Medication Prescription and Dispense (MPD)
1.0.0-preview - ci-build

Medication Prescription and Dispense (MPD), published by Integrating the Healthcare Enterprise (IHE). This guide is not an authorized publication; it is the continuous build for version 1.0.0-preview built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IHE/pharm-mpd/tree/92/merge and changes regularly. See the Directory of published versions

## Resource Profile: IHEMedicationOrder - Detailed Descriptions

Active as of 2025-05-01

Definitions for the IHEMedicationOrder resource profile.

- Key Elements Table
- Differential Elements Table
- Snapshot Elements Table

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

0. 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.
Short | Ordering of medication for patient or group
Control | 0..*
Is Modifier | false
Must Support | false
Summary | false
Alternate Names | Prescription, Order
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty()) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()) dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()) dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty()) dom-6: A resource should have narrative for robust management (text.`div`.exists())
2. 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 its narrative along with other profiles, value sets, etc.
Control | 0..1
Type | uri
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. MedicationRequest.contained
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.
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..* This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
Type | Resource
Is Modifier | false
Must Support | false
Summary | false
Alternate Names | inline resources, anonymous resources, contained resources
6. MedicationRequest.extension
Definition | An Extension May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and managable, 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 | ExtensionAdditional 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..*
Type | Extension
Is Modifier | false
Must Support | 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())
Slicing | 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
8. MedicationRequest.extension:offLabel
Slice Name | offLabel
Definition | Indicates that the prescriber has intentionally prescribed the medication in a manner not covered by the product authorization — such as for a different indication, age group, dosage, or route of administration.
Short | Indicates that the prescriber has knowingly prescribed the medication for an indication, age group, dosage, or route of administration that is not approved by the regulatory agencies and is not mentioned in the prescribing information for the product.
Control | 0..1
Type | Extension(Off-label use) (Complex Extension)
Is Modifier | false
Must Support | false
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()`)
10. 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 managable, 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 | 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..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Must Support | false
Summary | true
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
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())
12. 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 | Prescription/prescribed item IDExternal ids for this request
Comments | It is the prescription ID if the presciption includes only one prescribed item This is a business identifier, not a resource identifier.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..*
Type | Identifier
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
14. MedicationRequest.groupIdentifier
Definition | A shared identifier common to multiple independent Request instances that were activated/authorized more or less simultaneously by a single author. The presence of the same identifier on each request ties those requests together and may have business ramifications in terms of reporting of results, billing, etc. E.g. a requisition number shared by a set of lab tests ordered together, or a prescription number shared by all meds ordered at one time.
Short | Prescription this is part of. Not needed if a presciption includes only one prescribed item.Composite request this is part of
Comments | It is the prescription ID if the presciption includes multiple prescribed items
Control | 0..1
Type | Identifier
Is Modifier | false
Must Support | true
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()))
16. MedicationRequest.status
Definition | A code specifying the current state of the order. Generally, this will be active or completed state.
Short | Status of the orderactive | on-hold | ended | stopped | completed | cancelled | entered-in-error | draft | unknown
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.
Control | 1..1
Binding | The codes SHALL be taken from MedicationrequestStatus http://hl7.org/fhir/ValueSet/medicationrequest-status|5.0.0 (required to `http://hl7.org/fhir/ValueSet/medicationrequest-status|5.0.0` ) A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription.
Type | code
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()))
18. 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
Binding | For example codes, see MedicationRequestStatusReasonCodes http://hl7.org/fhir/ValueSet/medicationrequest-status-reason (example to `http://hl7.org/fhir/ValueSet/medicationrequest-status-reason` ) Identifies the reasons for a given status.
Type | CodeableConcept
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
20. MedicationRequest.intent
Definition | Whether the request is a proposal, plan, or an original order.
Short | proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
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
Binding | The codes SHALL be taken from MedicationRequestIntent http://hl7.org/fhir/ValueSet/medicationrequest-intent|5.0.0 (required to `http://hl7.org/fhir/ValueSet/medicationrequest-intent|5.0.0` ) The kind of medication order.
Type | code
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 | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
22. MedicationRequest.category
Definition | An arbitrary categorization or grouping of the medication request. It could be used for indicating where meds are intended to be administered, eg. in an inpatient setting or in a patient's home, or a legal category of the medication.
Short | Grouping or category of medication request
Comments | The category can be used to include where the medication is expected to be consumed or other types of requests. The examplar value set represents where the meds are intended to be administered and is just one example of request categorization.
Control | 0..*
Binding | For example codes, see MedicationRequestAdministrationLocationCodes http://hl7.org/fhir/ValueSet/medicationrequest-admin-location (example to `http://hl7.org/fhir/ValueSet/medicationrequest-admin-location` ) A coded concept identifying where the medication is to be consumed or administered.
Type | CodeableConcept
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
24. MedicationRequest.doNotPerform
Definition | If true, indicates that the provider is asking for the 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 create two seperate requests: one to stop using the current medication and another to start the new medication.
Short | True if patient is to stop taking or not to start taking the medication
Comments | If do not perform is not specified, the request is a positive request e.g. "do perform".
Control | 0..1
Type | boolean
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
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
26. 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.
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
Binding | For example codes, see SNOMEDCTMedicationCodes http://hl7.org/fhir/ValueSet/medication-codes (example to `http://hl7.org/fhir/ValueSet/medication-codes` ) A coded concept identifying substance or product that can be ordered.
Type | CodeableReference(IHE Medication, Medication)
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()))
28. MedicationRequest.subject
Definition | The individual or group for whom the medication has been requested.
Short | Individual or group for whom the medication has been requested
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
Type | Reference(Patient, Group)
Is Modifier | false
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
30. MedicationRequest.authoredOn
Definition | The date (and perhaps time) when the prescription was initially written or authored on.
Short | When request was initially authored
Control | 10..1
Type | dateTime
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()))
32. MedicationRequest.requester
Definition | The individual, organization, or device that initiated the request and has responsibility for its activation.
Short | Who/What requested the Request
Control | 10..1
Type | Reference(Practitioner, PractitionerRole, Organization, Patient, RelatedPerson, Device)
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
34. 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
Control | 0..1
Type | Reference(Practitioner, PractitionerRole)
Is Modifier | false
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
36. MedicationRequest.reason
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..*
Binding | For example codes, see ConditionProblemDiagnosisCodes http://hl7.org/fhir/ValueSet/condition-code (example to `http://hl7.org/fhir/ValueSet/condition-code` ) A coded concept indicating why the medication was ordered.
Type | CodeableReference(Condition, Observation)
Is Modifier | false
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
38. MedicationRequest.note
Definition | Extra information about the prescription that could not be conveyed by the other attributes.
Short | Information about the prescription
Control | 0..*
Type | Annotation
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
40. MedicationRequest.effectiveDosePeriod
Definition | The period over which the medication is to be taken. Where there are multiple dosageInstruction lines (for example, tapering doses), this is the earliest date and the latest end date of the dosageInstructions.
Short | Period over which the medication is to be taken
Control | 0..1
Type | Period
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
42. MedicationRequest.dosageInstruction
Definition | Specific instructions for how the medication is to be used by the patient.
Short | How the medication should be taken.Specific instructions for how the medication should be taken
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. In general, each prescribed drug will be a separate Medication Request. When drug orders are grouped together at the time of order entry, but each of the drugs can be manipulated independently e.g. changing the status of one order to "completed" or "cancelled", changing another order status to "on-hold", the method to "group" all of the medication requests together is to use MedicationRequest.groupIdentifier element. All of the orders grouped together in this manner will have the same groupIdentifier, and separately, each order in the group may have a unique identifier. There are cases that require grouping of Medication orders together when it is necessary to specify optionality e.g. order two drugs at one time, but stating either of these drugs may be used to treat the patient. The use of a RequestOrchestration should be used as a parent for the Medication orders that require this type of grouping. An example when it may be necessary to group medication orders together is when you specify timing relationships e.g. order drug "xyz" with dose 123, then taper the same drug to a different dose after some interval of time precedence: e.g. give drug "abc" followed by drug "def" e.g. give drug 30 minutes before some procedure was performed more generically this supports - hierarchical groups of actions, where each specific action references the action to be performed (in terms of a Request resource), and each group describes additional behavior, relationships, and applicable conditions between the actions in the overall group. Note that one should NOT use the List or Composition resource to accomplish the above requirements. You may use List or Composition for other business requirements, but not to address the specific requirements of grouping medication orders.
Control | 0..*
Type | Dosage
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
44. MedicationRequest.dosageInstruction.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 managable, 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 | 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..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
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, modifiers
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())
46. MedicationRequest.dosageInstruction.text
Definition | Free text dosage instructions e.g. SIG.
Short | Free text dosage instructionsFree text dosage instructions e.g. SIG
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing. Additional information about administration or preparation of the medication should be included as text.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
48. MedicationRequest.dosageInstruction.patientInstruction
Definition | Instructions in terms that are understood by the patient or consumer.
Short | Patient or consumer oriented instructions
Control | 0..1
Type | string
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()))
50. MedicationRequest.dosageInstruction.timing
Definition | When medication should be administered.
Short | Administration scheduleWhen medication should be administered
Comments | This attribute might not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.
Control | 0..1
Type | Timing
Is Modifier | false
Summary | true
Requirements | The timing schedule for giving the medication to the patient. This data type allows many different expressions. For example: "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
52. MedicationRequest.dosageInstruction.timing.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 managable, 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 | 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..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
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, modifiers
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())
54. MedicationRequest.dosageInstruction.timing.code
Definition | A code for the timing schedule (or just text in code.text). Some codes such as BID are ubiquitous, but many institutions define their own additional codes. If a code is provided, the code is understood to be a complete statement of whatever is specified in the structured timing data, and either the code or the data may be used to interpret the Timing, with the exception that .repeat.bounds still applies over the code (and is not contained in the code).
Short | A code for the timing schedule.C | BID | TID | QID | AM | PM | QD | QOD | +
Comments | BID etc. are defined as 'at institutionally specified times'. For example, an institution may choose that BID is "always at 7am and 6pm". If it is inappropriate for this choice to be made, the code BID should not be used. Instead, a distinct organization-specific code should be used in place of the HL7-defined BID code and/or a structured representation should be used (in this case, specifying the two event times).
Control | 0..1
Binding | The codes SHOULD be taken from TimingAbbreviation http://hl7.org/fhir/ValueSet/timing-abbreviation (preferred to `http://hl7.org/fhir/ValueSet/timing-abbreviation` ) Code for a known / defined timing pattern.
Type | CodeableConcept
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
56. MedicationRequest.dosageInstruction.route
Definition | How drug should enter body.
Short | Route of administrationHow drug should enter body
Control | 0..1
Binding | For example codes, see SNOMEDCTRouteCodes http://hl7.org/fhir/ValueSet/route-codes (example to `http://hl7.org/fhir/ValueSet/route-codes` ) A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
Type | CodeableConcept
Is Modifier | false
Summary | true
Requirements | A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
58. 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
Type | BackboneElement
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
60. MedicationRequest.dispenseRequest.extension
Definition | An Extension May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, 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 | ExtensionAdditional 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..*
Type | Extension
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())
Slicing | 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
62. MedicationRequest.dispenseRequest.extension:prescribedQuantity
Slice Name | prescribedQuantity
Definition | When Medication resource implies a pack size, prescribedQuantity should convey number of packages. When the Medication does not imply an amount, overall amount could be in tablets or millilitres.
Short | Overall amount of product prescribed, independent from the number of repeats.
Control | 0..1
Type | Extension(MedicationRequest - Prescribed Quantity) (Extension Type: Quantity)
Is Modifier | false
Summary | false
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())
64. 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 managable, 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 | 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..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
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, modifiers
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())
66. 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
Type | Period
Is Modifier | false
Must Support | true
Summary | false
Requirements | Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
68. 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
Type | BackboneElement
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
70. MedicationRequest.substitution.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 managable, 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 | 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..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
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, modifiers
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())
72. 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
Binding | The codes SHOULD be taken from ActSubstanceAdminSubstitutionCode http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode (preferred to `http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode` ) Identifies the type of substitution allowed.
Type | Choice of: boolean, CodeableConcept
[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 | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

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

0. MedicationRequest
2. MedicationRequest.extension
Slicing | 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
4. MedicationRequest.extension:offLabel
Slice Name | offLabel
Short | Indicates that the prescriber has knowingly prescribed the medication for an indication, age group, dosage, or route of administration that is not approved by the regulatory agencies and is not mentioned in the prescribing information for the product.
Control | 0..1
Type | Extension(Off-label use) (Complex Extension)
6. MedicationRequest.identifier
Short | Prescription/prescribed item ID
Comments | It is the prescription ID if the presciption includes only one prescribed item
Note | This is a business identifier, not a resource identifier (see discussion)
8. MedicationRequest.groupIdentifier
Short | Prescription this is part of. Not needed if a presciption includes only one prescribed item.
Comments | It is the prescription ID if the presciption includes multiple prescribed items
Must Support | true
10. MedicationRequest.status
Short | Status of the order
Must Support | true
12. MedicationRequest.statusReason
Must Support | true
14. MedicationRequest.category
Must Support | true
16. MedicationRequest.medication
Type | CodeableReference(IHE Medication)
Must Support | true
18. MedicationRequest.subject
Must Support | true
20. MedicationRequest.authoredOn
Control | 1..?
Must Support | true
22. MedicationRequest.requester
Control | 1..?
24. MedicationRequest.recorder
Must Support | true
26. MedicationRequest.reason
Must Support | true
28. MedicationRequest.note
Must Support | true
30. MedicationRequest.effectiveDosePeriod
Must Support | true
32. MedicationRequest.dosageInstruction
Short | How the medication should be taken.
Must Support | true
34. MedicationRequest.dosageInstruction.text
Short | Free text dosage instructions
36. MedicationRequest.dosageInstruction.patientInstruction
Must Support | true
38. MedicationRequest.dosageInstruction.timing
Short | Administration schedule
40. MedicationRequest.dosageInstruction.timing.repeat
42. MedicationRequest.dosageInstruction.timing.repeat.duration
Short | Duration of the treatment
44. MedicationRequest.dosageInstruction.timing.repeat.frequency
Short | Frequency times per period
46. MedicationRequest.dosageInstruction.timing.repeat.period
Short | Duration of time over which repetitions are to occur
48. MedicationRequest.dosageInstruction.timing.repeat.periodUnit
Short | Unit of the period (e.g. day)
50. MedicationRequest.dosageInstruction.timing.code
Short | A code for the timing schedule.
52. MedicationRequest.dosageInstruction.route
Short | Route of administration
54. MedicationRequest.dosageInstruction.doseAndRate
56. MedicationRequest.dosageInstruction.doseAndRate.dose[x]
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Slicing | This element introduces a set of slices on `MedicationRequest.dosageInstruction.doseAndRate.dose[x]`. The slices areUnordered and Open, and can be differentiated using the following discriminators: type @ $this
58. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity
Slice Name | doseQuantity
Control | 0..1
Type | Quantity(SimpleQuantity)
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
60. MedicationRequest.dispenseRequest
62. MedicationRequest.dispenseRequest.extension
Slicing | 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
64. MedicationRequest.dispenseRequest.extension:prescribedQuantity
Slice Name | prescribedQuantity
Definition | When Medication resource implies a pack size, prescribedQuantity should convey number of packages. When the Medication does not imply an amount, overall amount could be in tablets or millilitres.
Short | Overall amount of product prescribed, independent from the number of repeats.
Control | 0..1
Type | Extension(MedicationRequest - Prescribed Quantity) (Extension Type: Quantity)
66. MedicationRequest.dispenseRequest.validityPeriod
Must Support | true
68. MedicationRequest.substitution
Must Support | true

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

0. 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.
Short | Ordering of medication for patient or group
Control | 0..*
Is Modifier | false
Must Support | false
Summary | false
Alternate Names | Prescription, Order
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (`contained.contained.empty()`) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (`contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`) dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (`contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`) dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (`contained.meta.security.empty()`) dom-6: A resource should have narrative for robust management (`text.`div`.exists()`)
2. MedicationRequest.id
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Short | Logical id of this artifact
Comments | Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.
Control | 0..1
Type | id
Is Modifier | false
Must Support | 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
Type | Meta
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
6. 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 its narrative along with other profiles, value sets, etc.
Control | 0..1
Type | uri
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
8. 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
Binding | The codes SHALL be taken from AllLanguages (required to `http://hl7.org/fhir/ValueSet/all-languages|5.0.0` ) IETF language tag for a human language
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
10. 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 a 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 This element is affected by the following invariants: dom-6
Type | Narrative
Is Modifier | false
Must Support | 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())`)
12. MedicationRequest.contained
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.
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..* This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
Type | Resource
Is Modifier | false
Must Support | false
Summary | false
Alternate Names | inline resources, anonymous resources, contained resources
14. MedicationRequest.extension
Definition | An Extension
Short | Extension
Control | 0..*
Type | Extension
Is Modifier | false
Must Support | false
Summary | false
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()`)
Slicing | 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
16. MedicationRequest.extension:offLabel
Slice Name | offLabel
Definition | Indicates that the prescriber has intentionally prescribed the medication in a manner not covered by the product authorization — such as for a different indication, age group, dosage, or route of administration.
Short | Indicates that the prescriber has knowingly prescribed the medication for an indication, age group, dosage, or route of administration that is not approved by the regulatory agencies and is not mentioned in the prescribing information for the product.
Control | 0..1
Type | Extension(Off-label use) (Complex Extension)
Is Modifier | false
Must Support | false
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()`)
18. 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 managable, 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 | 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..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Must Support | false
Summary | true
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
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()`)
20. 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 | Prescription/prescribed item ID
Comments | It is the prescription ID if the presciption includes only one prescribed item
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..*
Type | Identifier
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
22. MedicationRequest.basedOn
Definition | A plan or request that is fulfilled in whole or in part by this medication request.
Short | A plan or request that is fulfilled in whole or in part by this medication request
Control | 0..*
Type | Reference(CarePlan, MedicationRequest, ServiceRequest, ImmunizationRecommendation)
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
24. MedicationRequest.priorPrescription
Definition | Reference to an order/prescription that is being replaced by this MedicationRequest.
Short | Reference to an order/prescription that is being replaced by this MedicationRequest
Control | 0..1
Type | Reference(MedicationRequest)
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
26. MedicationRequest.groupIdentifier
Definition | A shared identifier common to multiple independent Request instances that were activated/authorized more or less simultaneously by a single author. The presence of the same identifier on each request ties those requests together and may have business ramifications in terms of reporting of results, billing, etc. E.g. a requisition number shared by a set of lab tests ordered together, or a prescription number shared by all meds ordered at one time.
Short | Prescription this is part of. Not needed if a presciption includes only one prescribed item.
Comments | It is the prescription ID if the presciption includes multiple prescribed items
Control | 0..1
Type | Identifier
Is Modifier | false
Must Support | true
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())`)
28. MedicationRequest.status
Definition | A code specifying the current state of the order. Generally, this will be active or completed state.
Short | Status of the order
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.
Control | 1..1
Binding | The codes SHALL be taken from MedicationrequestStatus (required to `http://hl7.org/fhir/ValueSet/medicationrequest-status|5.0.0` ) A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription.
Type | code
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())`)
30. 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
Binding | For example codes, see MedicationRequestStatusReasonCodes (example to `http://hl7.org/fhir/ValueSet/medicationrequest-status-reason` ) Identifies the reasons for a given status.
Type | CodeableConcept
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
32. MedicationRequest.statusChanged
Definition | The date (and perhaps time) when the status was changed.
Short | When the status was changed
Control | 0..1
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
34. MedicationRequest.intent
Definition | Whether the request is a proposal, plan, or an original order.
Short | proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
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
Binding | The codes SHALL be taken from MedicationRequestIntent (required to `http://hl7.org/fhir/ValueSet/medicationrequest-intent|5.0.0` ) The kind of medication order.
Type | code
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 | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
36. MedicationRequest.category
Definition | An arbitrary categorization or grouping of the medication request. It could be used for indicating where meds are intended to be administered, eg. in an inpatient setting or in a patient's home, or a legal category of the medication.
Short | Grouping or category of medication request
Comments | The category can be used to include where the medication is expected to be consumed or other types of requests. The examplar value set represents where the meds are intended to be administered and is just one example of request categorization.
Control | 0..*
Binding | For example codes, see MedicationRequestAdministrationLocationCodes (example to `http://hl7.org/fhir/ValueSet/medicationrequest-admin-location` ) A coded concept identifying where the medication is to be consumed or administered.
Type | CodeableConcept
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
38. 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
Binding | The codes SHALL be taken from RequestPriority (required to `http://hl7.org/fhir/ValueSet/request-priority|5.0.0` ) Identifies the level of importance to be assigned to actioning the request.
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
40. MedicationRequest.doNotPerform
Definition | If true, indicates that the provider is asking for the 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 create two seperate requests: one to stop using the current medication and another to start the new medication.
Short | True if patient is to stop taking or not to start taking the medication
Comments | If do not perform is not specified, the request is a positive request e.g. "do perform".
Control | 0..1
Type | boolean
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
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
42. 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.
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
Binding | For example codes, see SNOMEDCTMedicationCodes (example to `http://hl7.org/fhir/ValueSet/medication-codes` ) A coded concept identifying substance or product that can be ordered.
Type | CodeableReference(IHE Medication)
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())`)
44. MedicationRequest.subject
Definition | The individual or group for whom the medication has been requested.
Short | Individual or group for whom the medication has been requested
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
Type | Reference(Patient, Group)
Is Modifier | false
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
46. 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.
Short | The person or organization who provided the information about this request, if the source is someone other than the requestor
Control | 0..*
Type | Reference(Patient, Practitioner, PractitionerRole, RelatedPerson, Organization)
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
48. 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
Type | Reference(Encounter)
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
50. MedicationRequest.supportingInformation
Definition | Information to support fulfilling (i.e. dispensing or administering) of the medication, for example, patient height and weight, a MedicationStatement for the patient).
Short | Information to support fulfilling of the medication
Comments | This attribute can be used to reference a MedicationStatement about the patients' medication use.
Control | 0..*
Type | Reference(Resource)
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
52. MedicationRequest.authoredOn
Definition | The date (and perhaps time) when the prescription was initially written or authored on.
Short | When request was initially authored
Control | 1..1
Type | dateTime
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())`)
54. MedicationRequest.requester
Definition | The individual, organization, or device that initiated the request and has responsibility for its activation.
Short | Who/What requested the Request
Control | 1..1
Type | Reference(Practitioner, PractitionerRole, Organization, Patient, RelatedPerson, Device)
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
56. 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.
Short | Reported rather than primary record
Comments | If not populated, then assume that this is the original record and not reported
Control | 0..1
Type | boolean
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
58. 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
Binding | Unless not suitable, these codes SHALL be taken from MedicationIntendedPerformerRole (extensible to `http://hl7.org/fhir/ValueSet/medication-intended-performer-role` ) Identifies the type of individual that is desired to administer the medication.
Type | CodeableConcept
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
60. MedicationRequest.performer
Definition | The specified desired performer of the medication treatment (e.g. the performer of the medication administration). For devices, this is the device that is intended to perform the administration of the medication. An IV Pump would be an example of a device that is performing the administration. Both the IV Pump and the practitioner that set the rate or bolus on the pump can be listed as performers.
Short | Intended performer of administration
Control | 0..*
Type | Reference(Practitioner, PractitionerRole, Organization, Patient, DeviceDefinition, RelatedPerson, CareTeam, HealthcareService)
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
62. MedicationRequest.device
Definition | The intended type of device that is to be used for the administration of the medication (for example, PCA Pump).
Short | Intended type of device for the administration
Control | 0..*
Type | CodeableReference(DeviceDefinition)
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
64. 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
Control | 0..1
Type | Reference(Practitioner, PractitionerRole)
Is Modifier | false
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
66. MedicationRequest.reason
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..*
Binding | For example codes, see ConditionProblemDiagnosisCodes (example to `http://hl7.org/fhir/ValueSet/condition-code` ) A coded concept indicating why the medication was ordered.
Type | CodeableReference(Condition, Observation)
Is Modifier | false
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
68. MedicationRequest.courseOfTherapyType
Definition | The description of the overall pattern 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
Binding | Unless not suitable, these codes SHALL be taken from MedicationRequestCourseOfTherapyCodes (extensible to `http://hl7.org/fhir/ValueSet/medicationrequest-course-of-therapy` ) Identifies the overall pattern of medication administratio.
Type | CodeableConcept
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
70. 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
Control | 0..*
Type | Reference(Coverage, ClaimResponse)
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
72. MedicationRequest.note
Definition | Extra information about the prescription that could not be conveyed by the other attributes.
Short | Information about the prescription
Control | 0..*
Type | Annotation
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
74. 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.
Short | Full representation of the dosage instructions
Control | 0..1
Type | markdown
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | false
Requirements | The content of the renderedDosageInstructions must not be different than the dose represented in the dosageInstruction content.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
76. MedicationRequest.effectiveDosePeriod
Definition | The period over which the medication is to be taken. Where there are multiple dosageInstruction lines (for example, tapering doses), this is the earliest date and the latest end date of the dosageInstructions.
Short | Period over which the medication is to be taken
Control | 0..1
Type | Period
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
78. MedicationRequest.dosageInstruction
Definition | Specific instructions for how the medication is to be used by the patient.
Short | How the medication should be taken.
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. In general, each prescribed drug will be a separate Medication Request. When drug orders are grouped together at the time of order entry, but each of the drugs can be manipulated independently e.g. changing the status of one order to "completed" or "cancelled", changing another order status to "on-hold", the method to "group" all of the medication requests together is to use MedicationRequest.groupIdentifier element. All of the orders grouped together in this manner will have the same groupIdentifier, and separately, each order in the group may have a unique identifier. There are cases that require grouping of Medication orders together when it is necessary to specify optionality e.g. order two drugs at one time, but stating either of these drugs may be used to treat the patient. The use of a RequestOrchestration should be used as a parent for the Medication orders that require this type of grouping. An example when it may be necessary to group medication orders together is when you specify timing relationships e.g. order drug "xyz" with dose 123, then taper the same drug to a different dose after some interval of time precedence: e.g. give drug "abc" followed by drug "def" e.g. give drug 30 minutes before some procedure was performed more generically this supports - hierarchical groups of actions, where each specific action references the action to be performed (in terms of a Request resource), and each group describes additional behavior, relationships, and applicable conditions between the actions in the overall group. Note that one should NOT use the List or Composition resource to accomplish the above requirements. You may use List or Composition for other business requirements, but not to address the specific requirements of grouping medication orders.
Control | 0..*
Type | Dosage
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
80. MedicationRequest.dosageInstruction.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 This element is affected by the following invariants: ele-1
Type | id
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
82. MedicationRequest.dosageInstruction.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 managable, 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..*
Type | Extension
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()`)
Slicing | This element introduces a set of slices on `MedicationRequest.dosageInstruction.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
84. MedicationRequest.dosageInstruction.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 managable, 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 | 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..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
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, modifiers
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()`)
86. MedicationRequest.dosageInstruction.sequence
Definition | Indicates the order in which the dosage instructions should be applied or interpreted.
Short | The order of the dosage instructions
Control | 0..1
Type | integer
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. If the sequence number is different, then the Dosages are intended to be sequential.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
88. MedicationRequest.dosageInstruction.text
Definition | Free text dosage instructions e.g. SIG.
Short | Free text dosage instructions
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing. Additional information about administration or preparation of the medication should be included as text.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
90. MedicationRequest.dosageInstruction.additionalInstruction
Definition | Supplemental instructions to the patient on how to take the medication (e.g. "with meals" or"take half to one hour before food") or warnings for the patient about the medication (e.g. "may cause drowsiness" or "avoid exposure of skin to direct sunlight or sunlamps").
Short | Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
Comments | Information about administration or preparation of the medication (e.g. "infuse as rapidly as possibly via intraperitoneal port" or take "immediately following drug x") should be populated in dosage.text.
Control | 0..*
Binding | For example codes, see SNOMEDCTAdditionalDosageInstructions (example to `http://hl7.org/fhir/ValueSet/additional-instruction-codes` ) A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
Type | CodeableConcept
Is Modifier | false
Summary | true
Requirements | Additional instruction is intended to be coded, but where no code exists, the element could include text. For example, "Swallow with plenty of water" which might or might not be coded.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
92. MedicationRequest.dosageInstruction.patientInstruction
Definition | Instructions in terms that are understood by the patient or consumer.
Short | Patient or consumer oriented instructions
Control | 0..1
Type | string
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())`)
94. MedicationRequest.dosageInstruction.timing
Definition | When medication should be administered.
Short | Administration schedule
Comments | This attribute might not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.
Control | 0..1
Type | Timing
Is Modifier | false
Summary | true
Requirements | The timing schedule for giving the medication to the patient. This data type allows many different expressions. For example: "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
96. MedicationRequest.dosageInstruction.timing.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 This element is affected by the following invariants: ele-1
Type | id
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
98. MedicationRequest.dosageInstruction.timing.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 managable, 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..*
Type | Extension
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()`)
Slicing | This element introduces a set of slices on `MedicationRequest.dosageInstruction.timing.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
100. MedicationRequest.dosageInstruction.timing.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 managable, 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 | 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..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
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, modifiers
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()`)
102. MedicationRequest.dosageInstruction.timing.event
Definition | Identifies specific times when the event occurs.
Short | When the event occurs
Control | 0..*
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | In a Medication Administration Record, for instance, you need to take a general specification, and turn it into a precise specification.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
104. MedicationRequest.dosageInstruction.timing.repeat
Definition | A set of rules that describe when the event is scheduled.
Short | When the event is to occur
Control | 0..1
Type | Element
Is Modifier | false
Summary | true
Requirements | Many timing schedules are determined by regular repetitions.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) tim-1: if there's a duration, there needs to be duration units (`duration.empty() or durationUnit.exists()`) tim-2: if there's a period, there needs to be period units (`period.empty() or periodUnit.exists()`) tim-4: duration SHALL be a non-negative value (`duration.exists() implies duration >= 0`) tim-5: period SHALL be a non-negative value (`period.exists() implies period >= 0`) tim-6: If there's a periodMax, there must be a period (`periodMax.empty() or period.exists()`) tim-7: If there's a durationMax, there must be a duration (`durationMax.empty() or duration.exists()`) tim-8: If there's a countMax, there must be a count (`countMax.empty() or count.exists()`) tim-9: If there's an offset, there must be a when (and not C, CM, CD, CV) (`offset.empty() or (when.exists() and when.select($this in ('C' | 'CM' | 'CD' | 'CV')).allFalse())`) tim-10: If there's a timeOfDay, there cannot be a when, or vice versa (`timeOfDay.empty() or when.empty()`)
106. MedicationRequest.dosageInstruction.timing.repeat.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 This element is affected by the following invariants: ele-1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
108. MedicationRequest.dosageInstruction.timing.repeat.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 managable, 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..*
Type | Extension
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()`)
Slicing | This element introduces a set of slices on `MedicationRequest.dosageInstruction.timing.repeat.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
110. MedicationRequest.dosageInstruction.timing.repeat.bounds[x]
Definition | Either a duration for the length of the timing schedule, a range of possible length, or outer bounds for start and/or end limits of the timing schedule.
Short | Length/Range of lengths, or (Start and/or end) limits
Control | 0..1
Type | Choice of: Duration, Range, Period
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
112. MedicationRequest.dosageInstruction.timing.repeat.count
Definition | A total count of the desired number of repetitions across the duration of the entire timing specification. If countMax is present, this element indicates the lower bound of the allowed range of count values.
Short | Number of times to repeat
Comments | If you have both bounds and count, then this should be understood as within the bounds period, until count times happens.
Control | 0..1 This element is affected by the following invariants: tim-8
Type | positiveInt
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Repetitions may be limited by end time or total occurrences.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
114. MedicationRequest.dosageInstruction.timing.repeat.countMax
Definition | If present, indicates that the count is a range - so to perform the action between [count] and [countMax] times.
Short | Maximum number of times to repeat
Control | 0..1 This element is affected by the following invariants: tim-8
Type | positiveInt
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())`)
116. MedicationRequest.dosageInstruction.timing.repeat.duration
Definition | How long this thing happens for when it happens. If durationMax is present, this element indicates the lower bound of the allowed range of the duration.
Short | Duration of the treatment
Comments | For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).
Control | 0..1 This element is affected by the following invariants: tim-7, tim-1, tim-4
Type | decimal
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Some activities are not instantaneous and need to be maintained for a period of time.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
118. MedicationRequest.dosageInstruction.timing.repeat.durationMax
Definition | If present, indicates that the duration is a range - so to perform the action between [duration] and [durationMax] time length.
Short | How long when it happens (Max)
Comments | For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).
Control | 0..1 This element is affected by the following invariants: tim-7
Type | decimal
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Some activities are not instantaneous and need to be maintained for a period of time.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
120. MedicationRequest.dosageInstruction.timing.repeat.durationUnit
Definition | The units of time for the duration, in UCUM units Normal practice is to use the 'mo' code as a calendar month when calculating the next occurrence.
Short | s | min | h | d | wk | mo | a - unit of time (UCUM)
Control | 0..1 This element is affected by the following invariants: tim-1
Binding | The codes SHALL be taken from UnitsOfTime (required to `http://hl7.org/fhir/ValueSet/units-of-time|5.0.0` ) A unit of time (units from UCUM).
Type | code
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())`)
122. MedicationRequest.dosageInstruction.timing.repeat.frequency
Definition | The number of times to repeat the action within the specified period. If frequencyMax is present, this element indicates the lower bound of the allowed range of the frequency.
Short | Frequency times per period
Control | 0..1
Type | positiveInt
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Meaning if Missing | If no frequency is stated, the assumption is that the event occurs once per period, but systems SHOULD always be specific about this
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
124. MedicationRequest.dosageInstruction.timing.repeat.frequencyMax
Definition | If present, indicates that the frequency is a range - so to repeat between [frequency] and [frequencyMax] times within the period or period range.
Short | Event occurs up to frequencyMax times per period
Control | 0..1
Type | positiveInt
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())`)
126. MedicationRequest.dosageInstruction.timing.repeat.period
Definition | Indicates the duration of time over which repetitions are to occur; e.g. to express "3 times per day", 3 would be the frequency and "1 day" would be the period. If periodMax is present, this element indicates the lower bound of the allowed range of the period length.
Short | Duration of time over which repetitions are to occur
Control | 0..1 This element is affected by the following invariants: tim-6, tim-5, tim-2
Type | decimal
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())`)
128. MedicationRequest.dosageInstruction.timing.repeat.periodMax
Definition | If present, indicates that the period is a range from [period] to [periodMax], allowing expressing concepts such as "do this once every 3-5 days.
Short | Upper limit of period (3-4 hours)
Control | 0..1 This element is affected by the following invariants: tim-6
Type | decimal
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())`)
130. MedicationRequest.dosageInstruction.timing.repeat.periodUnit
Definition | The units of time for the period in UCUM units Normal practice is to use the 'mo' code as a calendar month when calculating the next occurrence.
Short | Unit of the period (e.g. day)
Control | 0..1 This element is affected by the following invariants: tim-2
Binding | The codes SHALL be taken from UnitsOfTime (required to `http://hl7.org/fhir/ValueSet/units-of-time|5.0.0` ) A unit of time (units from UCUM).
Type | code
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())`)
132. MedicationRequest.dosageInstruction.timing.repeat.dayOfWeek
Definition | If one or more days of week is provided, then the action happens only on the specified day(s).
Short | mon | tue | wed | thu | fri | sat | sun
Comments | If no days are specified, the action is assumed to happen every day as otherwise specified.
Control | 0..*
Binding | The codes SHALL be taken from DaysOfWeek (required to `http://hl7.org/fhir/ValueSet/days-of-week|5.0.0` )
Type | code
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())`)
134. MedicationRequest.dosageInstruction.timing.repeat.timeOfDay
Definition | Specified time of day for action to take place.
Short | Time of day for action
Comments | When time of day is specified, it is inferred that the action happens every day (as filtered by dayofWeek) on the specified times. If there's a timeOfDay, there cannot be a when, or vice versa.
Control | 0..* This element is affected by the following invariants: tim-10
Type | time
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())`)
136. MedicationRequest.dosageInstruction.timing.repeat.when
Definition | An approximate time period during the day, potentially linked to an event of daily living that indicates when the action should occur.
Short | Code for time period of occurrence
Comments | When more than one event is listed, the event is tied to the union of the specified events.
Control | 0..* This element is affected by the following invariants: tim-9, tim-10
Binding | The codes SHALL be taken from EventTiming (required to `http://hl7.org/fhir/ValueSet/event-timing|5.0.0` ) Real-world event relating to the schedule.
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Timings are frequently determined by occurrences such as waking, eating and sleep.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
138. MedicationRequest.dosageInstruction.timing.repeat.offset
Definition | The number of minutes from the event. If the event code does not indicate whether the minutes is before or after the event, then the offset is assumed to be after the event.
Short | Minutes from event (before or after)
Control | 0..1 This element is affected by the following invariants: tim-9
Type | unsignedInt
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())`)
140. MedicationRequest.dosageInstruction.timing.code
Definition | A code for the timing schedule (or just text in code.text). Some codes such as BID are ubiquitous, but many institutions define their own additional codes. If a code is provided, the code is understood to be a complete statement of whatever is specified in the structured timing data, and either the code or the data may be used to interpret the Timing, with the exception that .repeat.bounds still applies over the code (and is not contained in the code).
Short | A code for the timing schedule.
Comments | BID etc. are defined as 'at institutionally specified times'. For example, an institution may choose that BID is "always at 7am and 6pm". If it is inappropriate for this choice to be made, the code BID should not be used. Instead, a distinct organization-specific code should be used in place of the HL7-defined BID code and/or a structured representation should be used (in this case, specifying the two event times).
Control | 0..1
Binding | The codes SHOULD be taken from TimingAbbreviation (preferred to `http://hl7.org/fhir/ValueSet/timing-abbreviation` ) Code for a known / defined timing pattern.
Type | CodeableConcept
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
142. MedicationRequest.dosageInstruction.asNeeded
Definition | Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option).
Short | Take "as needed"
Comments | Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated.
Control | 0..1 This element is affected by the following invariants: dos-1
Type | boolean
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())`)
144. MedicationRequest.dosageInstruction.asNeededFor
Definition | Indicates whether the Medication is only taken based on a precondition for taking the Medication (CodeableConcept).
Short | Take "as needed" (for x)
Comments | Can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be False, then the dose is given according to the schedule and is not "prn" or "as needed".
Control | 0..* This element is affected by the following invariants: dos-1
Binding | For example codes, see SNOMEDCTMedicationAsNeededReasonCodes (example to `http://hl7.org/fhir/ValueSet/medication-as-needed-reason` ) A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.
Type | CodeableConcept
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
146. MedicationRequest.dosageInstruction.site
Definition | Body site to administer to.
Short | Body site to administer to
Comments | If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension http://hl7.org/fhir/StructureDefinition/bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.
Control | 0..1
Binding | For example codes, see SNOMEDCTAnatomicalStructureAdministrationSites (example to `http://hl7.org/fhir/ValueSet/approach-site-codes` ) A coded concept describing the site location the medicine enters into or onto the body.
Type | CodeableConcept
Is Modifier | false
Summary | true
Requirements | A coded specification of the anatomic site where the medication first enters the body.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
148. MedicationRequest.dosageInstruction.route
Definition | How drug should enter body.
Short | Route of administration
Control | 0..1
Binding | For example codes, see SNOMEDCTRouteCodes (example to `http://hl7.org/fhir/ValueSet/route-codes` ) A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
Type | CodeableConcept
Is Modifier | false
Summary | true
Requirements | A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
150. MedicationRequest.dosageInstruction.method
Definition | Technique for administering medication.
Short | Technique for administering medication
Comments | Terminologies used often pre-coordinate this term with the route and or form of administration.
Control | 0..1
Binding | For example codes, see SNOMEDCTAdministrationMethodCodes (example to `http://hl7.org/fhir/ValueSet/administration-method-codes` ) A coded concept describing the technique by which the medicine is administered.
Type | CodeableConcept
Is Modifier | false
Summary | true
Requirements | A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
152. MedicationRequest.dosageInstruction.doseAndRate
Definition | Depending on the resource,this is the amount of medication administered, to be administered or typical amount to be administered.
Short | Amount of medication administered, to be administered or typical amount to be administered
Control | 0..*
Type | Element
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
154. MedicationRequest.dosageInstruction.doseAndRate.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 This element is affected by the following invariants: ele-1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
156. MedicationRequest.dosageInstruction.doseAndRate.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 managable, 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..*
Type | Extension
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()`)
Slicing | This element introduces a set of slices on `MedicationRequest.dosageInstruction.doseAndRate.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
158. MedicationRequest.dosageInstruction.doseAndRate.type
Definition | The kind of dose or rate specified, for example, ordered or calculated.
Short | The kind of dose or rate specified
Control | 0..1
Binding | For example codes, see DoseAndRateType (example to `http://terminology.hl7.org/ValueSet/dose-rate-type` ) The kind of dose or rate specified.
Type | CodeableConcept
Is Modifier | false
Summary | true
Requirements | If the type is not populated, assume to be "ordered".
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
160. MedicationRequest.dosageInstruction.doseAndRate.dose[x]
Definition | Amount of medication per dose.
Short | Amount of medication per dose
Comments | Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.
Control | 0..1
Type | Choice of: Range, Quantity(SimpleQuantity)
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Summary | true
Requirements | The amount of therapeutic or other substance given at one administration event.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
Slicing | This element introduces a set of slices on `MedicationRequest.dosageInstruction.doseAndRate.dose[x]`. The slices areUnordered and Open, and can be differentiated using the following discriminators: type @ $this
162. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity
Slice Name | doseQuantity
Definition | Amount of medication per dose.
Short | Amount of medication per dose
Comments | Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.
Control | 0..1
Type | Quantity(SimpleQuantity)
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Summary | true
Requirements | The amount of therapeutic or other substance given at one administration event.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
164. MedicationRequest.dosageInstruction.doseAndRate.rate[x]
Definition | Amount of medication per unit of time.
Short | Amount of medication per unit of time
Comments | It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate. It is possible to specify a rate over time (for example, 100 ml/hour) using either the rateRatio and rateQuantity. The rateQuantity approach requires systems to have the capability to parse UCUM grammar where ml/hour is included rather than a specific ratio where the time is specified as the denominator. Where a rate such as 500ml over 2 hours is specified, the use of rateRatio may be more semantically correct than specifying using a rateQuantity of 250 mg/hour.
Control | 0..1
Type | Choice of: Ratio, Range, Quantity(SimpleQuantity)
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Summary | true
Requirements | 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. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
166. MedicationRequest.dosageInstruction.maxDosePerPeriod
Definition | Upper limit on medication per unit of time.
Short | Upper limit on medication per unit of time
Comments | This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".
Control | 0..*
Type | Ratio
Is Modifier | false
Summary | true
Requirements | The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
168. MedicationRequest.dosageInstruction.maxDosePerAdministration
Definition | Upper limit on medication per administration.
Short | Upper limit on medication per administration
Comments | This is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg.
Control | 0..1
Type | Quantity(SimpleQuantity)
Is Modifier | false
Summary | true
Requirements | The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
170. MedicationRequest.dosageInstruction.maxDosePerLifetime
Definition | Upper limit on medication per lifetime of the patient.
Short | Upper limit on medication per lifetime of the patient
Control | 0..1
Type | Quantity(SimpleQuantity)
Is Modifier | false
Summary | true
Requirements | The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
172. 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
Type | BackboneElement
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
174. 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 This element is affected by the following invariants: ele-1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
176. MedicationRequest.dispenseRequest.extension
Definition | An Extension
Short | Extension
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
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()`)
Slicing | 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
178. MedicationRequest.dispenseRequest.extension:prescribedQuantity
Slice Name | prescribedQuantity
Definition | When Medication resource implies a pack size, prescribedQuantity should convey number of packages. When the Medication does not imply an amount, overall amount could be in tablets or millilitres.
Short | Overall amount of product prescribed, independent from the number of repeats.
Control | 0..1
Type | Extension(MedicationRequest - Prescribed Quantity) (Extension Type: Quantity)
Is Modifier | false
Summary | false
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()`)
180. 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 managable, 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 | 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..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
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, modifiers
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()`)
182. 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
Type | BackboneElement
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
184. 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 This element is affected by the following invariants: ele-1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
186. MedicationRequest.dispenseRequest.initialFill.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 managable, 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..*
Type | Extension
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()`)
188. MedicationRequest.dispenseRequest.initialFill.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 managable, 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 | 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..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
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, modifiers
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()`)
190. MedicationRequest.dispenseRequest.initialFill.quantity
Definition | The amount or quantity to provide as part of the first dispense.
Short | First fill quantity
Control | 0..1
Type | Quantity(SimpleQuantity)
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
192. MedicationRequest.dispenseRequest.initialFill.duration
Definition | The length of time that the first dispense is expected to last.
Short | First fill duration
Control | 0..1
Type | Duration
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
194. MedicationRequest.dispenseRequest.dispenseInterval
Definition | The minimum period of time that must occur between dispenses of the medication.
Short | Minimum period of time between dispenses
Control | 0..1
Type | Duration
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
196. 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
Type | Period
Is Modifier | false
Must Support | true
Summary | false
Requirements | Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
198. 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
Type | unsignedInt
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
200. MedicationRequest.dispenseRequest.quantity
Definition | The amount that is to be dispensed for one fill.
Short | Amount of medication to supply per dispense
Control | 0..1
Type | Quantity(SimpleQuantity)
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
202. 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
Type | Duration
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
204. MedicationRequest.dispenseRequest.dispenser
Definition | Indicates the intended performing Organization that will dispense the medication as specified by the prescriber.
Short | Intended performer of dispense
Control | 0..1
Type | Reference(Organization)
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
206. MedicationRequest.dispenseRequest.dispenserInstruction
Definition | Provides additional information to the dispenser, for example, counselling to be provided to the patient.
Short | Additional information for the dispenser
Control | 0..*
Type | Annotation
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
208. MedicationRequest.dispenseRequest.doseAdministrationAid
Definition | Provides information about the type of adherence packaging to be supplied for the medication dispense.
Short | Type of adherence packaging to use for the dispense
Control | 0..1
Binding | For example codes, see MedicationDoseAids (example to `http://hl7.org/fhir/ValueSet/medication-dose-aid` )
Type | CodeableConcept
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
210. 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
Type | BackboneElement
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
212. 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 This element is affected by the following invariants: ele-1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
214. MedicationRequest.substitution.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 managable, 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..*
Type | Extension
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()`)
216. MedicationRequest.substitution.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 managable, 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 | 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..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
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, modifiers
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()`)
218. 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
Binding | The codes SHOULD be taken from ActSubstanceAdminSubstitutionCode (preferred to `http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode` ) Identifies the type of substitution allowed.
Type | Choice of: boolean, CodeableConcept
[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 | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
220. 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
Control | 0..1
Binding | For example codes, see SubstanceAdminSubstitutionReason (example to `http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason` ) SubstanceAdminSubstitutionReason
Type | CodeableConcept
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
222. 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.
Short | A list of events of interest in the lifecycle
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.).
Control | 0..*
Type | Reference(Provenance)
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)