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Resource Profile: MedicationRequest: Outpatient

This StructureDefinition contains the maps for VistA file PRESCRIPTION (52) to us-core-medicationrequest.

Usage:

• Refer to this Resource Profile: MedicationDispense: Original, MedicationDispense: Partial and MedicationDispense: Refill
• CapabilityStatements using this Resource Profile: AMPL GUI, Lighthouse Clinical Health API and Lung Cancer Screening

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
• All

Name	Flags	Card.	Type	Description & Constraints
MedicationRequest		0..*	USCoreMedicationRequestProfile(5.0.1)	Ordering of medication for patient or group This profile also complies with the profiles US Core MedicationRequest Profile (6.1.0) and US Core MedicationRequest Profile (7.0.0) dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
id	SΣ	0..1	id	Logical id of this artifact
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:medicationrequest-pharmacyOrderStatus		0..1	(Complex)	Extension URL: http://va.gov/fhir/StructureDefinition/medicationrequest-pharmacyOrderStatus ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension		0..0
url		1..1	uri	"http://va.gov/fhir/StructureDefinition/medicationrequest-pharmacyOrderStatus"
value[x]		0..1	Coding	Value of extension ele-1: All FHIR elements must have a @value or children
system	SΣC	0..1	uri	Identity of the terminology system ele-1: All FHIR elements must have a @value or children mro-27-1746-1: If P then fixed value http://va.gov/terminology/vistaDefinedTerms/52-100 Required Pattern: http://va.gov/terminology/vistaDefinedTerms/52-100
code	SΣC	0..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children mro-27-1746: If (52-11) is P then fixed value #active-parked
extension:medicationrequest-cancelDate		0..1	(Complex)	Extension URL: http://va.gov/fhir/StructureDefinition/medicationrequest-cancelDate ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension		0..0
url		1..1	uri	"http://va.gov/fhir/StructureDefinition/medicationrequest-cancelDate"
value[x]	S	0..1	dateTime	Value of extension ele-1: All FHIR elements must have a @value or children
extension:medicationrequest-includeIndicationInSig		0..1	(Complex)	Extension URL: http://va.gov/fhir/StructureDefinition/medicationrequest-includeIndicationInSig ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension		0..0
url		1..1	uri	"http://va.gov/fhir/StructureDefinition/medicationrequest-includeIndicationInSig"
value[x]	S	0..1	boolean	Value of extension ele-1: All FHIR elements must have a @value or children
extension:medicationrequest-remainingRefillCount		0..1	(Complex)	Extension URL: http://va.gov/fhir/StructureDefinition/medicationrequest-remainingRefillCount ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension		0..0
url		1..1	uri	"http://va.gov/fhir/StructureDefinition/medicationrequest-remainingRefillCount"
value[x]	S	0..1	integer	Value of extension ele-1: All FHIR elements must have a @value or children
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier		0..*	Identifier	External ids for this request ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
type	SΣ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
code		1..1	code	Symbol in syntax defined by the system Fixed Value: FILL
value	SΣ	0..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
status	?!SΣ	1..1	code	active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown Binding: OutMedRequestStatus FHIR (required): see mapping VF_OutMedRequestStatus ele-1: All FHIR elements must have a @value or children
intent	?!SΣ	1..1	code	proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Binding: medicationRequest Intent (required): The kind of medication order. ele-1: All FHIR elements must have a @value or children Required Pattern: order
Slices for category	S	0..*	CodeableConcept	Type of medication usage Slice: Unordered, Open by pattern:$this Binding: medicationRequest Category Codes (example): A coded concept identifying the category of medication request. For example, where the medication is to be consumed or administered, or the type of medication treatment. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/medicationrequest-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: outpatient
category:us-core	S	0..*	CodeableConcept	Type of medication usage Binding: medicationRequest Category Codes (required): The type of medication order. ele-1: All FHIR elements must have a @value or children
doNotPerform	?!Σ	0..1	boolean	True if request is prohibiting action ele-1: All FHIR elements must have a @value or children
reported[x]	SΣ	0..1		Reported rather than primary record ele-1: All FHIR elements must have a @value or children
reportedBoolean			boolean
reportedReference			Reference(US Core Practitioner Profile(5.0.1))
Slices for medication[x]	SΣ	1..1		Medication to be taken Slice: Unordered, Open by type:$this Binding: Medication Clinical Drug (extensible) ele-1: All FHIR elements must have a @value or children
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(US Core Medication Profile(5.0.1))
medication[x]:medicationCodeableConcept	SΣ	0..1	CodeableConcept	Medication to be taken Binding: Medication Clinical Drug (extensible) ele-1: All FHIR elements must have a @value or children
coding	Σ	0..*	Coding	Code defined by a terminology system ele-1: All FHIR elements must have a @value or children
system	SΣ	0..1	uri	Identity of the terminology system ele-1: All FHIR elements must have a @value or children Required Pattern: http://www.nlm.nih.gov/research/umls/rxnorm
code	SΣ	0..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children
text	SΣ	0..1	string	Plain text representation of the concept ele-1: All FHIR elements must have a @value or children
subject	SΣ	1..1	Reference(Patient)	Who or group medication request is for ele-1: All FHIR elements must have a @value or children
encounter	S	0..1	Reference(US Core Encounter Profile(5.0.1))	Encounter created as part of encounter/admission/stay ele-1: All FHIR elements must have a @value or children
authoredOn	SΣ	0..1	dateTime	When request was initially authored ele-1: All FHIR elements must have a @value or children
requester	SΣ	1..1	Reference(Practitioner)	Who/What requested the Request ele-1: All FHIR elements must have a @value or children
reasonCode		0..*	CodeableConcept	Reason or indication for ordering or not ordering the medication Binding: Condition/Problem/DiagnosisCodes (example): A coded concept indicating why the medication was ordered. ele-1: All FHIR elements must have a @value or children
text	SΣ	0..1	string	Plain text representation of the concept ele-1: All FHIR elements must have a @value or children
dosageInstruction	S	0..*	Dosage	How the medication should be taken ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
text	SΣ	0..1	string	Free text dosage instructions e.g. SIG ele-1: All FHIR elements must have a @value or children
patientInstruction	SΣ	0..1	string	Patient or consumer oriented instructions ele-1: All FHIR elements must have a @value or children
route	Σ	0..1	CodeableConcept	How drug should enter body Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject. ele-1: All FHIR elements must have a @value or children
coding	Σ	0..*	Coding	Code defined by a terminology system ele-1: All FHIR elements must have a @value or children
system	SΣ	0..1	uri	Identity of the terminology system ele-1: All FHIR elements must have a @value or children Required Pattern: http://va.gov/terminology/vistaDefinedTerms/53.1-3
code	SΣ	0..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children
doseAndRate	Σ	0..*	Element	Amount of medication administered ele-1: All FHIR elements must have a @value or children
Slices for extension				Content/Rules for all slices
extension:originalText		0..1	(Complex)	Original Text that represents the data as seen/selected/uttered originally URL: http://hl7.org/fhir/StructureDefinition/originalText ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/originalText"
value[x]	SC	1..1		Value of extension ele-1: All FHIR elements must have a @value or children mro-27-841: If not a number then source value from (52-113 > 52.0113-.01)
valueString			string
valueUrl			url
Slices for dose[x]	Σ	0..1		Amount of medication per dose Slice: Unordered, Open by type:$this ele-1: All FHIR elements must have a @value or children
doseRange			Range
doseQuantity			Quantity(SimpleQuantity)
dose[x]:doseQuantity	Σ	0..1	SimpleQuantity	Amount of medication per dose ele-1: All FHIR elements must have a @value or children
value	SΣC	0..1	decimal	Numerical value (with implicit precision) ele-1: All FHIR elements must have a @value or children mro-27-811: If number then source value from (52-113 > 52.0113-.01)
unit	SΣ	0..1	string	Unit representation ele-1: All FHIR elements must have a @value or children
dispenseRequest		0..1	BackboneElement	Medication supply authorization ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
validityPeriod		0..1	Period	Time period supply is authorized for ele-1: All FHIR elements must have a @value or children
end	SΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing ele-1: All FHIR elements must have a @value or children
numberOfRepeatsAllowed	S	0..1	unsignedInt	Number of refills authorized ele-1: All FHIR elements must have a @value or children
quantity		0..1	SimpleQuantity	Amount of medication to supply per dispense ele-1: All FHIR elements must have a @value or children
value	SΣ	0..1	decimal	Numerical value (with implicit precision) ele-1: All FHIR elements must have a @value or children
expectedSupplyDuration	S	0..1	Duration	Number of days supply per dispense ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
MedicationRequest.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
MedicationRequest.identifier.type	extensible	Pattern: FILL http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
MedicationRequest.status	required	OutMedRequestStatus http://va.gov/fhir/ValueSet/OutMedRequestStatus from this IG
MedicationRequest.intent	required	Pattern: order http://hl7.org/fhir/ValueSet/medicationrequest-intent from the FHIR Standard
MedicationRequest.category	example	Pattern: outpatient http://hl7.org/fhir/ValueSet/medicationrequest-category from the FHIR Standard
MedicationRequest.category:us-core	required	medicationRequest Category Codes http://hl7.org/fhir/ValueSet/medicationrequest-category from the FHIR Standard
MedicationRequest.medication[x]	extensible	Medication Clinical Drug http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4 from https://vsac.nlm.nih.gov
MedicationRequest.medication[x]:medicationCodeableConcept	extensible	Medication Clinical Drug http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4 from https://vsac.nlm.nih.gov
MedicationRequest.reasonCode	example	Condition/Problem/DiagnosisCodes http://hl7.org/fhir/ValueSet/condition-code from the FHIR Standard
MedicationRequest.dosageInstruction.route	example	SNOMEDCTRouteCodes http://hl7.org/fhir/ValueSet/route-codes from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MedicationRequest	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MedicationRequest	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	error	MedicationRequest	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	error	MedicationRequest	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MedicationRequest	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
mro-27-811	warning	MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.value	If number then source value from (52-113 > 52.0113-.01) : true
mro-27-841	warning	MedicationRequest.dosageInstruction.doseAndRate.extension:originalText.value[x]	If not a number then source value from (52-113 > 52.0113-.01) : true
mro-27-1746	warning	MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].code	If (52-11) is P then fixed value #active-parked : true
mro-27-1746-1	warning	MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].system	If P then fixed value http://va.gov/terminology/vistaDefinedTerms/52-100 : true

This structure is derived from USCoreMedicationRequestProfile

Name	Flags	Card.	Type	Description & Constraints
MedicationRequest			USCoreMedicationRequestProfile(5.0.1)	This profile also complies with the profiles US Core MedicationRequest Profile (6.1.0) and US Core MedicationRequest Profile (7.0.0)
id	S	0..1	id	Logical id of this artifact
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:medicationrequest-pharmacyOrderStatus		0..1	(Complex)	Extension URL: http://va.gov/fhir/StructureDefinition/medicationrequest-pharmacyOrderStatus
value[x]
system	SC	0..1	uri	Identity of the terminology system mro-27-1746-1: If P then fixed value http://va.gov/terminology/vistaDefinedTerms/52-100 Required Pattern: http://va.gov/terminology/vistaDefinedTerms/52-100
code	SC	0..1	code	Symbol in syntax defined by the system mro-27-1746: If (52-11) is P then fixed value #active-parked
extension:medicationrequest-cancelDate		0..1	(Complex)	Extension URL: http://va.gov/fhir/StructureDefinition/medicationrequest-cancelDate
value[x]	S	0..1	dateTime	Value of extension
extension:medicationrequest-includeIndicationInSig		0..1	(Complex)	Extension URL: http://va.gov/fhir/StructureDefinition/medicationrequest-includeIndicationInSig
value[x]	S	0..1	boolean	Value of extension
extension:medicationrequest-remainingRefillCount		0..1	(Complex)	Extension URL: http://va.gov/fhir/StructureDefinition/medicationrequest-remainingRefillCount
value[x]	S	0..1	integer	Value of extension
identifier
type	S	0..1	CodeableConcept	Description of identifier Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
code		1..1	code	Symbol in syntax defined by the system Fixed Value: FILL
value	S	0..1	string	The value that is unique
status		1..1	code	active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown Binding: OutMedRequestStatus FHIR (required): see mapping VF_OutMedRequestStatus
intent		1..1	code	proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Required Pattern: order
category		0..*	CodeableConcept	Type of medication usage Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/medicationrequest-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: outpatient
Slices for medication[x]		1..1	CodeableConcept, Reference(US Core Medication Profile(5.0.1))	Medication to be taken Slice: Unordered, Open by type:$this
medication[x]:medicationCodeableConcept		0..1	CodeableConcept	Medication to be taken
coding
system	S	0..1	uri	Identity of the terminology system Required Pattern: http://www.nlm.nih.gov/research/umls/rxnorm
code	S	0..1	code	Symbol in syntax defined by the system
text	S	0..1	string	Plain text representation of the concept
subject		1..1	Reference(Patient)	Who or group medication request is for
authoredOn		0..1	dateTime	When request was initially authored
requester		1..1	Reference(Practitioner)	Who/What requested the Request
reasonCode
text	S	0..1	string	Plain text representation of the concept
dosageInstruction
text		0..1	string	Free text dosage instructions e.g. SIG
patientInstruction	S	0..1	string	Patient or consumer oriented instructions
route
coding
system	S	0..1	uri	Identity of the terminology system Required Pattern: http://va.gov/terminology/vistaDefinedTerms/53.1-3
code	S	0..1	code	Symbol in syntax defined by the system
doseAndRate
Slices for extension				Content/Rules for all slices
extension:originalText		0..1	(Complex)	Original Text that represents the data as seen/selected/uttered originally URL: http://hl7.org/fhir/StructureDefinition/originalText
value[x]	SC	1..1	string, url	Value of extension mro-27-841: If not a number then source value from (52-113 > 52.0113-.01)
Slices for dose[x]		0..1	Range, SimpleQuantity	Amount of medication per dose Slice: Unordered, Open by type:$this
dose[x]:doseQuantity		0..1	SimpleQuantity	Amount of medication per dose
value	SC	0..1	decimal	Numerical value (with implicit precision) mro-27-811: If number then source value from (52-113 > 52.0113-.01)
unit	S	0..1	string	Unit representation
dispenseRequest
validityPeriod
end	S	0..1	dateTime	End time with inclusive boundary, if not ongoing
numberOfRepeatsAllowed	S	0..1	unsignedInt	Number of refills authorized
quantity
value	S	0..1	decimal	Numerical value (with implicit precision)
expectedSupplyDuration	S	0..1	Duration	Number of days supply per dispense
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
MedicationRequest.status	required	OutMedRequestStatus http://va.gov/fhir/ValueSet/OutMedRequestStatus from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
mro-27-811	warning	MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.value	If number then source value from (52-113 > 52.0113-.01) : true
mro-27-841	warning	MedicationRequest.dosageInstruction.doseAndRate.extension:originalText.value[x]	If not a number then source value from (52-113 > 52.0113-.01) : true
mro-27-1746	warning	MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].code	If (52-11) is P then fixed value #active-parked : true
mro-27-1746-1	warning	MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].system	If P then fixed value http://va.gov/terminology/vistaDefinedTerms/52-100 : true

Name	Flags	Card.	Type	Description & Constraints
MedicationRequest		0..*	USCoreMedicationRequestProfile(5.0.1)	Ordering of medication for patient or group This profile also complies with the profiles US Core MedicationRequest Profile (6.1.0) and US Core MedicationRequest Profile (7.0.0)
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:medicationrequest-pharmacyOrderStatus		0..1	(Complex)	Extension URL: http://va.gov/fhir/StructureDefinition/medicationrequest-pharmacyOrderStatus
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://va.gov/fhir/StructureDefinition/medicationrequest-pharmacyOrderStatus"
value[x]		0..1	Coding	Value of extension
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣC	0..1	uri	Identity of the terminology system mro-27-1746-1: If P then fixed value http://va.gov/terminology/vistaDefinedTerms/52-100 Required Pattern: http://va.gov/terminology/vistaDefinedTerms/52-100
version	Σ	0..1	string	Version of the system - if relevant
code	SΣC	0..1	code	Symbol in syntax defined by the system mro-27-1746: If (52-11) is P then fixed value #active-parked
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
extension:medicationrequest-cancelDate		0..1	(Complex)	Extension URL: http://va.gov/fhir/StructureDefinition/medicationrequest-cancelDate
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://va.gov/fhir/StructureDefinition/medicationrequest-cancelDate"
value[x]	S	0..1	dateTime	Value of extension
extension:medicationrequest-includeIndicationInSig		0..1	(Complex)	Extension URL: http://va.gov/fhir/StructureDefinition/medicationrequest-includeIndicationInSig
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://va.gov/fhir/StructureDefinition/medicationrequest-includeIndicationInSig"
value[x]	S	0..1	boolean	Value of extension
extension:medicationrequest-remainingRefillCount		0..1	(Complex)	Extension URL: http://va.gov/fhir/StructureDefinition/medicationrequest-remainingRefillCount
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://va.gov/fhir/StructureDefinition/medicationrequest-remainingRefillCount"
value[x]	S	0..1	integer	Value of extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		0..*	Identifier	External ids for this request
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: FILL
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown Binding: OutMedRequestStatus FHIR (required): see mapping VF_OutMedRequestStatus
statusReason		0..1	CodeableConcept	Reason for current status Binding: medicationRequest Status Reason Codes (example): Identifies the reasons for a given status.
intent	?!SΣ	1..1	code	proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Binding: medicationRequest Intent (required): The kind of medication order. Required Pattern: order
Slices for category	S	0..*	CodeableConcept	Type of medication usage Slice: Unordered, Open by pattern:$this Binding: medicationRequest Category Codes (example): A coded concept identifying the category of medication request. For example, where the medication is to be consumed or administered, or the type of medication treatment. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/medicationrequest-category
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: outpatient
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
category:us-core	S	0..*	CodeableConcept	Type of medication usage Binding: medicationRequest Category Codes (required): The type of medication order.
priority	Σ	0..1	code	routine | urgent | asap | stat Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.
doNotPerform	?!Σ	0..1	boolean	True if request is prohibiting action
reported[x]	SΣ	0..1		Reported rather than primary record
reportedBoolean			boolean S
reportedReference			Reference S(US Core Practitioner Profile(5.0.1) S | US Core Organization Profile(5.0.1) | US Core Patient Profile(5.0.1) | US Core PractitionerRole Profile(5.0.1) | US Core RelatedPerson Profile)
Slices for medication[x]	SΣ	1..1		Medication to be taken Slice: Unordered, Open by type:$this Binding: Medication Clinical Drug (extensible)
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(US Core Medication Profile(5.0.1))
medication[x]:medicationCodeableConcept	SΣ	0..1	CodeableConcept	Medication to be taken Binding: Medication Clinical Drug (extensible)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	0..1	uri	Identity of the terminology system Required Pattern: http://www.nlm.nih.gov/research/umls/rxnorm
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	SΣ	0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(Patient)	Who or group medication request is for
encounter	S	0..1	Reference(US Core Encounter Profile(5.0.1))	Encounter created as part of encounter/admission/stay
supportingInformation		0..*	Reference(Resource)	Information to support ordering of the medication
authoredOn	SΣ	0..1	dateTime	When request was initially authored
requester	SΣ	1..1	Reference(Practitioner)	Who/What requested the Request
performer		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam)	Intended performer of administration
performerType	Σ	0..1	CodeableConcept	Desired kind of performer of the medication administration Binding: ProcedurePerformerRoleCodes (example): Identifies the type of individual that is desired to administer the medication.
recorder		0..1	Reference(Practitioner | PractitionerRole)	Person who entered the request
reasonCode		0..*	CodeableConcept	Reason or indication for ordering or not ordering the medication Binding: Condition/Problem/DiagnosisCodes (example): A coded concept indicating why the medication was ordered.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
text	SΣ	0..1	string	Plain text representation of the concept
reasonReference		0..*	Reference(Condition | Observation)	Condition or observation that supports why the prescription is being written
instantiatesCanonical	Σ	0..*	canonical()	Instantiates FHIR protocol or definition
instantiatesUri	Σ	0..*	uri	Instantiates external protocol or definition
basedOn	Σ	0..*	Reference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation)	What request fulfills
groupIdentifier	Σ	0..1	Identifier	Composite request this is part of
courseOfTherapyType		0..1	CodeableConcept	Overall pattern of medication administration Binding: medicationRequest Course of Therapy Codes (example): Identifies the overall pattern of medication administratio.
insurance		0..*	Reference(Coverage | ClaimResponse)	Associated insurance coverage
note		0..*	Annotation	Information about the prescription
dosageInstruction	S	0..*	Dosage	How the medication should be taken
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	Σ	0..1	integer	The order of the dosage instructions
text	SΣ	0..1	string	Free text dosage instructions e.g. SIG
additionalInstruction	Σ	0..*	CodeableConcept	Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness" Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
patientInstruction	SΣ	0..1	string	Patient or consumer oriented instructions
timing	Σ	0..1	Timing	When medication should be administered
asNeeded[x]	Σ	0..1		Take "as needed" (for x) Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): 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.
asNeededBoolean			boolean
asNeededCodeableConcept			CodeableConcept
site	Σ	0..1	CodeableConcept	Body site to administer to Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.
route	Σ	0..1	CodeableConcept	How drug should enter body Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	0..1	uri	Identity of the terminology system Required Pattern: http://va.gov/terminology/vistaDefinedTerms/53.1-3
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
method	Σ	0..1	CodeableConcept	Technique for administering medication Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.
doseAndRate	Σ	0..*	Element	Amount of medication administered
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
extension:originalText		0..1	(Complex)	Original Text that represents the data as seen/selected/uttered originally URL: http://hl7.org/fhir/StructureDefinition/originalText
id		0..1	id	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/originalText"
value[x]	SC	1..1		Value of extension mro-27-841: If not a number then source value from (52-113 > 52.0113-.01)
valueString			string
valueUrl			url
type	Σ	0..1	CodeableConcept	The kind of dose or rate specified Binding: DoseAndRateType (example): The kind of dose or rate specified.
Slices for dose[x]	Σ	0..1		Amount of medication per dose Slice: Unordered, Open by type:$this
doseRange			Range
doseQuantity			Quantity(SimpleQuantity)
dose[x]:doseQuantity	Σ	0..1	SimpleQuantity	Amount of medication per dose
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	SΣC	0..1	decimal	Numerical value (with implicit precision) mro-27-811: If number then source value from (52-113 > 52.0113-.01)
unit	SΣ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form
code	Σ	0..1	code	Coded form of the unit
rate[x]	Σ	0..1		Amount of medication per unit of time
rateRatio			Ratio
rateRange			Range
rateQuantity			Quantity(SimpleQuantity)
maxDosePerPeriod	Σ	0..1	Ratio	Upper limit on medication per unit of time
maxDosePerAdministration	Σ	0..1	SimpleQuantity	Upper limit on medication per administration
maxDosePerLifetime	Σ	0..1	SimpleQuantity	Upper limit on medication per lifetime of the patient
dispenseRequest		0..1	BackboneElement	Medication supply authorization
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
initialFill		0..1	BackboneElement	First fill details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
quantity		0..1	SimpleQuantity	First fill quantity
duration		0..1	Duration	First fill duration
dispenseInterval		0..1	Duration	Minimum period of time between dispenses
validityPeriod		0..1	Period	Time period supply is authorized for
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	ΣC	0..1	dateTime	Starting time with inclusive boundary
end	SΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing
numberOfRepeatsAllowed	S	0..1	unsignedInt	Number of refills authorized
quantity		0..1	SimpleQuantity	Amount of medication to supply per dispense
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	SΣ	0..1	decimal	Numerical value (with implicit precision)
unit	Σ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form
code	Σ	0..1	code	Coded form of the unit
expectedSupplyDuration	S	0..1	Duration	Number of days supply per dispense
performer		0..1	Reference(Organization)	Intended dispenser
substitution		0..1	BackboneElement	Any restrictions on medication substitution
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
allowed[x]		1..1		Whether substitution is allowed or not Binding: ActSubstanceAdminSubstitutionCode (example): Identifies the type of substitution allowed.
allowedBoolean			boolean
allowedCodeableConcept			CodeableConcept
reason		0..1	CodeableConcept	Why should (not) substitution be made Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
priorPrescription		0..1	Reference(MedicationRequest)	An order/prescription that is being replaced
detectedIssue		0..*	Reference(DetectedIssue)	Clinical Issue with action
eventHistory		0..*	Reference(Provenance)	A list of events of interest in the lifecycle
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
MedicationRequest.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
MedicationRequest.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
MedicationRequest.identifier.type	extensible	Pattern: FILL http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
MedicationRequest.status	required	OutMedRequestStatus http://va.gov/fhir/ValueSet/OutMedRequestStatus from this IG
MedicationRequest.statusReason	example	medicationRequest Status Reason Codes http://hl7.org/fhir/ValueSet/medicationrequest-status-reason from the FHIR Standard
MedicationRequest.intent	required	Pattern: order http://hl7.org/fhir/ValueSet/medicationrequest-intent from the FHIR Standard
MedicationRequest.category	example	Pattern: outpatient http://hl7.org/fhir/ValueSet/medicationrequest-category from the FHIR Standard
MedicationRequest.category:us-core	required	medicationRequest Category Codes http://hl7.org/fhir/ValueSet/medicationrequest-category from the FHIR Standard
MedicationRequest.priority	required	RequestPriority http://hl7.org/fhir/ValueSet/request-priority|4.0.1 from the FHIR Standard
MedicationRequest.medication[x]	extensible	Medication Clinical Drug http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4 from https://vsac.nlm.nih.gov
MedicationRequest.medication[x]:medicationCodeableConcept	extensible	Medication Clinical Drug http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4 from https://vsac.nlm.nih.gov
MedicationRequest.performerType	example	ProcedurePerformerRoleCodes http://hl7.org/fhir/ValueSet/performer-role from the FHIR Standard
MedicationRequest.reasonCode	example	Condition/Problem/DiagnosisCodes http://hl7.org/fhir/ValueSet/condition-code from the FHIR Standard
MedicationRequest.courseOfTherapyType	example	medicationRequest Course of Therapy Codes http://hl7.org/fhir/ValueSet/medicationrequest-course-of-therapy from the FHIR Standard
MedicationRequest.dosageInstruction.additionalInstruction	example	SNOMEDCTAdditionalDosageInstructions http://hl7.org/fhir/ValueSet/additional-instruction-codes from the FHIR Standard
MedicationRequest.dosageInstruction.asNeeded[x]	example	SNOMEDCTMedicationAsNeededReasonCodes http://hl7.org/fhir/ValueSet/medication-as-needed-reason from the FHIR Standard
MedicationRequest.dosageInstruction.site	example	SNOMEDCTAnatomicalStructureForAdministrationSiteCodes http://hl7.org/fhir/ValueSet/approach-site-codes from the FHIR Standard
MedicationRequest.dosageInstruction.route	example	SNOMEDCTRouteCodes http://hl7.org/fhir/ValueSet/route-codes from the FHIR Standard
MedicationRequest.dosageInstruction.method	example	SNOMEDCTAdministrationMethodCodes http://hl7.org/fhir/ValueSet/administration-method-codes from the FHIR Standard
MedicationRequest.dosageInstruction.doseAndRate.type	example	DoseAndRateType http://hl7.org/fhir/ValueSet/dose-rate-type from the FHIR Standard
MedicationRequest.substitution.allowed[x]	example	ActSubstanceAdminSubstitutionCode http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode
MedicationRequest.substitution.reason	example	SubstanceAdminSubstitutionReason http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MedicationRequest	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MedicationRequest	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	error	MedicationRequest	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	error	MedicationRequest	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MedicationRequest	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
mro-27-811	warning	MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.value	If number then source value from (52-113 > 52.0113-.01) : true
mro-27-841	warning	MedicationRequest.dosageInstruction.doseAndRate.extension:originalText.value[x]	If not a number then source value from (52-113 > 52.0113-.01) : true
mro-27-1746	warning	MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].code	If (52-11) is P then fixed value #active-parked : true
mro-27-1746-1	warning	MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].system	If P then fixed value http://va.gov/terminology/vistaDefinedTerms/52-100 : true

This structure is derived from USCoreMedicationRequestProfile

Summary

Must-Support: 22 elements

Structures

This structure refers to these other structures:

• Patient (http://va.gov/fhir/StructureDefinition/Patient)
• Practitioner (http://va.gov/fhir/StructureDefinition/Practitioner)
• SimpleQuantity (http://hl7.org/fhir/StructureDefinition/SimpleQuantity)

Extensions

This structure refers to these extensions:

• http://va.gov/fhir/StructureDefinition/medicationrequest-pharmacyOrderStatus
• http://va.gov/fhir/StructureDefinition/medicationrequest-cancelDate
• http://va.gov/fhir/StructureDefinition/medicationrequest-includeIndicationInSig
• http://va.gov/fhir/StructureDefinition/medicationrequest-remainingRefillCount
• http://hl7.org/fhir/StructureDefinition/originalText

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of MedicationRequest.medication[x]
• The element 1 is sliced based on the value of MedicationRequest.dosageInstruction.doseAndRate.dose[x]

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
MedicationRequest		0..*	USCoreMedicationRequestProfile(5.0.1)	Ordering of medication for patient or group This profile also complies with the profiles US Core MedicationRequest Profile (6.1.0) and US Core MedicationRequest Profile (7.0.0) dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
id	SΣ	0..1	id	Logical id of this artifact
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:medicationrequest-pharmacyOrderStatus		0..1	(Complex)	Extension URL: http://va.gov/fhir/StructureDefinition/medicationrequest-pharmacyOrderStatus ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension		0..0
url		1..1	uri	"http://va.gov/fhir/StructureDefinition/medicationrequest-pharmacyOrderStatus"
value[x]		0..1	Coding	Value of extension ele-1: All FHIR elements must have a @value or children
system	SΣC	0..1	uri	Identity of the terminology system ele-1: All FHIR elements must have a @value or children mro-27-1746-1: If P then fixed value http://va.gov/terminology/vistaDefinedTerms/52-100 Required Pattern: http://va.gov/terminology/vistaDefinedTerms/52-100
code	SΣC	0..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children mro-27-1746: If (52-11) is P then fixed value #active-parked
extension:medicationrequest-cancelDate		0..1	(Complex)	Extension URL: http://va.gov/fhir/StructureDefinition/medicationrequest-cancelDate ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension		0..0
url		1..1	uri	"http://va.gov/fhir/StructureDefinition/medicationrequest-cancelDate"
value[x]	S	0..1	dateTime	Value of extension ele-1: All FHIR elements must have a @value or children
extension:medicationrequest-includeIndicationInSig		0..1	(Complex)	Extension URL: http://va.gov/fhir/StructureDefinition/medicationrequest-includeIndicationInSig ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension		0..0
url		1..1	uri	"http://va.gov/fhir/StructureDefinition/medicationrequest-includeIndicationInSig"
value[x]	S	0..1	boolean	Value of extension ele-1: All FHIR elements must have a @value or children
extension:medicationrequest-remainingRefillCount		0..1	(Complex)	Extension URL: http://va.gov/fhir/StructureDefinition/medicationrequest-remainingRefillCount ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension		0..0
url		1..1	uri	"http://va.gov/fhir/StructureDefinition/medicationrequest-remainingRefillCount"
value[x]	S	0..1	integer	Value of extension ele-1: All FHIR elements must have a @value or children
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier		0..*	Identifier	External ids for this request ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
type	SΣ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
code		1..1	code	Symbol in syntax defined by the system Fixed Value: FILL
value	SΣ	0..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
status	?!SΣ	1..1	code	active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown Binding: OutMedRequestStatus FHIR (required): see mapping VF_OutMedRequestStatus ele-1: All FHIR elements must have a @value or children
intent	?!SΣ	1..1	code	proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Binding: medicationRequest Intent (required): The kind of medication order. ele-1: All FHIR elements must have a @value or children Required Pattern: order
Slices for category	S	0..*	CodeableConcept	Type of medication usage Slice: Unordered, Open by pattern:$this Binding: medicationRequest Category Codes (example): A coded concept identifying the category of medication request. For example, where the medication is to be consumed or administered, or the type of medication treatment. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/medicationrequest-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: outpatient
category:us-core	S	0..*	CodeableConcept	Type of medication usage Binding: medicationRequest Category Codes (required): The type of medication order. ele-1: All FHIR elements must have a @value or children
doNotPerform	?!Σ	0..1	boolean	True if request is prohibiting action ele-1: All FHIR elements must have a @value or children
reported[x]	SΣ	0..1		Reported rather than primary record ele-1: All FHIR elements must have a @value or children
reportedBoolean			boolean
reportedReference			Reference(US Core Practitioner Profile(5.0.1))
Slices for medication[x]	SΣ	1..1		Medication to be taken Slice: Unordered, Open by type:$this Binding: Medication Clinical Drug (extensible) ele-1: All FHIR elements must have a @value or children
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(US Core Medication Profile(5.0.1))
medication[x]:medicationCodeableConcept	SΣ	0..1	CodeableConcept	Medication to be taken Binding: Medication Clinical Drug (extensible) ele-1: All FHIR elements must have a @value or children
coding	Σ	0..*	Coding	Code defined by a terminology system ele-1: All FHIR elements must have a @value or children
system	SΣ	0..1	uri	Identity of the terminology system ele-1: All FHIR elements must have a @value or children Required Pattern: http://www.nlm.nih.gov/research/umls/rxnorm
code	SΣ	0..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children
text	SΣ	0..1	string	Plain text representation of the concept ele-1: All FHIR elements must have a @value or children
subject	SΣ	1..1	Reference(Patient)	Who or group medication request is for ele-1: All FHIR elements must have a @value or children
encounter	S	0..1	Reference(US Core Encounter Profile(5.0.1))	Encounter created as part of encounter/admission/stay ele-1: All FHIR elements must have a @value or children
authoredOn	SΣ	0..1	dateTime	When request was initially authored ele-1: All FHIR elements must have a @value or children
requester	SΣ	1..1	Reference(Practitioner)	Who/What requested the Request ele-1: All FHIR elements must have a @value or children
reasonCode		0..*	CodeableConcept	Reason or indication for ordering or not ordering the medication Binding: Condition/Problem/DiagnosisCodes (example): A coded concept indicating why the medication was ordered. ele-1: All FHIR elements must have a @value or children
text	SΣ	0..1	string	Plain text representation of the concept ele-1: All FHIR elements must have a @value or children
dosageInstruction	S	0..*	Dosage	How the medication should be taken ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
text	SΣ	0..1	string	Free text dosage instructions e.g. SIG ele-1: All FHIR elements must have a @value or children
patientInstruction	SΣ	0..1	string	Patient or consumer oriented instructions ele-1: All FHIR elements must have a @value or children
route	Σ	0..1	CodeableConcept	How drug should enter body Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject. ele-1: All FHIR elements must have a @value or children
coding	Σ	0..*	Coding	Code defined by a terminology system ele-1: All FHIR elements must have a @value or children
system	SΣ	0..1	uri	Identity of the terminology system ele-1: All FHIR elements must have a @value or children Required Pattern: http://va.gov/terminology/vistaDefinedTerms/53.1-3
code	SΣ	0..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children
doseAndRate	Σ	0..*	Element	Amount of medication administered ele-1: All FHIR elements must have a @value or children
Slices for extension				Content/Rules for all slices
extension:originalText		0..1	(Complex)	Original Text that represents the data as seen/selected/uttered originally URL: http://hl7.org/fhir/StructureDefinition/originalText ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/originalText"
value[x]	SC	1..1		Value of extension ele-1: All FHIR elements must have a @value or children mro-27-841: If not a number then source value from (52-113 > 52.0113-.01)
valueString			string
valueUrl			url
Slices for dose[x]	Σ	0..1		Amount of medication per dose Slice: Unordered, Open by type:$this ele-1: All FHIR elements must have a @value or children
doseRange			Range
doseQuantity			Quantity(SimpleQuantity)
dose[x]:doseQuantity	Σ	0..1	SimpleQuantity	Amount of medication per dose ele-1: All FHIR elements must have a @value or children
value	SΣC	0..1	decimal	Numerical value (with implicit precision) ele-1: All FHIR elements must have a @value or children mro-27-811: If number then source value from (52-113 > 52.0113-.01)
unit	SΣ	0..1	string	Unit representation ele-1: All FHIR elements must have a @value or children
dispenseRequest		0..1	BackboneElement	Medication supply authorization ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
validityPeriod		0..1	Period	Time period supply is authorized for ele-1: All FHIR elements must have a @value or children
end	SΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing ele-1: All FHIR elements must have a @value or children
numberOfRepeatsAllowed	S	0..1	unsignedInt	Number of refills authorized ele-1: All FHIR elements must have a @value or children
quantity		0..1	SimpleQuantity	Amount of medication to supply per dispense ele-1: All FHIR elements must have a @value or children
value	SΣ	0..1	decimal	Numerical value (with implicit precision) ele-1: All FHIR elements must have a @value or children
expectedSupplyDuration	S	0..1	Duration	Number of days supply per dispense ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
MedicationRequest.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
MedicationRequest.identifier.type	extensible	Pattern: FILL http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
MedicationRequest.status	required	OutMedRequestStatus http://va.gov/fhir/ValueSet/OutMedRequestStatus from this IG
MedicationRequest.intent	required	Pattern: order http://hl7.org/fhir/ValueSet/medicationrequest-intent from the FHIR Standard
MedicationRequest.category	example	Pattern: outpatient http://hl7.org/fhir/ValueSet/medicationrequest-category from the FHIR Standard
MedicationRequest.category:us-core	required	medicationRequest Category Codes http://hl7.org/fhir/ValueSet/medicationrequest-category from the FHIR Standard
MedicationRequest.medication[x]	extensible	Medication Clinical Drug http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4 from https://vsac.nlm.nih.gov
MedicationRequest.medication[x]:medicationCodeableConcept	extensible	Medication Clinical Drug http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4 from https://vsac.nlm.nih.gov
MedicationRequest.reasonCode	example	Condition/Problem/DiagnosisCodes http://hl7.org/fhir/ValueSet/condition-code from the FHIR Standard
MedicationRequest.dosageInstruction.route	example	SNOMEDCTRouteCodes http://hl7.org/fhir/ValueSet/route-codes from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MedicationRequest	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MedicationRequest	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	error	MedicationRequest	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	error	MedicationRequest	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MedicationRequest	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
mro-27-811	warning	MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.value	If number then source value from (52-113 > 52.0113-.01) : true
mro-27-841	warning	MedicationRequest.dosageInstruction.doseAndRate.extension:originalText.value[x]	If not a number then source value from (52-113 > 52.0113-.01) : true
mro-27-1746	warning	MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].code	If (52-11) is P then fixed value #active-parked : true
mro-27-1746-1	warning	MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].system	If P then fixed value http://va.gov/terminology/vistaDefinedTerms/52-100 : true

Differential View

This structure is derived from USCoreMedicationRequestProfile

Name	Flags	Card.	Type	Description & Constraints
MedicationRequest			USCoreMedicationRequestProfile(5.0.1)	This profile also complies with the profiles US Core MedicationRequest Profile (6.1.0) and US Core MedicationRequest Profile (7.0.0)
id	S	0..1	id	Logical id of this artifact
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:medicationrequest-pharmacyOrderStatus		0..1	(Complex)	Extension URL: http://va.gov/fhir/StructureDefinition/medicationrequest-pharmacyOrderStatus
value[x]
system	SC	0..1	uri	Identity of the terminology system mro-27-1746-1: If P then fixed value http://va.gov/terminology/vistaDefinedTerms/52-100 Required Pattern: http://va.gov/terminology/vistaDefinedTerms/52-100
code	SC	0..1	code	Symbol in syntax defined by the system mro-27-1746: If (52-11) is P then fixed value #active-parked
extension:medicationrequest-cancelDate		0..1	(Complex)	Extension URL: http://va.gov/fhir/StructureDefinition/medicationrequest-cancelDate
value[x]	S	0..1	dateTime	Value of extension
extension:medicationrequest-includeIndicationInSig		0..1	(Complex)	Extension URL: http://va.gov/fhir/StructureDefinition/medicationrequest-includeIndicationInSig
value[x]	S	0..1	boolean	Value of extension
extension:medicationrequest-remainingRefillCount		0..1	(Complex)	Extension URL: http://va.gov/fhir/StructureDefinition/medicationrequest-remainingRefillCount
value[x]	S	0..1	integer	Value of extension
identifier
type	S	0..1	CodeableConcept	Description of identifier Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
code		1..1	code	Symbol in syntax defined by the system Fixed Value: FILL
value	S	0..1	string	The value that is unique
status		1..1	code	active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown Binding: OutMedRequestStatus FHIR (required): see mapping VF_OutMedRequestStatus
intent		1..1	code	proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Required Pattern: order
category		0..*	CodeableConcept	Type of medication usage Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/medicationrequest-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: outpatient
Slices for medication[x]		1..1	CodeableConcept, Reference(US Core Medication Profile(5.0.1))	Medication to be taken Slice: Unordered, Open by type:$this
medication[x]:medicationCodeableConcept		0..1	CodeableConcept	Medication to be taken
coding
system	S	0..1	uri	Identity of the terminology system Required Pattern: http://www.nlm.nih.gov/research/umls/rxnorm
code	S	0..1	code	Symbol in syntax defined by the system
text	S	0..1	string	Plain text representation of the concept
subject		1..1	Reference(Patient)	Who or group medication request is for
authoredOn		0..1	dateTime	When request was initially authored
requester		1..1	Reference(Practitioner)	Who/What requested the Request
reasonCode
text	S	0..1	string	Plain text representation of the concept
dosageInstruction
text		0..1	string	Free text dosage instructions e.g. SIG
patientInstruction	S	0..1	string	Patient or consumer oriented instructions
route
coding
system	S	0..1	uri	Identity of the terminology system Required Pattern: http://va.gov/terminology/vistaDefinedTerms/53.1-3
code	S	0..1	code	Symbol in syntax defined by the system
doseAndRate
Slices for extension				Content/Rules for all slices
extension:originalText		0..1	(Complex)	Original Text that represents the data as seen/selected/uttered originally URL: http://hl7.org/fhir/StructureDefinition/originalText
value[x]	SC	1..1	string, url	Value of extension mro-27-841: If not a number then source value from (52-113 > 52.0113-.01)
Slices for dose[x]		0..1	Range, SimpleQuantity	Amount of medication per dose Slice: Unordered, Open by type:$this
dose[x]:doseQuantity		0..1	SimpleQuantity	Amount of medication per dose
value	SC	0..1	decimal	Numerical value (with implicit precision) mro-27-811: If number then source value from (52-113 > 52.0113-.01)
unit	S	0..1	string	Unit representation
dispenseRequest
validityPeriod
end	S	0..1	dateTime	End time with inclusive boundary, if not ongoing
numberOfRepeatsAllowed	S	0..1	unsignedInt	Number of refills authorized
quantity
value	S	0..1	decimal	Numerical value (with implicit precision)
expectedSupplyDuration	S	0..1	Duration	Number of days supply per dispense
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
MedicationRequest.status	required	OutMedRequestStatus http://va.gov/fhir/ValueSet/OutMedRequestStatus from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
mro-27-811	warning	MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.value	If number then source value from (52-113 > 52.0113-.01) : true
mro-27-841	warning	MedicationRequest.dosageInstruction.doseAndRate.extension:originalText.value[x]	If not a number then source value from (52-113 > 52.0113-.01) : true
mro-27-1746	warning	MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].code	If (52-11) is P then fixed value #active-parked : true
mro-27-1746-1	warning	MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].system	If P then fixed value http://va.gov/terminology/vistaDefinedTerms/52-100 : true

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
MedicationRequest		0..*	USCoreMedicationRequestProfile(5.0.1)	Ordering of medication for patient or group This profile also complies with the profiles US Core MedicationRequest Profile (6.1.0) and US Core MedicationRequest Profile (7.0.0)
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:medicationrequest-pharmacyOrderStatus		0..1	(Complex)	Extension URL: http://va.gov/fhir/StructureDefinition/medicationrequest-pharmacyOrderStatus
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://va.gov/fhir/StructureDefinition/medicationrequest-pharmacyOrderStatus"
value[x]		0..1	Coding	Value of extension
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣC	0..1	uri	Identity of the terminology system mro-27-1746-1: If P then fixed value http://va.gov/terminology/vistaDefinedTerms/52-100 Required Pattern: http://va.gov/terminology/vistaDefinedTerms/52-100
version	Σ	0..1	string	Version of the system - if relevant
code	SΣC	0..1	code	Symbol in syntax defined by the system mro-27-1746: If (52-11) is P then fixed value #active-parked
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
extension:medicationrequest-cancelDate		0..1	(Complex)	Extension URL: http://va.gov/fhir/StructureDefinition/medicationrequest-cancelDate
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://va.gov/fhir/StructureDefinition/medicationrequest-cancelDate"
value[x]	S	0..1	dateTime	Value of extension
extension:medicationrequest-includeIndicationInSig		0..1	(Complex)	Extension URL: http://va.gov/fhir/StructureDefinition/medicationrequest-includeIndicationInSig
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://va.gov/fhir/StructureDefinition/medicationrequest-includeIndicationInSig"
value[x]	S	0..1	boolean	Value of extension
extension:medicationrequest-remainingRefillCount		0..1	(Complex)	Extension URL: http://va.gov/fhir/StructureDefinition/medicationrequest-remainingRefillCount
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://va.gov/fhir/StructureDefinition/medicationrequest-remainingRefillCount"
value[x]	S	0..1	integer	Value of extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		0..*	Identifier	External ids for this request
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	SΣ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: FILL
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown Binding: OutMedRequestStatus FHIR (required): see mapping VF_OutMedRequestStatus
statusReason		0..1	CodeableConcept	Reason for current status Binding: medicationRequest Status Reason Codes (example): Identifies the reasons for a given status.
intent	?!SΣ	1..1	code	proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option Binding: medicationRequest Intent (required): The kind of medication order. Required Pattern: order
Slices for category	S	0..*	CodeableConcept	Type of medication usage Slice: Unordered, Open by pattern:$this Binding: medicationRequest Category Codes (example): A coded concept identifying the category of medication request. For example, where the medication is to be consumed or administered, or the type of medication treatment. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/medicationrequest-category
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: outpatient
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
category:us-core	S	0..*	CodeableConcept	Type of medication usage Binding: medicationRequest Category Codes (required): The type of medication order.
priority	Σ	0..1	code	routine | urgent | asap | stat Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.
doNotPerform	?!Σ	0..1	boolean	True if request is prohibiting action
reported[x]	SΣ	0..1		Reported rather than primary record
reportedBoolean			boolean S
reportedReference			Reference S(US Core Practitioner Profile(5.0.1) S | US Core Organization Profile(5.0.1) | US Core Patient Profile(5.0.1) | US Core PractitionerRole Profile(5.0.1) | US Core RelatedPerson Profile)
Slices for medication[x]	SΣ	1..1		Medication to be taken Slice: Unordered, Open by type:$this Binding: Medication Clinical Drug (extensible)
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(US Core Medication Profile(5.0.1))
medication[x]:medicationCodeableConcept	SΣ	0..1	CodeableConcept	Medication to be taken Binding: Medication Clinical Drug (extensible)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	0..1	uri	Identity of the terminology system Required Pattern: http://www.nlm.nih.gov/research/umls/rxnorm
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	SΣ	0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(Patient)	Who or group medication request is for
encounter	S	0..1	Reference(US Core Encounter Profile(5.0.1))	Encounter created as part of encounter/admission/stay
supportingInformation		0..*	Reference(Resource)	Information to support ordering of the medication
authoredOn	SΣ	0..1	dateTime	When request was initially authored
requester	SΣ	1..1	Reference(Practitioner)	Who/What requested the Request
performer		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam)	Intended performer of administration
performerType	Σ	0..1	CodeableConcept	Desired kind of performer of the medication administration Binding: ProcedurePerformerRoleCodes (example): Identifies the type of individual that is desired to administer the medication.
recorder		0..1	Reference(Practitioner | PractitionerRole)	Person who entered the request
reasonCode		0..*	CodeableConcept	Reason or indication for ordering or not ordering the medication Binding: Condition/Problem/DiagnosisCodes (example): A coded concept indicating why the medication was ordered.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
text	SΣ	0..1	string	Plain text representation of the concept
reasonReference		0..*	Reference(Condition | Observation)	Condition or observation that supports why the prescription is being written
instantiatesCanonical	Σ	0..*	canonical()	Instantiates FHIR protocol or definition
instantiatesUri	Σ	0..*	uri	Instantiates external protocol or definition
basedOn	Σ	0..*	Reference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation)	What request fulfills
groupIdentifier	Σ	0..1	Identifier	Composite request this is part of
courseOfTherapyType		0..1	CodeableConcept	Overall pattern of medication administration Binding: medicationRequest Course of Therapy Codes (example): Identifies the overall pattern of medication administratio.
insurance		0..*	Reference(Coverage | ClaimResponse)	Associated insurance coverage
note		0..*	Annotation	Information about the prescription
dosageInstruction	S	0..*	Dosage	How the medication should be taken
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	Σ	0..1	integer	The order of the dosage instructions
text	SΣ	0..1	string	Free text dosage instructions e.g. SIG
additionalInstruction	Σ	0..*	CodeableConcept	Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness" Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
patientInstruction	SΣ	0..1	string	Patient or consumer oriented instructions
timing	Σ	0..1	Timing	When medication should be administered
asNeeded[x]	Σ	0..1		Take "as needed" (for x) Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): 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.
asNeededBoolean			boolean
asNeededCodeableConcept			CodeableConcept
site	Σ	0..1	CodeableConcept	Body site to administer to Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.
route	Σ	0..1	CodeableConcept	How drug should enter body Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	0..1	uri	Identity of the terminology system Required Pattern: http://va.gov/terminology/vistaDefinedTerms/53.1-3
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
method	Σ	0..1	CodeableConcept	Technique for administering medication Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.
doseAndRate	Σ	0..*	Element	Amount of medication administered
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
extension:originalText		0..1	(Complex)	Original Text that represents the data as seen/selected/uttered originally URL: http://hl7.org/fhir/StructureDefinition/originalText
id		0..1	id	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/originalText"
value[x]	SC	1..1		Value of extension mro-27-841: If not a number then source value from (52-113 > 52.0113-.01)
valueString			string
valueUrl			url
type	Σ	0..1	CodeableConcept	The kind of dose or rate specified Binding: DoseAndRateType (example): The kind of dose or rate specified.
Slices for dose[x]	Σ	0..1		Amount of medication per dose Slice: Unordered, Open by type:$this
doseRange			Range
doseQuantity			Quantity(SimpleQuantity)
dose[x]:doseQuantity	Σ	0..1	SimpleQuantity	Amount of medication per dose
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	SΣC	0..1	decimal	Numerical value (with implicit precision) mro-27-811: If number then source value from (52-113 > 52.0113-.01)
unit	SΣ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form
code	Σ	0..1	code	Coded form of the unit
rate[x]	Σ	0..1		Amount of medication per unit of time
rateRatio			Ratio
rateRange			Range
rateQuantity			Quantity(SimpleQuantity)
maxDosePerPeriod	Σ	0..1	Ratio	Upper limit on medication per unit of time
maxDosePerAdministration	Σ	0..1	SimpleQuantity	Upper limit on medication per administration
maxDosePerLifetime	Σ	0..1	SimpleQuantity	Upper limit on medication per lifetime of the patient
dispenseRequest		0..1	BackboneElement	Medication supply authorization
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
initialFill		0..1	BackboneElement	First fill details
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
quantity		0..1	SimpleQuantity	First fill quantity
duration		0..1	Duration	First fill duration
dispenseInterval		0..1	Duration	Minimum period of time between dispenses
validityPeriod		0..1	Period	Time period supply is authorized for
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	ΣC	0..1	dateTime	Starting time with inclusive boundary
end	SΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing
numberOfRepeatsAllowed	S	0..1	unsignedInt	Number of refills authorized
quantity		0..1	SimpleQuantity	Amount of medication to supply per dispense
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	SΣ	0..1	decimal	Numerical value (with implicit precision)
unit	Σ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form
code	Σ	0..1	code	Coded form of the unit
expectedSupplyDuration	S	0..1	Duration	Number of days supply per dispense
performer		0..1	Reference(Organization)	Intended dispenser
substitution		0..1	BackboneElement	Any restrictions on medication substitution
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
allowed[x]		1..1		Whether substitution is allowed or not Binding: ActSubstanceAdminSubstitutionCode (example): Identifies the type of substitution allowed.
allowedBoolean			boolean
allowedCodeableConcept			CodeableConcept
reason		0..1	CodeableConcept	Why should (not) substitution be made Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
priorPrescription		0..1	Reference(MedicationRequest)	An order/prescription that is being replaced
detectedIssue		0..*	Reference(DetectedIssue)	Clinical Issue with action
eventHistory		0..*	Reference(Provenance)	A list of events of interest in the lifecycle
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
MedicationRequest.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
MedicationRequest.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
MedicationRequest.identifier.type	extensible	Pattern: FILL http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
MedicationRequest.status	required	OutMedRequestStatus http://va.gov/fhir/ValueSet/OutMedRequestStatus from this IG
MedicationRequest.statusReason	example	medicationRequest Status Reason Codes http://hl7.org/fhir/ValueSet/medicationrequest-status-reason from the FHIR Standard
MedicationRequest.intent	required	Pattern: order http://hl7.org/fhir/ValueSet/medicationrequest-intent from the FHIR Standard
MedicationRequest.category	example	Pattern: outpatient http://hl7.org/fhir/ValueSet/medicationrequest-category from the FHIR Standard
MedicationRequest.category:us-core	required	medicationRequest Category Codes http://hl7.org/fhir/ValueSet/medicationrequest-category from the FHIR Standard
MedicationRequest.priority	required	RequestPriority http://hl7.org/fhir/ValueSet/request-priority|4.0.1 from the FHIR Standard
MedicationRequest.medication[x]	extensible	Medication Clinical Drug http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4 from https://vsac.nlm.nih.gov
MedicationRequest.medication[x]:medicationCodeableConcept	extensible	Medication Clinical Drug http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4 from https://vsac.nlm.nih.gov
MedicationRequest.performerType	example	ProcedurePerformerRoleCodes http://hl7.org/fhir/ValueSet/performer-role from the FHIR Standard
MedicationRequest.reasonCode	example	Condition/Problem/DiagnosisCodes http://hl7.org/fhir/ValueSet/condition-code from the FHIR Standard
MedicationRequest.courseOfTherapyType	example	medicationRequest Course of Therapy Codes http://hl7.org/fhir/ValueSet/medicationrequest-course-of-therapy from the FHIR Standard
MedicationRequest.dosageInstruction.additionalInstruction	example	SNOMEDCTAdditionalDosageInstructions http://hl7.org/fhir/ValueSet/additional-instruction-codes from the FHIR Standard
MedicationRequest.dosageInstruction.asNeeded[x]	example	SNOMEDCTMedicationAsNeededReasonCodes http://hl7.org/fhir/ValueSet/medication-as-needed-reason from the FHIR Standard
MedicationRequest.dosageInstruction.site	example	SNOMEDCTAnatomicalStructureForAdministrationSiteCodes http://hl7.org/fhir/ValueSet/approach-site-codes from the FHIR Standard
MedicationRequest.dosageInstruction.route	example	SNOMEDCTRouteCodes http://hl7.org/fhir/ValueSet/route-codes from the FHIR Standard
MedicationRequest.dosageInstruction.method	example	SNOMEDCTAdministrationMethodCodes http://hl7.org/fhir/ValueSet/administration-method-codes from the FHIR Standard
MedicationRequest.dosageInstruction.doseAndRate.type	example	DoseAndRateType http://hl7.org/fhir/ValueSet/dose-rate-type from the FHIR Standard
MedicationRequest.substitution.allowed[x]	example	ActSubstanceAdminSubstitutionCode http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode
MedicationRequest.substitution.reason	example	SubstanceAdminSubstitutionReason http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MedicationRequest	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MedicationRequest	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	error	MedicationRequest	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	error	MedicationRequest	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MedicationRequest	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
mro-27-811	warning	MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.value	If number then source value from (52-113 > 52.0113-.01) : true
mro-27-841	warning	MedicationRequest.dosageInstruction.doseAndRate.extension:originalText.value[x]	If not a number then source value from (52-113 > 52.0113-.01) : true
mro-27-1746	warning	MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].code	If (52-11) is P then fixed value #active-parked : true
mro-27-1746-1	warning	MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].system	If P then fixed value http://va.gov/terminology/vistaDefinedTerms/52-100 : true

This structure is derived from USCoreMedicationRequestProfile

Summary

Must-Support: 22 elements

Structures

This structure refers to these other structures:

• Patient (http://va.gov/fhir/StructureDefinition/Patient)
• Practitioner (http://va.gov/fhir/StructureDefinition/Practitioner)
• SimpleQuantity (http://hl7.org/fhir/StructureDefinition/SimpleQuantity)

Extensions

This structure refers to these extensions:

• http://va.gov/fhir/StructureDefinition/medicationrequest-pharmacyOrderStatus
• http://va.gov/fhir/StructureDefinition/medicationrequest-cancelDate
• http://va.gov/fhir/StructureDefinition/medicationrequest-includeIndicationInSig
• http://va.gov/fhir/StructureDefinition/medicationrequest-remainingRefillCount
• http://hl7.org/fhir/StructureDefinition/originalText

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of MedicationRequest.medication[x]
• The element 1 is sliced based on the value of MedicationRequest.dosageInstruction.doseAndRate.dose[x]