US Veterans Health Administration FHIR Map Set Implementation Guide
1.3.1 - 250401 United States of America flag

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Resource Profile: MedicationRequestOutpatient - Detailed Descriptions

Active as of 2025-03-31

Definitions for the MedicationRequestOutpatient resource profile.

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.

ShortOrdering of medication for patient or group
Comments

-

Control0..*
Is Modifierfalse
Must Supportfalse
Complies with ProfileThis profile complies with the profile
  • http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest|6.1.0
  • http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest|7.0.0
Summaryfalse
Alternate NamesPrescription, Order
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
2. MedicationRequest.id
Definition

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

ShortLogical id of this artifact
Comments

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

Control0..1
Typeidstring
Is Modifierfalse
Must Supporttrue
Summarytrue
4. 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.

ShortA set of rules under which this content was created
Comments

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

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortExtensionAdditional content defined by implementations
Comments

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

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

    Extension medicationrequest-pharmacyOrderStatus

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

    An Extension


    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

    ShortExtensionAdditional content defined by implementations
    Comments

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

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

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

      Shortidentifies the meaning of the extension
      Comments

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

      Control1..1
      Typeuri
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      Fixed Valuehttp://va.gov/fhir/StructureDefinition/medicationrequest-pharmacyOrderStatus
      14. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x]
      Definition

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

      ShortValue of extension
      Control0..1
      TypeCoding, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      16. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].system
      Definition

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

      ShortIdentity of the terminology system
      Comments

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

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

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

      Pattern Valuehttp://va.gov/terminology/vistaDefinedTerms/52-100
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      mro-27-1746-1: If P then fixed value http://va.gov/terminology/vistaDefinedTerms/52-100 (true)
      18. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].code
      Definition

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

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

      Need to refer to a particular code in the system.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      mro-27-1746: If (52-11) is P then fixed value #active-parked (true)
      20. MedicationRequest.extension:medicationrequest-cancelDate
      Slice Namemedicationrequest-cancelDate
      Definition

      Extension medicationrequest-cancelDate

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

      An Extension


      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

      ShortExtensionAdditional content defined by implementations
      Comments

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

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

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

        Shortidentifies the meaning of the extension
        Comments

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

        Control1..1
        Typeuri
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        Fixed Valuehttp://va.gov/fhir/StructureDefinition/medicationrequest-cancelDate
        26. MedicationRequest.extension:medicationrequest-cancelDate.value[x]
        Definition

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

        ShortValue of extension
        Control0..1
        TypedateTime, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        28. MedicationRequest.extension:medicationrequest-includeIndicationInSig
        Slice Namemedicationrequest-includeIndicationInSig
        Definition

        Extension medicationrequest-includeIndicationInSig

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

        An Extension


        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

        ShortExtensionAdditional content defined by implementations
        Comments

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

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

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

          Shortidentifies the meaning of the extension
          Comments

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

          Control1..1
          Typeuri
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          Fixed Valuehttp://va.gov/fhir/StructureDefinition/medicationrequest-includeIndicationInSig
          34. MedicationRequest.extension:medicationrequest-includeIndicationInSig.value[x]
          Definition

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

          ShortValue of extension
          Comments

          see mapping VF_Boolean

          Control0..1
          Typeboolean, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, Expression, Signature, unsignedInt, time
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          36. MedicationRequest.extension:medicationrequest-remainingRefillCount
          Slice Namemedicationrequest-remainingRefillCount
          Definition

          Extension medicationrequest-remainingRefillCount

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

          An Extension


          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

          ShortExtensionAdditional content defined by implementations
          Comments

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

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

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

            Shortidentifies the meaning of the extension
            Comments

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

            Control1..1
            Typeuri
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            Fixed Valuehttp://va.gov/fhir/StructureDefinition/medicationrequest-remainingRefillCount
            42. MedicationRequest.extension:medicationrequest-remainingRefillCount.value[x]
            Definition

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

            ShortValue of extension
            Control0..1
            Typeinteger, date, Meta, Address, Attachment, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            44. MedicationRequest.modifierExtension
            Definition

            May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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

            ShortExtensions that cannot be ignored
            Comments

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

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

            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

            Alternate Namesextensions, user content
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            46. 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.

            ShortExternal ids for this request
            Comments

            This is a business identifier, not a resource identifier.

            NoteThis is a business identifier, not a resource identifier (see discussion)
            Control0..*
            TypeIdentifier
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            48. MedicationRequest.identifier.use
            Definition

            The purpose of this identifier.

            Shortusual | official | temp | secondary | old (If known)
            Comments

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

            Control0..1
            BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
            (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

            Identifies the purpose for this identifier, if known .

            Typecode
            Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

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

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

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

            ShortDescription of identifier
            Comments

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

            Control0..1
            BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-type
            (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

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

            TypeCodeableConcept
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Requirements

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

            Pattern Value{
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                "code" : "FILL"
              }]
            }
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            52. MedicationRequest.identifier.value
            Definition

            The portion of the identifier typically relevant to the user and which is unique within the context of the system.

            ShortThe value that is unique
            Comments

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

            Control0..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Example<br/><b>General</b>:123456
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            54. MedicationRequest.status
            Definition

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

            Shortactive | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
            Comments

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

            Control1..1
            BindingThe codes SHALL be taken from OutMedRequestStatus FHIRhttp://hl7.org/fhir/ValueSet/medicationrequest-status|4.0.1
            (required to http://va.gov/fhir/ValueSet/OutMedRequestStatus)

            see mapping VF_OutMedRequestStatus


            A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription.

            Typecode
            Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            56. MedicationRequest.intent
            Definition

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

            Shortproposal | 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.

            Control1..1
            BindingThe codes SHALL be taken from medicationRequest Intenthttp://hl7.org/fhir/ValueSet/medicationrequest-intent|4.0.1
            (required to http://hl7.org/fhir/ValueSet/medicationrequest-intent)

            The kind of medication order.

            Typecode
            Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Pattern Valueorder
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            58. MedicationRequest.category
            Definition

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

            ShortType of medication usage
            Comments

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

            Control0..*
            BindingFor example codes, see medicationRequest Category Codeshttp://hl7.org/fhir/ValueSet/medicationrequest-category
            (example to http://hl7.org/fhir/ValueSet/medicationrequest-category)

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

            TypeCodeableConcept
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Pattern Value{
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                "code" : "outpatient"
              }]
            }
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            SlicingThis element introduces a set of slices on MedicationRequest.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • pattern @ $this
            • 60. MedicationRequest.category:us-core
              Slice Nameus-core
              Definition

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

              ShortType of medication usage
              Comments

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

              Control0..*
              BindingThe codes SHALL be taken from For example codes, see medicationRequest Category Codeshttp://hl7.org/fhir/ValueSet/medicationrequest-category
              (required to http://hl7.org/fhir/ValueSet/medicationrequest-category)

              The type of medication order.


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

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

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

              ShortTrue if request is prohibiting action
              Comments

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

              Control0..1
              Typeboolean
              Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              64. MedicationRequest.reported[x]
              Definition

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

              ShortReported rather than primary record
              Control0..1
              TypeChoice of: boolean, Reference(US Core Practitioner Profile, US Core Organization Profile, US Core Patient Profile, US Core PractitionerRole Profile, US Core RelatedPerson Profile, Patient, Practitioner, PractitionerRole, RelatedPerson, Organization)
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Must Support TypesChoice of: boolean, Reference(US Core Practitioner Profile)
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              66. MedicationRequest.medication[x]
              Definition

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

              ShortMedication 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.

              Control1..1
              BindingUnless not suitable, these codes SHALL be taken from For example codes, see Medication Clinical Drug .http://hl7.org/fhir/ValueSet/medication-codes
              (extensible to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4)
              TypeChoice of: CodeableConcept, Reference(US Core Medication Profile, Medication)
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Must Supporttrue
              Must Support TypesNo must-support rules about the choice of types/profiles
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              SlicingThis element introduces a set of slices on MedicationRequest.medication[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • type @ $this
              • 68. MedicationRequest.medication[x]:medicationCodeableConcept
                Slice NamemedicationCodeableConcept
                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.

                ShortMedication 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.

                Control01..1
                BindingUnless not suitable, these codes SHALL be taken from For example codes, see Medication Clinical Drug .http://hl7.org/fhir/ValueSet/medication-codes
                (extensible to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4)
                TypeCodeableConcept, Reference(Medication)
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Is Modifierfalse
                Must Supporttrue
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                70. MedicationRequest.medication[x]:medicationCodeableConcept.coding
                Definition

                A reference to a code defined by a terminology system.

                ShortCode defined by a terminology system
                Comments

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

                Control0..*
                TypeCoding
                Is Modifierfalse
                Summarytrue
                Requirements

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

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                72. MedicationRequest.medication[x]:medicationCodeableConcept.coding.system
                Definition

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

                ShortIdentity of the terminology system
                Comments

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

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

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

                Pattern Valuehttp://www.nlm.nih.gov/research/umls/rxnorm
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                74. MedicationRequest.medication[x]:medicationCodeableConcept.coding.code
                Definition

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

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

                Need to refer to a particular code in the system.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                76. MedicationRequest.medication[x]:medicationCodeableConcept.text
                Definition

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

                ShortPlain text representation of the concept
                Comments

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

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

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

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

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

                ShortWho or group medication request is for
                Comments

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

                Control1..1
                TypeReference(Patient, Patient, Group)
                Is Modifierfalse
                Must Supporttrue
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                80. MedicationRequest.encounter
                Definition

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

                ShortEncounter 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.

                Control0..1
                TypeReference(US Core Encounter Profile, Encounter)
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                82. MedicationRequest.authoredOn
                Definition

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

                ShortWhen request was initially authored
                Control0..1
                TypedateTime
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                84. MedicationRequest.requester
                Definition

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

                ShortWho/What requested the Request
                Control10..1
                TypeReference(Practitioner, Practitioner, PractitionerRole, Organization, Patient, RelatedPerson, Device)
                Is Modifierfalse
                Must Supporttrue
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                86. MedicationRequest.reasonCode
                Definition

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

                ShortReason 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.

                Control0..*
                BindingFor example codes, see Condition/Problem/DiagnosisCodeshttp://hl7.org/fhir/ValueSet/condition-code
                (example to http://hl7.org/fhir/ValueSet/condition-code)

                A coded concept indicating why the medication was ordered.

                TypeCodeableConcept
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                88. MedicationRequest.reasonCode.text
                Definition

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

                ShortPlain text representation of the concept
                Comments

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

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

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

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

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

                ShortHow 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.

                Control0..*
                TypeDosage
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                92. 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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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

                ShortExtensions that cannot be ignored even if unrecognized
                Comments

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

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

                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

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

                Free text dosage instructions e.g. SIG.

                ShortFree text dosage instructions e.g. SIG
                Control0..1
                Typestring
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Summarytrue
                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.

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

                Instructions in terms that are understood by the patient or consumer.

                ShortPatient or consumer oriented instructions
                Control0..1
                Typestring
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                98. MedicationRequest.dosageInstruction.route
                Definition

                How drug should enter body.

                ShortHow drug should enter body
                Control0..1
                BindingFor example codes, see SNOMEDCTRouteCodeshttp://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.

                TypeCodeableConcept
                Is Modifierfalse
                Summarytrue
                Requirements

                A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                100. MedicationRequest.dosageInstruction.route.coding
                Definition

                A reference to a code defined by a terminology system.

                ShortCode defined by a terminology system
                Comments

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

                Control0..*
                TypeCoding
                Is Modifierfalse
                Summarytrue
                Requirements

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

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                102. MedicationRequest.dosageInstruction.route.coding.system
                Definition

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

                ShortIdentity of the terminology system
                Comments

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

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

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

                Pattern Valuehttp://va.gov/terminology/vistaDefinedTerms/53.1-3
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                104. MedicationRequest.dosageInstruction.route.coding.code
                Definition

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

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

                Need to refer to a particular code in the system.

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

                The amount of medication administered.

                ShortAmount of medication administered
                Control0..*
                TypeElement
                Is Modifierfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                108. MedicationRequest.dosageInstruction.doseAndRate.extension:originalText
                Slice NameoriginalText
                Definition

                A human language representation of the concept (resource/element) as seen/selected/uttered by the user who entered the data and/or which represents the full intended meaning of the user. This can be provided either directly as text, or as a url that is a reference to a portion of the narrative of a resource (DomainResource.text or Composition.section.text). When it a url, the value should end with a #{id} where the id identifies a specific portion of the referenced content (via an XHTML id attribute).

                ShortOriginal Text that represents the data as seen/selected/uttered originally
                Comments

                The data in the element does not always capture the correct meaning with all the nuances of the original text. In these cases, the text is used to capture the full meaning of the source. This is commonly used to provide "what did the user actually see/type". Note that this extension has the same definition as CodeableConcept.text and SHALL NOT be used on CodeableConcept with type = string in place of CodeableConcept.text but MAY be used with type url. If present on a CodeableConcept with type url as well as CodeableConcept.text, then the CodeableConcept.text SHALL match the referenced narrative.

                It's also possible to link to the resource narrative using the narrativeLink extension which does not claim that the data is derived from the text.

                Control0..1
                TypeExtension(Original Text) (Extension Type: Choice of: string, url)
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                110. MedicationRequest.dosageInstruction.doseAndRate.extension:originalText.extension
                Definition

                An Extension


                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                ShortExtensionAdditional content defined by implementations
                Comments

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

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

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

                  Shortidentifies the meaning of the extension
                  Comments

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

                  Control1..1
                  Typeuri
                  Is Modifierfalse
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Summaryfalse
                  Fixed Valuehttp://hl7.org/fhir/StructureDefinition/originalText
                  114. MedicationRequest.dosageInstruction.doseAndRate.extension:originalText.value[x]
                  Definition

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


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

                  ShortValue of extension
                  Control10..1
                  This element is affected by the following invariants: ext-1
                  TypeChoice of: string, url, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Must Support TypesNo must-support rules about the choice of types/profiles
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  mro-27-841: If not a number then source value from (52-113 > 52.0113-.01) (true)
                  ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  116. MedicationRequest.dosageInstruction.doseAndRate.dose[x]
                  Definition

                  Amount of medication per dose.

                  ShortAmount 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.

                  Control0..1
                  TypeChoice of: Range, Quantity(SimpleQuantity)
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Summarytrue
                  Requirements

                  The amount of therapeutic or other substance given at one administration event.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  SlicingThis element introduces a set of slices on MedicationRequest.dosageInstruction.doseAndRate.dose[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • type @ $this
                  • 118. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity
                    Slice NamedoseQuantity
                    Definition

                    Amount of medication per dose.

                    ShortAmount 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.

                    Control0..1
                    TypeQuantity(SimpleQuantity), Range
                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                    Is Modifierfalse
                    Summarytrue
                    Requirements

                    The amount of therapeutic or other substance given at one administration event.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    120. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.value
                    Definition

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

                    ShortNumerical value (with implicit precision)
                    Comments

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

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

                    Precision is handled implicitly in almost all cases of measurement.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    mro-27-811: If number then source value from (52-113 > 52.0113-.01) (true)
                    122. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.comparator
                    Definition

                    Not allowed to be used in this context


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

                    Short< | <= | >= | > - how to understand the value
                    Control0..01
                    BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
                    (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                    How the Quantity should be understood and represented.

                    Typecode
                    Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Requirements

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

                    Meaning if MissingIf there is no comparator, then there is no modification of the value
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    124. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.unit
                    Definition

                    A human-readable form of the unit.

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

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

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    126. 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.

                    ShortMedication supply authorization
                    Control0..1
                    TypeBackboneElement
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    128. MedicationRequest.dispenseRequest.modifierExtension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

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

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

                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

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

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

                    ShortTime 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.

                    Control0..1
                    TypePeriod
                    Is Modifierfalse
                    Summaryfalse
                    Requirements

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

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    132. MedicationRequest.dispenseRequest.validityPeriod.end
                    Definition

                    The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

                    ShortEnd time with inclusive boundary, if not ongoing
                    Comments

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

                    Control0..1
                    This element is affected by the following invariants: per-1
                    TypedateTime
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supporttrue
                    Summarytrue
                    Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    134. 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.

                    ShortNumber of refills authorized
                    Comments

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

                    Control0..1
                    TypeunsignedInt
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supporttrue
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    136. MedicationRequest.dispenseRequest.quantity
                    Definition

                    The amount that is to be dispensed for one fill.

                    ShortAmount of medication to supply per dispense
                    Control0..1
                    TypeQuantity(SimpleQuantity)
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    138. MedicationRequest.dispenseRequest.quantity.value
                    Definition

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

                    ShortNumerical value (with implicit precision)
                    Comments

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

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

                    Precision is handled implicitly in almost all cases of measurement.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    140. MedicationRequest.dispenseRequest.quantity.comparator
                    Definition

                    Not allowed to be used in this context


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

                    Short< | <= | >= | > - how to understand the value
                    Control0..01
                    BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
                    (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                    How the Quantity should be understood and represented.

                    Typecode
                    Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Requirements

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

                    Meaning if MissingIf there is no comparator, then there is no modification of the value
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    142. 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.

                    ShortNumber 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.

                    Control0..1
                    TypeDuration
                    Is Modifierfalse
                    Must Supporttrue
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

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

                    0. MedicationRequest
                    Complies with ProfileThis profile complies with the profile
                    • http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest|6.1.0
                    • http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest|7.0.0
                    2. MedicationRequest.id
                    Must Supporttrue
                    4. MedicationRequest.extension
                    SlicingThis element introduces a set of slices on MedicationRequest.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ url
                    • 6. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus
                      Slice Namemedicationrequest-pharmacyOrderStatus
                      Control0..1
                      TypeExtension(MedicationRequestPharmacyOrderStatus) (Extension Type: Coding)
                      8. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x]
                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                      10. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].system
                      Must Supporttrue
                      Pattern Valuehttp://va.gov/terminology/vistaDefinedTerms/52-100
                      Invariantsmro-27-1746-1: If P then fixed value http://va.gov/terminology/vistaDefinedTerms/52-100 (true)
                      12. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].code
                      Must Supporttrue
                      Invariantsmro-27-1746: If (52-11) is P then fixed value #active-parked (true)
                      14. MedicationRequest.extension:medicationrequest-cancelDate
                      Slice Namemedicationrequest-cancelDate
                      Control0..1
                      TypeExtension(MedicationRequestCancelDate) (Extension Type: dateTime)
                      16. MedicationRequest.extension:medicationrequest-cancelDate.value[x]
                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                      Must Supporttrue
                      18. MedicationRequest.extension:medicationrequest-includeIndicationInSig
                      Slice Namemedicationrequest-includeIndicationInSig
                      Control0..1
                      TypeExtension(MedicationRequestIncludeIndicationInSig) (Extension Type: boolean)
                      20. MedicationRequest.extension:medicationrequest-includeIndicationInSig.value[x]
                      Comments

                      see mapping VF_Boolean

                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                      Must Supporttrue
                      22. MedicationRequest.extension:medicationrequest-remainingRefillCount
                      Slice Namemedicationrequest-remainingRefillCount
                      Control0..1
                      TypeExtension(MedicationrequestRemainingRefillCount) (Extension Type: integer)
                      24. MedicationRequest.extension:medicationrequest-remainingRefillCount.value[x]
                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                      Must Supporttrue
                      26. MedicationRequest.identifier
                      NoteThis is a business identifier, not a resource identifier (see discussion)
                      28. MedicationRequest.identifier.type
                      Must Supporttrue
                      Pattern Value{
                        "coding" : [{
                          "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                          "code" : "FILL"
                        }]
                      }
                      30. MedicationRequest.identifier.value
                      Must Supporttrue
                      32. MedicationRequest.status
                      BindingThe codes SHALL be taken from OutMedRequestStatus FHIR
                      (required to http://va.gov/fhir/ValueSet/OutMedRequestStatus)

                      see mapping VF_OutMedRequestStatus

                      34. MedicationRequest.intent
                      Pattern Valueorder
                      36. MedicationRequest.category
                      Pattern Value{
                        "coding" : [{
                          "system" : "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                          "code" : "outpatient"
                        }]
                      }
                      38. MedicationRequest.medication[x]
                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                      SlicingThis element introduces a set of slices on MedicationRequest.medication[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • type @ $this
                      • 40. MedicationRequest.medication[x]:medicationCodeableConcept
                        Slice NamemedicationCodeableConcept
                        Control0..1
                        TypeCodeableConcept
                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        42. MedicationRequest.medication[x]:medicationCodeableConcept.coding
                        44. MedicationRequest.medication[x]:medicationCodeableConcept.coding.system
                        Must Supporttrue
                        Pattern Valuehttp://www.nlm.nih.gov/research/umls/rxnorm
                        46. MedicationRequest.medication[x]:medicationCodeableConcept.coding.code
                        Must Supporttrue
                        48. MedicationRequest.medication[x]:medicationCodeableConcept.text
                        Must Supporttrue
                        50. MedicationRequest.subject
                        TypeReference(Patient)
                        52. MedicationRequest.authoredOn
                        54. MedicationRequest.requester
                        TypeReference(Practitioner)
                        56. MedicationRequest.reasonCode
                        58. MedicationRequest.reasonCode.text
                        Must Supporttrue
                        60. MedicationRequest.dosageInstruction
                        62. MedicationRequest.dosageInstruction.text
                        64. MedicationRequest.dosageInstruction.patientInstruction
                        Must Supporttrue
                        66. MedicationRequest.dosageInstruction.route
                        68. MedicationRequest.dosageInstruction.route.coding
                        70. MedicationRequest.dosageInstruction.route.coding.system
                        Must Supporttrue
                        Pattern Valuehttp://va.gov/terminology/vistaDefinedTerms/53.1-3
                        72. MedicationRequest.dosageInstruction.route.coding.code
                        Must Supporttrue
                        74. MedicationRequest.dosageInstruction.doseAndRate
                        76. MedicationRequest.dosageInstruction.doseAndRate.extension:originalText
                        Slice NameoriginalText
                        Control0..1
                        TypeExtension(Original Text) (Extension Type: Choice of: string, url)
                        78. MedicationRequest.dosageInstruction.doseAndRate.extension:originalText.value[x]
                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        Must Supporttrue
                        Invariantsmro-27-841: If not a number then source value from (52-113 > 52.0113-.01) (true)
                        80. MedicationRequest.dosageInstruction.doseAndRate.dose[x]
                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        SlicingThis 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
                        • 82. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity
                          Slice NamedoseQuantity
                          Control0..1
                          TypeQuantity(SimpleQuantity)
                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                          84. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.value
                          Must Supporttrue
                          Invariantsmro-27-811: If number then source value from (52-113 > 52.0113-.01) (true)
                          86. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.unit
                          Must Supporttrue
                          88. MedicationRequest.dispenseRequest
                          90. MedicationRequest.dispenseRequest.validityPeriod
                          92. MedicationRequest.dispenseRequest.validityPeriod.end
                          Must Supporttrue
                          94. MedicationRequest.dispenseRequest.numberOfRepeatsAllowed
                          Must Supporttrue
                          96. MedicationRequest.dispenseRequest.quantity
                          98. MedicationRequest.dispenseRequest.quantity.value
                          Must Supporttrue
                          100. MedicationRequest.dispenseRequest.expectedSupplyDuration
                          Must Supporttrue

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

                          0. MedicationRequest
                          Definition

                          -

                          ShortOrdering of medication for patient or group
                          Comments

                          -

                          Control0..*
                          Is Modifierfalse
                          Must Supportfalse
                          Complies with ProfileThis profile complies with the profile
                          • http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest|6.1.0
                          • http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest|7.0.0
                          Summaryfalse
                          Alternate NamesPrescription, Order
                          Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                          dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
                          dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
                          dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                          dom-6: A resource should have narrative for robust management (text.`div`.exists())
                          2. MedicationRequest.id
                          Definition

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

                          ShortLogical id of this artifact
                          Comments

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

                          Control0..1
                          Typeid
                          Is Modifierfalse
                          Must Supporttrue
                          Summarytrue
                          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.

                          ShortMetadata about the resource
                          Control0..1
                          TypeMeta
                          Is Modifierfalse
                          Summarytrue
                          Invariantsele-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.

                          ShortA set of rules under which this content was created
                          Comments

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

                          Control0..1
                          Typeuri
                          Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          8. MedicationRequest.language
                          Definition

                          The base language in which the resource is written.

                          ShortLanguage of the resource content
                          Comments

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

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

                          A human language.

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

                          ShortText summary of the resource, for human interpretation
                          Comments

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

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

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

                          ShortContained, inline Resources
                          Comments

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

                          Control0..*
                          TypeResource
                          Is Modifierfalse
                          Summaryfalse
                          Alternate Namesinline resources, anonymous resources, contained resources
                          14. MedicationRequest.extension
                          Definition

                          An Extension

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

                            Extension medicationrequest-pharmacyOrderStatus

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

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

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

                            An Extension

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

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

                              Shortidentifies the meaning of the extension
                              Comments

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

                              Control1..1
                              Typeuri
                              Is Modifierfalse
                              XML FormatIn the XML format, this property is represented as an attribute.
                              Summaryfalse
                              Fixed Valuehttp://va.gov/fhir/StructureDefinition/medicationrequest-pharmacyOrderStatus
                              24. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x]
                              Definition

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

                              ShortValue of extension
                              Control0..1
                              TypeCoding
                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              26. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].id
                              Definition

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

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

                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                              ShortAdditional content defined by implementations
                              Comments

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

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

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

                                ShortIdentity of the terminology system
                                Comments

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

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

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

                                Pattern Valuehttp://va.gov/terminology/vistaDefinedTerms/52-100
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                mro-27-1746-1: If P then fixed value http://va.gov/terminology/vistaDefinedTerms/52-100 (true)
                                32. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].version
                                Definition

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

                                ShortVersion of the system - if relevant
                                Comments

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

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

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

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

                                Need to refer to a particular code in the system.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                mro-27-1746: If (52-11) is P then fixed value #active-parked (true)
                                36. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].display
                                Definition

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

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

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

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                38. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].userSelected
                                Definition

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

                                ShortIf this coding was chosen directly by the user
                                Comments

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

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

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

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                40. MedicationRequest.extension:medicationrequest-cancelDate
                                Slice Namemedicationrequest-cancelDate
                                Definition

                                Extension medicationrequest-cancelDate

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

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

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

                                An Extension

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

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

                                  Shortidentifies the meaning of the extension
                                  Comments

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

                                  Control1..1
                                  Typeuri
                                  Is Modifierfalse
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  Summaryfalse
                                  Fixed Valuehttp://va.gov/fhir/StructureDefinition/medicationrequest-cancelDate
                                  48. MedicationRequest.extension:medicationrequest-cancelDate.value[x]
                                  Definition

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

                                  ShortValue of extension
                                  Control0..1
                                  TypedateTime
                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Must Supporttrue
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  50. MedicationRequest.extension:medicationrequest-includeIndicationInSig
                                  Slice Namemedicationrequest-includeIndicationInSig
                                  Definition

                                  Extension medicationrequest-includeIndicationInSig

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

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

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

                                  An Extension

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

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

                                    Shortidentifies the meaning of the extension
                                    Comments

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

                                    Control1..1
                                    Typeuri
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    Fixed Valuehttp://va.gov/fhir/StructureDefinition/medicationrequest-includeIndicationInSig
                                    58. MedicationRequest.extension:medicationrequest-includeIndicationInSig.value[x]
                                    Definition

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

                                    ShortValue of extension
                                    Comments

                                    see mapping VF_Boolean

                                    Control0..1
                                    Typeboolean
                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Must Supporttrue
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    60. MedicationRequest.extension:medicationrequest-remainingRefillCount
                                    Slice Namemedicationrequest-remainingRefillCount
                                    Definition

                                    Extension medicationrequest-remainingRefillCount

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

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

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

                                    An Extension

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

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

                                      Shortidentifies the meaning of the extension
                                      Comments

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

                                      Control1..1
                                      Typeuri
                                      Is Modifierfalse
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      Summaryfalse
                                      Fixed Valuehttp://va.gov/fhir/StructureDefinition/medicationrequest-remainingRefillCount
                                      68. MedicationRequest.extension:medicationrequest-remainingRefillCount.value[x]
                                      Definition

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

                                      ShortValue of extension
                                      Control0..1
                                      Typeinteger
                                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Must Supporttrue
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      70. MedicationRequest.modifierExtension
                                      Definition

                                      May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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

                                      ShortExtensions that cannot be ignored
                                      Comments

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

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

                                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                      Alternate Namesextensions, user content
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      72. 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.

                                      ShortExternal ids for this request
                                      Comments

                                      This is a business identifier, not a resource identifier.

                                      NoteThis is a business identifier, not a resource identifier (see discussion)
                                      Control0..*
                                      TypeIdentifier
                                      Is Modifierfalse
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      74. MedicationRequest.identifier.id
                                      Definition

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

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

                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                      ShortAdditional content defined by implementations
                                      Comments

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

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

                                        The purpose of this identifier.

                                        Shortusual | official | temp | secondary | old (If known)
                                        Comments

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

                                        Control0..1
                                        BindingThe codes SHALL be taken from IdentifierUse
                                        (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                                        Identifies the purpose for this identifier, if known .

                                        Typecode
                                        Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        Requirements

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

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

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

                                        ShortDescription of identifier
                                        Comments

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

                                        Control0..1
                                        BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                                        (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

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

                                        TypeCodeableConcept
                                        Is Modifierfalse
                                        Must Supporttrue
                                        Summarytrue
                                        Requirements

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

                                        Pattern Value{
                                          "coding" : [{
                                            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                                            "code" : "FILL"
                                          }]
                                        }
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        82. MedicationRequest.identifier.system
                                        Definition

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

                                        ShortThe namespace for the identifier value
                                        Comments

                                        Identifier.system is always case sensitive.

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

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

                                        Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        84. MedicationRequest.identifier.value
                                        Definition

                                        The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                                        ShortThe value that is unique
                                        Comments

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

                                        Control0..1
                                        Typestring
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Must Supporttrue
                                        Summarytrue
                                        Example<br/><b>General</b>:123456
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        86. MedicationRequest.identifier.period
                                        Definition

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

                                        ShortTime period when id is/was valid for use
                                        Control0..1
                                        TypePeriod
                                        Is Modifierfalse
                                        Summarytrue
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        88. MedicationRequest.identifier.assigner
                                        Definition

                                        Organization that issued/manages the identifier.

                                        ShortOrganization that issued id (may be just text)
                                        Comments

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

                                        Control0..1
                                        TypeReference(Organization)
                                        Is Modifierfalse
                                        Summarytrue
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        90. MedicationRequest.status
                                        Definition

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

                                        Shortactive | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
                                        Comments

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

                                        Control1..1
                                        BindingThe codes SHALL be taken from OutMedRequestStatus FHIR
                                        (required to http://va.gov/fhir/ValueSet/OutMedRequestStatus)

                                        see mapping VF_OutMedRequestStatus

                                        Typecode
                                        Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Must Supporttrue
                                        Summarytrue
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        92. MedicationRequest.statusReason
                                        Definition

                                        Captures the reason for the current state of the MedicationRequest.

                                        ShortReason 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.

                                        Control0..1
                                        BindingFor example codes, see medicationRequest Status Reason Codes
                                        (example to http://hl7.org/fhir/ValueSet/medicationrequest-status-reason)

                                        Identifies the reasons for a given status.

                                        TypeCodeableConcept
                                        Is Modifierfalse
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        94. MedicationRequest.intent
                                        Definition

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

                                        Shortproposal | 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.

                                        Control1..1
                                        BindingThe codes SHALL be taken from medicationRequest Intent
                                        (required to http://hl7.org/fhir/ValueSet/medicationrequest-intent)

                                        The kind of medication order.

                                        Typecode
                                        Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Must Supporttrue
                                        Summarytrue
                                        Pattern Valueorder
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        96. MedicationRequest.category
                                        Definition

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

                                        ShortType of medication usage
                                        Comments

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

                                        Control0..*
                                        BindingFor example codes, see medicationRequest Category Codes
                                        (example to http://hl7.org/fhir/ValueSet/medicationrequest-category)

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

                                        TypeCodeableConcept
                                        Is Modifierfalse
                                        Must Supporttrue
                                        Summaryfalse
                                        Pattern Value{
                                          "coding" : [{
                                            "system" : "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                                            "code" : "outpatient"
                                          }]
                                        }
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        SlicingThis element introduces a set of slices on MedicationRequest.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                        • pattern @ $this
                                        • 98. MedicationRequest.category:us-core
                                          Slice Nameus-core
                                          Definition

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

                                          ShortType of medication usage
                                          Comments

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

                                          Control0..*
                                          BindingThe codes SHALL be taken from medicationRequest Category Codes
                                          (required to http://hl7.org/fhir/ValueSet/medicationrequest-category)

                                          The type of medication order.

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

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

                                          Shortroutine | urgent | asap | stat
                                          Control0..1
                                          BindingThe codes SHALL be taken from RequestPriority
                                          (required to http://hl7.org/fhir/ValueSet/request-priority|4.0.1)

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

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

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

                                          ShortTrue if request is prohibiting action
                                          Comments

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

                                          Control0..1
                                          Typeboolean
                                          Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summarytrue
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          104. MedicationRequest.reported[x]
                                          Definition

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

                                          ShortReported rather than primary record
                                          Control0..1
                                          TypeChoice of: boolean, Reference(US Core Practitioner Profile, US Core Organization Profile, US Core Patient Profile, US Core PractitionerRole Profile, US Core RelatedPerson Profile)
                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Must Supporttrue
                                          Must Support TypesChoice of: boolean, Reference(US Core Practitioner Profile)
                                          Summarytrue
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          106. MedicationRequest.medication[x]
                                          Definition

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

                                          ShortMedication 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.

                                          Control1..1
                                          BindingUnless not suitable, these codes SHALL be taken from Medication Clinical Drug .
                                          (extensible to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4)
                                          TypeChoice of: CodeableConcept, Reference(US Core Medication Profile)
                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Must Support TypesNo must-support rules about the choice of types/profiles
                                          Summarytrue
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          SlicingThis element introduces a set of slices on MedicationRequest.medication[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                          • type @ $this
                                          • 108. MedicationRequest.medication[x]:medicationCodeableConcept
                                            Slice NamemedicationCodeableConcept
                                            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.

                                            ShortMedication 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.

                                            Control0..1
                                            BindingUnless not suitable, these codes SHALL be taken from Medication Clinical Drug .
                                            (extensible to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4)
                                            TypeCodeableConcept
                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                            Is Modifierfalse
                                            Must Supporttrue
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            110. MedicationRequest.medication[x]:medicationCodeableConcept.id
                                            Definition

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

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

                                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                            ShortAdditional content defined by implementations
                                            Comments

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

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

                                              A reference to a code defined by a terminology system.

                                              ShortCode defined by a terminology system
                                              Comments

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

                                              Control0..*
                                              TypeCoding
                                              Is Modifierfalse
                                              Summarytrue
                                              Requirements

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

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              116. MedicationRequest.medication[x]:medicationCodeableConcept.coding.id
                                              Definition

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

                                              ShortUnique id for inter-element referencing
                                              Control0..1
                                              Typestring
                                              Is Modifierfalse
                                              XML FormatIn the XML format, this property is represented as an attribute.
                                              Summaryfalse
                                              118. MedicationRequest.medication[x]:medicationCodeableConcept.coding.extension
                                              Definition

                                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                              ShortAdditional content defined by implementations
                                              Comments

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

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

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

                                                ShortIdentity of the terminology system
                                                Comments

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

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

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

                                                Pattern Valuehttp://www.nlm.nih.gov/research/umls/rxnorm
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                122. MedicationRequest.medication[x]:medicationCodeableConcept.coding.version
                                                Definition

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

                                                ShortVersion of the system - if relevant
                                                Comments

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

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

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

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

                                                Need to refer to a particular code in the system.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                126. MedicationRequest.medication[x]:medicationCodeableConcept.coding.display
                                                Definition

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

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

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

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                128. MedicationRequest.medication[x]:medicationCodeableConcept.coding.userSelected
                                                Definition

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

                                                ShortIf this coding was chosen directly by the user
                                                Comments

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

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

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

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                130. MedicationRequest.medication[x]:medicationCodeableConcept.text
                                                Definition

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

                                                ShortPlain text representation of the concept
                                                Comments

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

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

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

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

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

                                                ShortWho or group medication request is for
                                                Comments

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

                                                Control1..1
                                                TypeReference(Patient)
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summarytrue
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                134. MedicationRequest.encounter
                                                Definition

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

                                                ShortEncounter 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.

                                                Control0..1
                                                TypeReference(US Core Encounter Profile)
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summaryfalse
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                136. MedicationRequest.supportingInformation
                                                Definition

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

                                                ShortInformation to support ordering of the medication
                                                Control0..*
                                                TypeReference(Resource)
                                                Is Modifierfalse
                                                Summaryfalse
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                138. MedicationRequest.authoredOn
                                                Definition

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

                                                ShortWhen request was initially authored
                                                Control0..1
                                                TypedateTime
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Summarytrue
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                140. MedicationRequest.requester
                                                Definition

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

                                                ShortWho/What requested the Request
                                                Control1..1
                                                TypeReference(Practitioner)
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Summarytrue
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                142. MedicationRequest.performer
                                                Definition

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

                                                ShortIntended performer of administration
                                                Control0..1
                                                TypeReference(Practitioner, PractitionerRole, Organization, Patient, Device, RelatedPerson, CareTeam)
                                                Is Modifierfalse
                                                Summaryfalse
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                144. MedicationRequest.performerType
                                                Definition

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

                                                ShortDesired 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.

                                                Control0..1
                                                BindingFor example codes, see ProcedurePerformerRoleCodes
                                                (example to http://hl7.org/fhir/ValueSet/performer-role)

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

                                                TypeCodeableConcept
                                                Is Modifierfalse
                                                Summarytrue
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                146. 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.

                                                ShortPerson who entered the request
                                                Control0..1
                                                TypeReference(Practitioner, PractitionerRole)
                                                Is Modifierfalse
                                                Summaryfalse
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                148. MedicationRequest.reasonCode
                                                Definition

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

                                                ShortReason 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.

                                                Control0..*
                                                BindingFor example codes, see Condition/Problem/DiagnosisCodes
                                                (example to http://hl7.org/fhir/ValueSet/condition-code)

                                                A coded concept indicating why the medication was ordered.

                                                TypeCodeableConcept
                                                Is Modifierfalse
                                                Summaryfalse
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                150. MedicationRequest.reasonCode.id
                                                Definition

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

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

                                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                ShortAdditional content defined by implementations
                                                Comments

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

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

                                                  A reference to a code defined by a terminology system.

                                                  ShortCode defined by a terminology system
                                                  Comments

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

                                                  Control0..*
                                                  TypeCoding
                                                  Is Modifierfalse
                                                  Summarytrue
                                                  Requirements

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

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

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

                                                  ShortPlain text representation of the concept
                                                  Comments

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

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

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

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

                                                  Condition or observation that supports why the medication was ordered.

                                                  ShortCondition or observation that supports why the prescription is being written
                                                  Comments

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

                                                  Control0..*
                                                  TypeReference(Condition, Observation)
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  160. MedicationRequest.instantiatesCanonical
                                                  Definition

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

                                                  ShortInstantiates FHIR protocol or definition
                                                  Control0..*
                                                  Typecanonical
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  162. MedicationRequest.instantiatesUri
                                                  Definition

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

                                                  ShortInstantiates external protocol or definition
                                                  Control0..*
                                                  Typeuri
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  164. MedicationRequest.basedOn
                                                  Definition

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

                                                  ShortWhat request fulfills
                                                  Control0..*
                                                  TypeReference(CarePlan, MedicationRequest, ServiceRequest, ImmunizationRecommendation)
                                                  Is Modifierfalse
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  166. MedicationRequest.groupIdentifier
                                                  Definition

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

                                                  ShortComposite request this is part of
                                                  Control0..1
                                                  TypeIdentifier
                                                  Is Modifierfalse
                                                  Summarytrue
                                                  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.

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

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

                                                  ShortOverall pattern of medication administration
                                                  Comments

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

                                                  Control0..1
                                                  BindingFor example codes, see medicationRequest Course of Therapy Codes
                                                  (example to http://hl7.org/fhir/ValueSet/medicationrequest-course-of-therapy)

                                                  Identifies the overall pattern of medication administratio.

                                                  TypeCodeableConcept
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  170. MedicationRequest.insurance
                                                  Definition

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

                                                  ShortAssociated insurance coverage
                                                  Control0..*
                                                  TypeReference(Coverage, ClaimResponse)
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  172. MedicationRequest.note
                                                  Definition

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

                                                  ShortInformation about the prescription
                                                  Control0..*
                                                  TypeAnnotation
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  174. MedicationRequest.dosageInstruction
                                                  Definition

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

                                                  ShortHow 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.

                                                  Control0..*
                                                  TypeDosage
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  176. 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.

                                                  ShortUnique id for inter-element referencing
                                                  Control0..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  Summaryfalse
                                                  178. 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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                  ShortAdditional content defined by implementations
                                                  Comments

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

                                                  Control0..*
                                                  TypeExtension
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Alternate Namesextensions, user content
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                  SlicingThis element introduces a set of slices on MedicationRequest.dosageInstruction.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                  • value @ url
                                                  • 180. 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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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

                                                    ShortExtensions that cannot be ignored even if unrecognized
                                                    Comments

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

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

                                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

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

                                                    Indicates the order in which the dosage instructions should be applied or interpreted.

                                                    ShortThe order of the dosage instructions
                                                    Control0..1
                                                    Typeinteger
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summarytrue
                                                    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.

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

                                                    Free text dosage instructions e.g. SIG.

                                                    ShortFree text dosage instructions e.g. SIG
                                                    Control0..1
                                                    Typestring
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Must Supporttrue
                                                    Summarytrue
                                                    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.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    186. 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").

                                                    ShortSupplemental 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 "immediately following drug x") should be populated in dosage.text.

                                                    Control0..*
                                                    BindingFor 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".

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summarytrue
                                                    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.

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

                                                    Instructions in terms that are understood by the patient or consumer.

                                                    ShortPatient or consumer oriented instructions
                                                    Control0..1
                                                    Typestring
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Must Supporttrue
                                                    Summarytrue
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    190. MedicationRequest.dosageInstruction.timing
                                                    Definition

                                                    When medication should be administered.

                                                    ShortWhen 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.

                                                    Control0..1
                                                    TypeTiming
                                                    Is Modifierfalse
                                                    Summarytrue
                                                    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.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    192. MedicationRequest.dosageInstruction.asNeeded[x]
                                                    Definition

                                                    Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept).

                                                    ShortTake "as needed" (for x)
                                                    Comments

                                                    Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not "prn" or "as needed".

                                                    Control0..1
                                                    BindingFor 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.

                                                    TypeChoice of: boolean, CodeableConcept
                                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summarytrue
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    194. MedicationRequest.dosageInstruction.site
                                                    Definition

                                                    Body site to administer to.

                                                    ShortBody 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 bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.

                                                    Control0..1
                                                    BindingFor example codes, see SNOMEDCTAnatomicalStructureForAdministrationSiteCodes
                                                    (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.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summarytrue
                                                    Requirements

                                                    A coded specification of the anatomic site where the medication first enters the body.

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

                                                    How drug should enter body.

                                                    ShortHow drug should enter body
                                                    Control0..1
                                                    BindingFor 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.

                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summarytrue
                                                    Requirements

                                                    A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.

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

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

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

                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                    ShortAdditional content defined by implementations
                                                    Comments

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

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

                                                      A reference to a code defined by a terminology system.

                                                      ShortCode defined by a terminology system
                                                      Comments

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

                                                      Control0..*
                                                      TypeCoding
                                                      Is Modifierfalse
                                                      Summarytrue
                                                      Requirements

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

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      204. MedicationRequest.dosageInstruction.route.coding.id
                                                      Definition

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

                                                      ShortUnique id for inter-element referencing
                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                      Summaryfalse
                                                      206. MedicationRequest.dosageInstruction.route.coding.extension
                                                      Definition

                                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                      ShortAdditional content defined by implementations
                                                      Comments

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

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

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

                                                        ShortIdentity of the terminology system
                                                        Comments

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

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

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

                                                        Pattern Valuehttp://va.gov/terminology/vistaDefinedTerms/53.1-3
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        210. MedicationRequest.dosageInstruction.route.coding.version
                                                        Definition

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

                                                        ShortVersion of the system - if relevant
                                                        Comments

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

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

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

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

                                                        Need to refer to a particular code in the system.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        214. MedicationRequest.dosageInstruction.route.coding.display
                                                        Definition

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

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

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

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        216. MedicationRequest.dosageInstruction.route.coding.userSelected
                                                        Definition

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

                                                        ShortIf this coding was chosen directly by the user
                                                        Comments

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

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

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

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        218. MedicationRequest.dosageInstruction.route.text
                                                        Definition

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

                                                        ShortPlain text representation of the concept
                                                        Comments

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

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

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

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

                                                        Technique for administering medication.

                                                        ShortTechnique for administering medication
                                                        Comments

                                                        Terminologies used often pre-coordinate this term with the route and or form of administration.

                                                        Control0..1
                                                        BindingFor 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.

                                                        TypeCodeableConcept
                                                        Is Modifierfalse
                                                        Summarytrue
                                                        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.

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

                                                        The amount of medication administered.

                                                        ShortAmount of medication administered
                                                        Control0..*
                                                        TypeElement
                                                        Is Modifierfalse
                                                        Summarytrue
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        224. 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.

                                                        ShortUnique id for inter-element referencing
                                                        Control0..1
                                                        Typestring
                                                        Is Modifierfalse
                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                        Summaryfalse
                                                        226. 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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                        ShortAdditional content defined by implementations
                                                        Comments

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

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

                                                          A human language representation of the concept (resource/element) as seen/selected/uttered by the user who entered the data and/or which represents the full intended meaning of the user. This can be provided either directly as text, or as a url that is a reference to a portion of the narrative of a resource (DomainResource.text or Composition.section.text). When it a url, the value should end with a #{id} where the id identifies a specific portion of the referenced content (via an XHTML id attribute).

                                                          ShortOriginal Text that represents the data as seen/selected/uttered originally
                                                          Comments

                                                          The data in the element does not always capture the correct meaning with all the nuances of the original text. In these cases, the text is used to capture the full meaning of the source. This is commonly used to provide "what did the user actually see/type". Note that this extension has the same definition as CodeableConcept.text and SHALL NOT be used on CodeableConcept with type = string in place of CodeableConcept.text but MAY be used with type url. If present on a CodeableConcept with type url as well as CodeableConcept.text, then the CodeableConcept.text SHALL match the referenced narrative.

                                                          It's also possible to link to the resource narrative using the narrativeLink extension which does not claim that the data is derived from the text.

                                                          Control0..1
                                                          TypeExtension(Original Text) (Extension Type: Choice of: string, url)
                                                          Is Modifierfalse
                                                          Summaryfalse
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                          230. MedicationRequest.dosageInstruction.doseAndRate.extension:originalText.id
                                                          Definition

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

                                                          ShortUnique id for inter-element referencing
                                                          Control0..1
                                                          This element is affected by the following invariants: ele-1
                                                          Typeid
                                                          Is Modifierfalse
                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                          Summaryfalse
                                                          232. MedicationRequest.dosageInstruction.doseAndRate.extension:originalText.extension
                                                          Definition

                                                          An Extension

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

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

                                                            Shortidentifies the meaning of the extension
                                                            Comments

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

                                                            Control1..1
                                                            Typeuri
                                                            Is Modifierfalse
                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                            Summaryfalse
                                                            Fixed Valuehttp://hl7.org/fhir/StructureDefinition/originalText
                                                            236. MedicationRequest.dosageInstruction.doseAndRate.extension:originalText.value[x]
                                                            Definition

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

                                                            ShortValue of extension
                                                            Control1..1
                                                            This element is affected by the following invariants: ext-1
                                                            TypeChoice of: string, url
                                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                            Is Modifierfalse
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Must Supporttrue
                                                            Must Support TypesNo must-support rules about the choice of types/profiles
                                                            Summaryfalse
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            mro-27-841: If not a number then source value from (52-113 > 52.0113-.01) (true)
                                                            238. MedicationRequest.dosageInstruction.doseAndRate.type
                                                            Definition

                                                            The kind of dose or rate specified, for example, ordered or calculated.

                                                            ShortThe kind of dose or rate specified
                                                            Control0..1
                                                            BindingFor example codes, see DoseAndRateType
                                                            (example to http://hl7.org/fhir/ValueSet/dose-rate-type)

                                                            The kind of dose or rate specified.

                                                            TypeCodeableConcept
                                                            Is Modifierfalse
                                                            Summarytrue
                                                            Requirements

                                                            If the type is not populated, assume to be "ordered".

                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            240. MedicationRequest.dosageInstruction.doseAndRate.dose[x]
                                                            Definition

                                                            Amount of medication per dose.

                                                            ShortAmount 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.

                                                            Control0..1
                                                            TypeChoice of: Range, Quantity(SimpleQuantity)
                                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                            Is Modifierfalse
                                                            Summarytrue
                                                            Requirements

                                                            The amount of therapeutic or other substance given at one administration event.

                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            SlicingThis element introduces a set of slices on MedicationRequest.dosageInstruction.doseAndRate.dose[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                            • type @ $this
                                                            • 242. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity
                                                              Slice NamedoseQuantity
                                                              Definition

                                                              Amount of medication per dose.

                                                              ShortAmount 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.

                                                              Control0..1
                                                              TypeQuantity(SimpleQuantity)
                                                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                              Is Modifierfalse
                                                              Summarytrue
                                                              Requirements

                                                              The amount of therapeutic or other substance given at one administration event.

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              244. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.id
                                                              Definition

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

                                                              ShortUnique id for inter-element referencing
                                                              Control0..1
                                                              Typestring
                                                              Is Modifierfalse
                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                              Summaryfalse
                                                              246. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.extension
                                                              Definition

                                                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                              ShortAdditional content defined by implementations
                                                              Comments

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

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

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

                                                                ShortNumerical value (with implicit precision)
                                                                Comments

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

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

                                                                Precision is handled implicitly in almost all cases of measurement.

                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                mro-27-811: If number then source value from (52-113 > 52.0113-.01) (true)
                                                                250. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.comparator
                                                                Definition

                                                                Not allowed to be used in this context

                                                                Short< | <= | >= | > - how to understand the value
                                                                Control0..0
                                                                BindingThe codes SHALL be taken from QuantityComparator
                                                                (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                                How the Quantity should be understood and represented.

                                                                Typecode
                                                                Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                Summarytrue
                                                                Requirements

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

                                                                Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                252. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.unit
                                                                Definition

                                                                A human-readable form of the unit.

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

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

                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                254. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.system
                                                                Definition

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

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

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

                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                256. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.code
                                                                Definition

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

                                                                ShortCoded form of the unit
                                                                Comments

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

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

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

                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                258. MedicationRequest.dosageInstruction.doseAndRate.rate[x]
                                                                Definition

                                                                Amount of medication per unit of time.

                                                                ShortAmount 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 grammer 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.

                                                                Control0..1
                                                                TypeChoice of: Ratio, Range, Quantity(SimpleQuantity)
                                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                Is Modifierfalse
                                                                Summarytrue
                                                                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.

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

                                                                Upper limit on medication per unit of time.

                                                                ShortUpper 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".

                                                                Control0..1
                                                                TypeRatio
                                                                Is Modifierfalse
                                                                Summarytrue
                                                                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.

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

                                                                Upper limit on medication per administration.

                                                                ShortUpper 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.

                                                                Control0..1
                                                                TypeQuantity(SimpleQuantity)
                                                                Is Modifierfalse
                                                                Summarytrue
                                                                Requirements

                                                                The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.

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

                                                                Upper limit on medication per lifetime of the patient.

                                                                ShortUpper limit on medication per lifetime of the patient
                                                                Control0..1
                                                                TypeQuantity(SimpleQuantity)
                                                                Is Modifierfalse
                                                                Summarytrue
                                                                Requirements

                                                                The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.

                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                266. 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.

                                                                ShortMedication supply authorization
                                                                Control0..1
                                                                TypeBackboneElement
                                                                Is Modifierfalse
                                                                Summaryfalse
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                268. 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.

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

                                                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                ShortAdditional content defined by implementations
                                                                Comments

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

                                                                Control0..*
                                                                TypeExtension
                                                                Is Modifierfalse
                                                                Summaryfalse
                                                                Alternate Namesextensions, user content
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                272. MedicationRequest.dispenseRequest.modifierExtension
                                                                Definition

                                                                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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

                                                                ShortExtensions that cannot be ignored even if unrecognized
                                                                Comments

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

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

                                                                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

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

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

                                                                ShortFirst fill details
                                                                Comments

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

                                                                Control0..1
                                                                TypeBackboneElement
                                                                Is Modifierfalse
                                                                Summaryfalse
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                276. 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.

                                                                ShortUnique id for inter-element referencing
                                                                Control0..1
                                                                Typestring
                                                                Is Modifierfalse
                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                Summaryfalse
                                                                278. 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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                ShortAdditional content defined by implementations
                                                                Comments

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

                                                                Control0..*
                                                                TypeExtension
                                                                Is Modifierfalse
                                                                Summaryfalse
                                                                Alternate Namesextensions, user content
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                280. 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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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

                                                                ShortExtensions that cannot be ignored even if unrecognized
                                                                Comments

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

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

                                                                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

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

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

                                                                ShortFirst fill quantity
                                                                Control0..1
                                                                TypeQuantity(SimpleQuantity)
                                                                Is Modifierfalse
                                                                Summaryfalse
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                284. MedicationRequest.dispenseRequest.initialFill.duration
                                                                Definition

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

                                                                ShortFirst fill duration
                                                                Control0..1
                                                                TypeDuration
                                                                Is Modifierfalse
                                                                Summaryfalse
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                286. MedicationRequest.dispenseRequest.dispenseInterval
                                                                Definition

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

                                                                ShortMinimum period of time between dispenses
                                                                Control0..1
                                                                TypeDuration
                                                                Is Modifierfalse
                                                                Summaryfalse
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                288. MedicationRequest.dispenseRequest.validityPeriod
                                                                Definition

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

                                                                ShortTime 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.

                                                                Control0..1
                                                                TypePeriod
                                                                Is Modifierfalse
                                                                Summaryfalse
                                                                Requirements

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

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

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

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

                                                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                ShortAdditional content defined by implementations
                                                                Comments

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

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

                                                                  The start of the period. The boundary is inclusive.

                                                                  ShortStarting time with inclusive boundary
                                                                  Comments

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

                                                                  Control0..1
                                                                  This element is affected by the following invariants: per-1
                                                                  TypedateTime
                                                                  Is Modifierfalse
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Summarytrue
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  296. MedicationRequest.dispenseRequest.validityPeriod.end
                                                                  Definition

                                                                  The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

                                                                  ShortEnd time with inclusive boundary, if not ongoing
                                                                  Comments

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

                                                                  Control0..1
                                                                  This element is affected by the following invariants: per-1
                                                                  TypedateTime
                                                                  Is Modifierfalse
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Must Supporttrue
                                                                  Summarytrue
                                                                  Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  298. 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.

                                                                  ShortNumber of refills authorized
                                                                  Comments

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

                                                                  Control0..1
                                                                  TypeunsignedInt
                                                                  Is Modifierfalse
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Must Supporttrue
                                                                  Summaryfalse
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  300. MedicationRequest.dispenseRequest.quantity
                                                                  Definition

                                                                  The amount that is to be dispensed for one fill.

                                                                  ShortAmount of medication to supply per dispense
                                                                  Control0..1
                                                                  TypeQuantity(SimpleQuantity)
                                                                  Is Modifierfalse
                                                                  Summaryfalse
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  302. MedicationRequest.dispenseRequest.quantity.id
                                                                  Definition

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

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

                                                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                  ShortAdditional content defined by implementations
                                                                  Comments

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

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

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

                                                                    ShortNumerical value (with implicit precision)
                                                                    Comments

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

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

                                                                    Precision is handled implicitly in almost all cases of measurement.

                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    308. MedicationRequest.dispenseRequest.quantity.comparator
                                                                    Definition

                                                                    Not allowed to be used in this context

                                                                    Short< | <= | >= | > - how to understand the value
                                                                    Control0..0
                                                                    BindingThe codes SHALL be taken from QuantityComparator
                                                                    (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                                    How the Quantity should be understood and represented.

                                                                    Typecode
                                                                    Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    Summarytrue
                                                                    Requirements

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

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

                                                                    A human-readable form of the unit.

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

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

                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    312. MedicationRequest.dispenseRequest.quantity.system
                                                                    Definition

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

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

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

                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    314. MedicationRequest.dispenseRequest.quantity.code
                                                                    Definition

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

                                                                    ShortCoded form of the unit
                                                                    Comments

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

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

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

                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    316. 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.

                                                                    ShortNumber 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.

                                                                    Control0..1
                                                                    TypeDuration
                                                                    Is Modifierfalse
                                                                    Must Supporttrue
                                                                    Summaryfalse
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    318. MedicationRequest.dispenseRequest.performer
                                                                    Definition

                                                                    Indicates the intended dispensing Organization specified by the prescriber.

                                                                    ShortIntended dispenser
                                                                    Control0..1
                                                                    TypeReference(Organization)
                                                                    Is Modifierfalse
                                                                    Summaryfalse
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    320. 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.

                                                                    ShortAny restrictions on medication substitution
                                                                    Control0..1
                                                                    TypeBackboneElement
                                                                    Is Modifierfalse
                                                                    Summaryfalse
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    322. 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.

                                                                    ShortUnique id for inter-element referencing
                                                                    Control0..1
                                                                    Typestring
                                                                    Is Modifierfalse
                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                    Summaryfalse
                                                                    324. 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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                                    ShortAdditional content defined by implementations
                                                                    Comments

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

                                                                    Control0..*
                                                                    TypeExtension
                                                                    Is Modifierfalse
                                                                    Summaryfalse
                                                                    Alternate Namesextensions, user content
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                                    326. 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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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

                                                                    ShortExtensions that cannot be ignored even if unrecognized
                                                                    Comments

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

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

                                                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

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

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

                                                                    ShortWhether substitution is allowed or not
                                                                    Comments

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

                                                                    Control1..1
                                                                    BindingFor example codes, see ActSubstanceAdminSubstitutionCode
                                                                    (example to http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode)

                                                                    Identifies the type of substitution allowed.

                                                                    TypeChoice of: boolean, CodeableConcept
                                                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                    Is Modifierfalse
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    Summaryfalse
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    330. MedicationRequest.substitution.reason
                                                                    Definition

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

                                                                    ShortWhy should (not) substitution be made
                                                                    Control0..1
                                                                    BindingFor example codes, see SubstanceAdminSubstitutionReason
                                                                    (example to http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason)

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

                                                                    TypeCodeableConcept
                                                                    Is Modifierfalse
                                                                    Summaryfalse
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    332. MedicationRequest.priorPrescription
                                                                    Definition

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

                                                                    ShortAn order/prescription that is being replaced
                                                                    Control0..1
                                                                    TypeReference(MedicationRequest)
                                                                    Is Modifierfalse
                                                                    Summaryfalse
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    334. MedicationRequest.detectedIssue
                                                                    Definition

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

                                                                    ShortClinical Issue with action
                                                                    Comments

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

                                                                    Control0..*
                                                                    TypeReference(DetectedIssue)
                                                                    Is Modifierfalse
                                                                    Summaryfalse
                                                                    Alternate NamesContraindication, Drug Utilization Review (DUR), Alert
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    336. 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.

                                                                    ShortA 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.).

                                                                    Control0..*
                                                                    TypeReference(Provenance)
                                                                    Is Modifierfalse
                                                                    Summaryfalse
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))