definition

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

Cardinality 1..1
Terminology Binding V3 Value SetActSubstanceAdminSubstitutionCode ( Example )
Type boolean | CodeableConcept
[x] Note See Choice of Data Types for further information about how to use [x]
Comments

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

MedicationRequest.substitution.reason
Element Id MedicationRequest.substitution.reason
Definition

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

Cardinality 0..1
Terminology Binding V3 Value SetSubstanceAdminSubstitutionReason ( Example )
Type CodeableConcept
MedicationRequest.priorPrescription
Element Id MedicationRequest.priorPrescription
Definition

A link to a resource representing an earlier order related order or prescription.

Cardinality 0..1
Type Reference ( MedicationRequest )
MedicationRequest.detectedIssue
Element Id MedicationRequest.detectedIssue
Definition

Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. Drug-drug interaction, duplicate therapy, dosage alert etc.

Cardinality 0..*
Type Reference ( DetectedIssue )
Alternate Names Contraindication; Drug Utilization Review (DUR); Alert
Comments

This element can include a detected issue that has been identified either by a decision support system or by a clinician and may include information on the steps that were taken to address the issue.

MedicationRequest.eventHistory
Element Id MedicationRequest.eventHistory
Definition

Links to Provenance records for past versions of this resource or fulfilling request or event resources that identify key state transitions or updates that are likely to be relevant to a user looking at the current version of the resource.

Cardinality 0..*
Type Reference ( Provenance )
Comments

This might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.).