NHS Digital FHIR Medicines

There are no (further) constraints on this element

Element id

MedicationRequest.id

Short description

Logical id of this artifact

Definition

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

Comments

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

Data type

There are no (further) constraints on this element

Element id

MedicationRequest.meta

Short description

Metadata about the resource

Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

Data type

Constraints

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

implicitRules

Σ ?!

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.implicitRules

Short description

A set of rules under which this content was created

Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Comments

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

Data type

Constraints

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

language

0..1

codeBinding

There are no (further) constraints on this element

Element id

MedicationRequest.language

Short description

Language of the resource content

Definition

The base language in which the resource is written.

Comments

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

Data type

Binding

A human language.

CommonLanguages (preferred)

Binding extensions

maxValueSet	AllLanguages

Constraints

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

text

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.text

Short description

Text summary of the resource, for human interpretation

Alternate names

narrative, html, xhtml, display

Definition

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Comments

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

Data type

Constraints

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

Mappings

rim: Act.text?

contained

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.contained

Short description

Contained, inline Resources

Alternate names

inline resources, anonymous resources, contained resources

Definition

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

Comments

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

Data type

Mappings

rim: N/A

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

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

Comments

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

Data type

https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation

Slicing

Unordered, Open, by url(Value)

Constraints

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

Mappings

rim: N/A

medicationRepeatInformation

S C

0..1

Extension(Complex)

Element id

MedicationRequest.extension:medicationRepeatInformation

Short description

Continous and Continuous Repeat Dispensing

Alternate names

extensions, user content

Definition

This extension <b>SHOULD</b> be present for continuous and continuous-repeat-dispensing therapy types.

Field	Description
numberOfPrescriptionsIssued	Running total of number of issues made against a repeat authorisation. Including this issue.
~~numberOfRepeatPrescriptionsAllowed~~	Retired. See <a href="#numberOfRepeatsAllowed">numberOfRepeatsAllowed</a>
authorisationExpiryDate	The date a repeat prescription authorisation will expire.

"extension": [
  {
       "url": "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation",
       "extension": [
           {
               "url": "numberOfPrescriptionsIssued",
               "valueUnsignedInt": 3
           },
           {
               "url": "authorisationExpiryDate",
               "valueDateTime": "2020-08-07"
           }
       ]
   }
]

Comments

Data type

Extension(Complex)

Extension URL

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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

Mappings

rim: N/A
rim: n/a

responsiblePractitioner

S C

0..1

Element id

MedicationRequest.extension:responsiblePractitioner

Short description

Responsible Practitioner for the prescription

Alternate names

extensions, user content

Definition

Must only be populated if the requester can not be responsible for the prescription, i.e. they would not be named as the prescriber on the FP10.

"extension": [
        
    {
        "url": "https://fhir.nhs.uk/StructureDefinition/Extension-DM-ResponsiblePractitioner",
        "valueReference": {
            "reference": "urn:uuid:a5acefc1-f8ca-4989-a5ac-34ae36741466",
            "display": "DR SAZ RAZ"
        }
    }
],

Comments

Data type

https://fhir.nhs.uk/StructureDefinition/Extension-DM-ResponsiblePractitioner

Extension URL

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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

Mappings

rim: N/A
rim: n/a

prescriptionEndorsement

S C

0..*

Element id

MedicationRequest.extension:prescriptionEndorsement

Short description

NHS BSA Prescription Endorsements

Alternate names

extensions, user content

Definition

The codes are contained in the valueset

Code	Display
CC	Contraceptive
FS	Sexual Health
ACBS	Advisory Committee on Borderline Substances. Part XV Drug Tariff
SLS	Selected List Scheme. Part XVIIIB Drug Tariff
AF	Food replacement/food supplement products

"resourceType": "MedicationRequest",
    "extension":  [
      {
          "url": "https://fhir.nhs.uk/StructureDefinition/Extension-DM-PrescriptionEndorsement",
          "valueCodeableConcept": {
              "coding":  [
                {
                    "system": "https://fhir.nhs.uk/CodeSystem/medicationrequest-endorsement",
                    "code": "SLS",
                    "display": "Selected List Scheme"
                }
            ]
        }
    }
  ],

Comments

Data type

https://fhir.nhs.uk/StructureDefinition/Extension-DM-PrescriptionEndorsement

Extension URL

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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

Mappings

rim: N/A
rim: n/a

prescriptionTaskStatusReason

S C

0..*

Extension(Complex)

Element id

MedicationRequest.extension:prescriptionTaskStatusReason

Short description

Prescription task status reason

Alternate names

extensions, user content

Definition

The status history within EPS is primarily a technical Status and the statusReason will reflect current clinical status of the order.

Comments

Data type

Extension(Complex)

Extension URL

https://fhir.nhs.uk/StructureDefinition/Extension-DM-PrescriptionStatusHistory

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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

Mappings

rim: N/A
rim: n/a

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

1..*

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

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

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

statusDate

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:statusDate

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Constraints

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

Mappings

rim: n/a

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:statusDate.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:statusDate.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

url

1..1

uriAuto Value

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:statusDate.url

Short description

identifies the meaning of the extension

Definition

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

Comments

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

Data type

Auto value

statusDate

Mappings

rim: N/A

value[x]

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:statusDate.value[x]

Short description

Value of extension

Definition

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

Constraints

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

Mappings

rim: N/A

valueDateTime

There are no (further) constraints on this element

Data type

status

1..1

ExtensionBinding

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

TaskMedicationRequestStatusReason (required)

Binding

Constraints

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

Mappings

rim: n/a

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

url

1..1

uriAuto Value

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.url

Short description

identifies the meaning of the extension

Definition

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

Comments

Data type

Auto value

status

Mappings

rim: N/A

value[x]

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.value[x]

Short description

Value of extension

Definition

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

Constraints

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

Mappings

rim: N/A

valueCoding

There are no (further) constraints on this element

Data type

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.value[x].id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.value[x].extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

system

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.value[x].system

Short description

Identity of the terminology system

Definition

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

Requirements

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

Comments

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

Data type

Constraints

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

Mappings

v2: C*E.3
rim: ./codeSystem
orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

version

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.value[x].version

Short description

Version of the system - if relevant

Definition

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

Comments

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

Data type

Constraints

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

Mappings

v2: C*E.7
rim: ./codeSystemVersion
orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.value[x].code

Short description

Symbol in syntax defined by the system

Definition

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

Requirements

Need to refer to a particular code in the system.

Data type

Constraints

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

Mappings

v2: C*E.1
rim: ./code
orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

display

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.value[x].display

Short description

Representation defined by the system

Definition

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

Requirements

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

Data type

Constraints

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

Mappings

v2: C*E.2 - but note this is not well followed
rim: CV.displayName
orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

userSelected

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.value[x].userSelected

Short description

If this coding was chosen directly by the user

Definition

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

Requirements

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

Comments

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

Data type

Constraints

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

Mappings

v2: Sometimes implied by being first
rim: CD.codingRationale
orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]

url

1..1

uriAuto Value

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.url

Short description

identifies the meaning of the extension

Definition

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

Comments

Data type

Auto value

https://fhir.nhs.uk/StructureDefinition/Extension-DM-PrescriptionStatusHistory

Mappings

rim: N/A

value[x]

0..0

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.value[x]

Short description

Value of extension

Definition

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

Constraints

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

Mappings

rim: N/A

NHSBSAprescriptionType

S C

0..1

Element id

MedicationRequest.extension:NHSBSAprescriptionType

Short description

NHS BSA Prescription Type

Alternate names

extensions, user content

Definition

The vocabulary for the ‘PrescriptionType’ vocabulary is defined within the NHSBSA Overprint Specification.

The System must populate the ‘PrescriptionType’ attribute for the appropriate combination of prescriber and care setting. Retired codes within this vocabulary must not be used

"extension":  [
    {
        "url": "https://fhir.nhs.uk/StructureDefinition/Extension-DM-PrescriptionType",
        "valueCoding": {
            "system": "https://fhir.nhs.uk/CodeSystem/prescription-type",
            "code": "1201",
            "display": "Outpatient Homecare Prescriber - Medical Prescriber"
        }
    }
    ]

Comments

Data type

https://fhir.nhs.uk/StructureDefinition/Extension-DM-PrescriptionType

Extension URL

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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

Mappings

rim: N/A
rim: n/a

controlledDrug

S C

0..1

Extension(Complex)

Element id

MedicationRequest.extension:controlledDrug

Short description

Optional Controlled Drug Extensions

Alternate names

extensions, user content

Definition

The table below summarises the EPS requirements for the CD schedules. The terms “Hand signature” and “Electronic signature” expressed in the table are shortened references to the legal definition of signature requirements within government legislation.

Sch.	Code	Signing Legal Requirement	EPS Scope	Expiry Date	Quantity Representation	Repeat Dispensing Allowed	RD 1st Issue Expiry	RD Subsequent Expiry
1	CD1	Invalid to prescribe	Out of scope	N/A	N/A	N/A	N/A
2	CD2	Hand signature or electronic signature	In scope	28 days	Words and Figures	No	N/A	N/A
3	CD3	Hand signature or electronic signature	In scope	28 days	Words and Figures	No	N/A	N/A
4	CD4-1 CD4-2	Hand signature or electronic signature	In scope	28 days	Figures	Yes	28 days	Up to 12 months
5	CD5	Hand signature or electronic signature	In scope	6 Months	Figures	Yes	6 months	Up to 12 months

It is a legal requirement to state the prescribed quantity as words in the quantityWords

{
    "url": "https://fhir.nhs.uk/StructureDefinition/Extension-DM-ControlledDrug",
    "extension": [
        {
            "url": "quantityWords",
            "valueString": "twenty eight"
        },
        {
            "url": "schedule",
            "valueCoding": {
                "system": "https://fhir.nhs.uk/CodeSystem/medicationrequest-controlled-drug",
                "code": "CD2",
                "display": "Schedule 2"
            }
        }
    ]
}

Comments

Data type

Extension(Complex)

Extension URL

https://fhir.nhs.uk/StructureDefinition/Extension-DM-ControlledDrug

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
eps-cd1: Extension(controlledDrug) - For schedule 2 or 3 Controlled Drugs, the quantity must be expressed in words
(((extension('schedule').value.code='CD2' and extension('quantityWords').exists()) or (extension('schedule').value.code='CD3' and extension('quantityWords').exists()) or (extension('schedule').value.code != 'CD2' and extension('schedule').value.code != 'CD3')) and extension('scheduled').exists()) or (extension('scheduled').exists().not())

Mappings

rim: N/A
rim: n/a

dispensingInformation

S C

0..1

Extension(Complex)

Element id

MedicationRequest.extension:dispensingInformation

Short description

For EPS use only

Alternate names

extensions, user content

Definition

This extension is used in continuous-repeat-dispensing prescriptions sent by EPS to dispensing systems to convey information on prior dispensed medications.

"extension":  [
                {
                    "url": "https://fhir.nhs.uk/StructureDefinition/Extension-EPS-DispensingInformation",
                    "extension":  [
                        {
                            "url": "dispenseStatus",
                            "valueCoding": {
                                "system": "https://fhir.nhs.uk/CodeSystem/medicationdispense-type",
                                "code": "0001",
                                "display": "Item fully dispensed"
                            }
                        },
                        {
                            "url": "dateLastDispensed",
                            "valueDateTime": "2018-04-22T09:57:03+00:00"
                        }
                    ]
                }
            ],

Comments

Data type

Extension(Complex)

Extension URL

https://fhir.nhs.uk/StructureDefinition/Extension-EPS-DispensingInformation

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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

Mappings

rim: N/A
rim: n/a

modifierExtension

?! C

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.modifierExtension

Short description

Extensions that cannot be ignored

Alternate names

extensions, user content

Definition

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

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

Requirements

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

Comments

Data type

Constraints

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

Mappings

rim: N/A

identifier

1..*

Element id

MedicationRequest.identifier

Short description

Each MedicationRequest MUST be identified by an Universal Unique Identifiers (UUIDs) with a system of https://fhir.nhs.uk/Id/prescription-order-item-number

Definition

UUID example (for illustration purposes only);

a54219b8-f741-4c47-b662-e4f8dfa49ab6

 "identifier":  [
    {
        "system": "https://fhir.nhs.uk/Id/prescription-order-item-number",
        "value": "a54219b8-f741-4c47-b662-e4f8dfa49ab6"
    }
]

Comments

This is a business identifier, not a resource identifier.

Data type

Slicing

Unordered, Open, by system(Value)

Constraints

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

Mappings

workflow: Request.identifier
script10.6: Message/Header/PrescriberOrderNumber
w5: FiveWs.identifier
v2: ORC-2-Placer Order Number / ORC-3-Filler Order Number
rim: .id

(All Slices)

The requirements in this element apply to all slices

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.identifier.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.identifier.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element id

MedicationRequest.identifier.use

Short description

usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Requirements

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

Comments

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

Data type

Binding

Identifies the purpose for this identifier, if known .

Constraints

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

Mappings

v2: N/A
rim: Role.code or implied by context

type

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element id

MedicationRequest.identifier.type

Short description

Description of identifier

Definition

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

Requirements

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

Comments

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

Data type

Binding

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

Constraints

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

Mappings

v2: CX.5
rim: Role.code or implied by context

system

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.identifier.system

Short description

The namespace for the identifier value

Definition

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

Requirements

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

Comments

Identifier.system is always case sensitive.

Data type

Constraints

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

Examples
General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

value

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.identifier.value

Short description

The value that is unique

Definition

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

Comments

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

Data type

Constraints

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

Examples
General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

period

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.identifier.period

Short description

Time period when id is/was valid for use

Definition

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

Data type

Constraints

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

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

assigner

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.identifier.assigner

Short description

Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Comments

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

Data type

Constraints

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

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

prescriptionOrderItem

1..1

Element id

MedicationRequest.identifier:prescriptionOrderItem

Short description

Prescription Order Item

Definition

Unique Id of the MedicationRequest within EPS

Comments

This is a business identifier, not a resource identifier.

Data type

Constraints

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

Mappings

workflow: Request.identifier
script10.6: Message/Header/PrescriberOrderNumber
w5: FiveWs.identifier
v2: ORC-2-Placer Order Number / ORC-3-Filler Order Number
rim: .id

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.identifier:prescriptionOrderItem.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.identifier:prescriptionOrderItem.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element id

MedicationRequest.identifier:prescriptionOrderItem.use

Short description

usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Requirements

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

Comments

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

Data type

Binding

Identifies the purpose for this identifier, if known .

Constraints

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

Mappings

v2: N/A
rim: Role.code or implied by context

type

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element id

MedicationRequest.identifier:prescriptionOrderItem.type

Short description

Description of identifier

Definition

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

Requirements

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

Comments

Data type

Binding

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

Constraints

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

Mappings

v2: CX.5
rim: Role.code or implied by context

system

1..1

uriAuto Value

Element id

MedicationRequest.identifier:prescriptionOrderItem.system

Short description

The namespace for the identifier value

Definition

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

Requirements

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

Comments

Identifier.system is always case sensitive.

Data type

Constraints

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

Auto value

https://fhir.nhs.uk/Id/prescription-order-item-number

Examples
General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

value

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.identifier:prescriptionOrderItem.value

Short description

The value that is unique

Definition

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

Comments

Data type

Constraints

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

Examples
General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

period

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.identifier:prescriptionOrderItem.period

Short description

Time period when id is/was valid for use

Definition

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

Data type

Constraints

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

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

assigner

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.identifier:prescriptionOrderItem.assigner

Short description

Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Comments

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

Data type

Constraints

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

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

status

S Σ ?!

1..1

codeBinding

Element id

MedicationRequest.status

Short description

active | cancelled | stopped

Definition

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

code	Definition
active	The prescription is 'actionable', but not all actions that are implied by it have occurred yet. It has not been dispensed or filled.
cancelled	The prescription is to be cancelled or it has been cancelled been withdrawn before any administrations have occurred. Prescriptions in the process of being cancelled will be regarded as active until all actions are complete.
stopped	Actions implied by the prescription are to be permanently halted, before all of the administrations occurred. This should not be used if the original order was entered in error
completed	All actions that are implied by the prescription have occurred.

Logical medicationRequest status transitions

This state transition diagram is an enhancement over the generic State Machine defined within the FHIR specification. It includes the status values associated with a medication request with transitions applicable to a UK implementation.

Comments

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

Data type

medicationrequest Status (required)

Binding

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

Constraints

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

Mappings

workflow: Request.status
script10.6: no mapping
w5: FiveWs.status
rim: .statusCode

statusReason

0..1

CodeableConceptBinding

Element id

MedicationRequest.statusReason

Short description

Reason for current status

Definition

This is generally only used for exception statuses such as suspended or cancelled. It is the clinical status reason for the cancellation.

This is mandatory for 'prescription-order-update' messages.

"statusReason": {
    "coding": [
        {
            "system": "https://fhir.nhs.uk/CodeSystem/medicationrequest-status-reason",
            "code": "0001",
            "display": "Prescribing Error"
        }
    ]
},

Comments

This is generally only used for "exception" statuses such as "suspended" or "cancelled". The reason why the MedicationRequest was created at all is captured in reasonCode, not here.

Data type

MedicationRequestStatusReason (required)

Binding

Identifies the reasons for a given status.

Constraints

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

Mappings

workflow: Request.statusReason
rim: .inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.statusReason.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.statusReason.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

coding

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.statusReason.coding

Short description

Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Requirements

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

Comments

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

Data type

Constraints

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

Mappings

v2: C*E.1-8, C*E.10-22
rim: union(., ./translation)
orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.statusReason.coding.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.statusReason.coding.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

system

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.statusReason.coding.system

Short description

Identity of the terminology system

Definition

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

Requirements

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

Comments

Data type

Constraints

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

Mappings

v2: C*E.3
rim: ./codeSystem
orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

version

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.statusReason.coding.version

Short description

Version of the system - if relevant

Definition

Comments

Data type

Constraints

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

Mappings

v2: C*E.7
rim: ./codeSystemVersion
orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.statusReason.coding.code

Short description

Symbol in syntax defined by the system

Definition

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

Requirements

Need to refer to a particular code in the system.

Data type

Constraints

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

Mappings

v2: C*E.1
rim: ./code
orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

display

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.statusReason.coding.display

Short description

Representation defined by the system

Definition

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

Requirements

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

Data type

Constraints

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

Mappings

v2: C*E.2 - but note this is not well followed
rim: CV.displayName
orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

userSelected

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.statusReason.coding.userSelected

Short description

If this coding was chosen directly by the user

Definition

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

Requirements

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

Comments

Data type

Constraints

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

Mappings

v2: Sometimes implied by being first
rim: CD.codingRationale
orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]

text

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.statusReason.text

Short description

Plain text representation of the concept

Definition

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

Requirements

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

Comments

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

Data type

Constraints

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

Mappings

v2: C*E.9. But note many systems use C*E.2 for this
rim: ./originalText[mediaType/code="text/plain"]/data
orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

intent

Σ ?!

1..1

codeBinding

Element id

MedicationRequest.intent

Short description

Definition

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

Comments

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

code	display	courseOfTherapyType	Definition
order	Order	acute	The request represents a request/demand and authorization for action
original-order	Original Order	continuous-repeat-dispensing continuous	The request represents the original authorization for the medication request.
reflex-order	Reflex Order	continuous-repeat-dispensing	The request represents an automatically generated supplemental authorization (by EPS) for action based on a parent authorization together with initial results of the action taken against that parent authorization.
instance-order	Instance Order	continuous	The request represents an instance for the particular order.

Data type

medicationRequest Intent (required)

Binding

The kind of medication order.

Constraints

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

Mappings

workflow: Request.intent
w5: FiveWs.class
rim: .moodCode (nuances beyond PRP/PLAN/RQO would need to be elsewhere)

Sequential Instructions

Where the value of sequence is an incremental integer it defines a sequential instruction.

Concurrent Instructions

Where the same integer value of sequence is defines it means a concurrent instruction.

Requirements

If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. If the sequence number is different, then the Dosages are intended to be sequential.

Data type

integer

Constraints

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

Mappings

v2: TQ1-1
rim: .text

text

S Σ

0..1

Element id

MedicationRequest.dosageInstruction.text

Short description

The complete dosage instruction as a human readable string.

Definition

The complete dosage instruction as a human readable string.

<div class="nhsd-a-box nhsd-a-box--bg-light-blue nhsd-!t-margin-bottom-6 nhsd-t-body"> <strong>Recommendation</strong>: Use the <a href='DosetoTextTranslation'>translation algorithm</a> published within this guide to create a string from the coded Dosage elements. It is planned for this translation algorithm to be available as an API. </div>

For example;

<text value="1 tablet - every 6 hours - oral" />

Where additional dosage instructions need to be conveyed that cannot be described using any other element of the Dosage structure, then append these to the end of the translated dosage text.

For example, the instruction to “infuse as rapidly as possibly via intraperitoneal port” is not a coded term so cannot be shared as a additionalInstruction. It would neither be appropriate as a patientInstruction string.

For example;

<text value="{the dosage elements translated as text} - infuse as rapidly as possibly via intraperitoneal port" />

For example, the instruction “immediately following drug {X}”), where {X} is the name of a drug, is neither suitable as a additionalInstruction nor patientInstruction.

For example;

<text value="500 milligrams - once - oral - immediately following drug {X}" />

Requirements

Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing. Additional information about administration or preparation of the medication should be included as text.

Data type

Constraints

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

Mappings

v2: RXO-6; RXE-21
rim: .text

additionalInstruction

S Σ

0..*

Element id

MedicationRequest.dosageInstruction.additionalInstruction

Short description

Additional dosage instructions that can be either SNOMED-CT coded terms or free-text instructions.

Definition

These sections MUST be used only be used to pass notes regarding the prescription to the pharmacist or patient. Lists of repeat medications and general practice notifications to the patient SHOULD be recorded in NHSDigital-CommunicationRequest resource.

Patient instructions for taking the drug are contained with in the patientInstruction and additionalInstruction as per the guidance in Dosage Structure Overview

"dosageInstruction": [
    {
        "text": "10 milligram, Inject, Subcutaneous route, once weekly",
        "additionalInstruction": [
            "coding": [
                {
                    "system": "http://snomed.info/sct",
                    "code": "421769005",
                    "display": "Follow directions"
                }
            ],
        ],
        "patientInstruction": "As directed"
    }
]

Requirements

Additional instruction is intended to be coded, but where no code exists, the element could include text. For example, "Swallow with plenty of water" which might or might not be coded.

Comments

Information about administration or preparation of the medication (e.g. "infuse as rapidly as possibly via intraperitoneal port" or "immediately following drug x") should be populated in dosage.text.

Data type

SNOMEDCTAdditionalDosageInstructions (example)

Binding

A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".

Constraints

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

Mappings

v2: RXO-7
rim: .text

patientInstruction

S Σ

0..1

Element id

MedicationRequest.dosageInstruction.patientInstruction

Short description

Patient or consumer oriented instructions

Definition

Patient instructions for taking the drug are contained with in the patientInstruction and additionalInstruction as per the guidance in Dosage Structure Overview

"dosageInstruction": [
    {
        "text": "10 milligram, Inject, Subcutaneous route, once weekly",
        "additionalInstruction": [
            "coding": [
                {
                    "system": "http://snomed.info/sct",
                    "code": "421769005",
                    "display": "Follow directions"
                }
            ],
        ],
        "patientInstruction": "As directed"
    }
]

Data type

Constraints

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

Mappings

v2: RXO-7
rim: .text

timing

S Σ

0..1

Element id

MedicationRequest.dosageInstruction.timing

Short description

When medication should be administered

Definition

Adding constraints, bounds or limits to a dosage instruction.

Requirements

The timing schedule for giving the medication to the patient. This data type allows many different expressions. For example: "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

Comments

This attribute might not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.

Data type

Constraints

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

Mappings

rim: .effectiveTime

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

modifierExtension

Σ ?! C

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.modifierExtension

Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

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

Requirements

Comments

Data type

Constraints

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

Mappings

rim: N/A

event

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.event

Short description

When the event occurs

Definition

Identifies specific times when the event occurs.

Requirements

In a Medication Administration Record, for instance, you need to take a general specification, and turn it into a precise specification.

Data type

Constraints

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

Mappings

rim: QLIST<TS>

repeat

Σ C

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat

Short description

When the event is to occur

Definition

A set of rules that describe when the event is scheduled.

Requirements

Many timing schedules are determined by regular repetitions.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
tim-1: if there's a duration, there needs to be duration units
duration.empty() or durationUnit.exists()
tim-2: if there's a period, there needs to be period units
period.empty() or periodUnit.exists()
tim-4: duration SHALL be a non-negative value
duration.exists() implies duration >= 0
tim-5: period SHALL be a non-negative value
period.exists() implies period >= 0
tim-6: If there's a periodMax, there must be a period
periodMax.empty() or period.exists()
tim-7: If there's a durationMax, there must be a duration
durationMax.empty() or duration.exists()
tim-8: If there's a countMax, there must be a count
countMax.empty() or count.exists()
tim-9: If there's an offset, there must be a when (and not C, CM, CD, CV)
offset.empty() or (when.exists() and ((when in ('C' | 'CM' | 'CD' | 'CV')).not()))
tim-10: If there's a timeOfDay, there cannot be a when, or vice versa
timeOfDay.empty() or when.empty()

Mappings

rim: Implies PIVL or EIVL

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

bounds[x]

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.bounds[x]

Short description

Length/Range of lengths, or (Start and/or end) limits

Definition

Either a duration for the length of the timing schedule, a range of possible length, or outer bounds for start and/or end limits of the timing schedule.

Constraints

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

Mappings

rim: IVL(TS) used in a QSI

boundsDuration

Data type

boundsRange

Data type

boundsPeriod

Data type

count

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.count

Short description

Number of times to repeat

Definition

A total count of the desired number of repetitions across the duration of the entire timing specification. If countMax is present, this element indicates the lower bound of the allowed range of count values.

Requirements

Repetitions may be limited by end time or total occurrences.

Comments

If you have both bounds and count, then this should be understood as within the bounds period, until count times happens.

Data type

Constraints

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

Mappings

rim: PIVL.count

countMax

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.countMax

Short description

Maximum number of times to repeat

Definition

If present, indicates that the count is a range - so to perform the action between [count] and [countMax] times.

Data type

Constraints

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

Mappings

rim: PIVL.count

duration

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.duration

Short description

How long when it happens

Definition

How long this thing happens for when it happens. If durationMax is present, this element indicates the lower bound of the allowed range of the duration.

Requirements

Some activities are not instantaneous and need to be maintained for a period of time.

Comments

For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).

Data type

Constraints

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

Mappings

rim: PIVL.phase

durationMax

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.durationMax

Short description

How long when it happens (Max)

Definition

If present, indicates that the duration is a range - so to perform the action between [duration] and [durationMax] time length.

Requirements

Some activities are not instantaneous and need to be maintained for a period of time.

Comments

Data type

Constraints

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

Mappings

rim: PIVL.phase

durationUnit

0..1

codeBinding

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.durationUnit

Short description

s | min | h | d | wk | mo | a - unit of time (UCUM)

Definition

The units of time for the duration, in UCUM units.

Data type

Binding

A unit of time (units from UCUM).

Constraints

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

Mappings

rim: PIVL.phase.unit

frequency

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.frequency

Short description

Event occurs frequency times per period

Definition

The number of times to repeat the action within the specified period. If frequencyMax is present, this element indicates the lower bound of the allowed range of the frequency.

Meaning when missing

If no frequency is stated, the assumption is that the event occurs once per period, but systems SHOULD always be specific about this

Data type

Constraints

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

Mappings

rim: PIVL.phase

frequencyMax

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.frequencyMax

Short description

Event occurs up to frequencyMax times per period

Definition

If present, indicates that the frequency is a range - so to repeat between [frequency] and [frequencyMax] times within the period or period range.

Data type

Constraints

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

Mappings

rim: PIVL.phase

period

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.period

Short description

Event occurs frequency times per period

Definition

Indicates the duration of time over which repetitions are to occur; e.g. to express "3 times per day", 3 would be the frequency and "1 day" would be the period. If periodMax is present, this element indicates the lower bound of the allowed range of the period length.

Data type

Constraints

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

Mappings

rim: PIVL.phase

periodMax

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.periodMax

Short description

Upper limit of period (3-4 hours)

Definition

If present, indicates that the period is a range from [period] to [periodMax], allowing expressing concepts such as "do this once every 3-5 days.

Data type

Constraints

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

Mappings

rim: PIVL.phase

periodUnit

0..1

codeBinding

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.periodUnit

Short description

s | min | h | d | wk | mo | a - unit of time (UCUM)

Definition

The units of time for the period in UCUM units.

Data type

Binding

A unit of time (units from UCUM).

Constraints

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

Mappings

rim: PIVL.phase.unit

dayOfWeek

0..*

codeBinding

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.dayOfWeek

Short description

mon | tue | wed | thu | fri | sat | sun

Definition

If one or more days of week is provided, then the action happens only on the specified day(s).

Comments

If no days are specified, the action is assumed to happen every day as otherwise specified. The elements frequency and period cannot be used as well as dayOfWeek.

Data type

Binding

DaysOfWeek (required)

Constraints

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

Mappings

rim: n/a

timeOfDay

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.timeOfDay

Short description

Time of day for action

Definition

Specified time of day for action to take place.

Comments

When time of day is specified, it is inferred that the action happens every day (as filtered by dayofWeek) on the specified times. The elements when, frequency and period cannot be used as well as timeOfDay.

Data type

Constraints

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

Mappings

rim: n/a

when

0..*

codeBinding

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.when

Short description

Code for time period of occurrence

Definition

An approximate time period during the day, potentially linked to an event of daily living that indicates when the action should occur.

Requirements

Timings are frequently determined by occurrences such as waking, eating and sleep.

Comments

When more than one event is listed, the event is tied to the union of the specified events.

Data type

Binding

Real world event relating to the schedule.

EventTiming (required)

Constraints

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

Mappings

rim: EIVL.event

offset

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.offset

Short description

Minutes from event (before or after)

Definition

The number of minutes from the event. If the event code does not indicate whether the minutes is before or after the event, then the offset is assumed to be after the event.

Data type

Constraints

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

Mappings

rim: EIVL.offset

code

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.code

Short description

BID | TID | QID | AM | PM | QD | QOD | +

Definition

A code for the timing schedule (or just text in code.text). Some codes such as BID are ubiquitous, but many institutions define their own additional codes. If a code is provided, the code is understood to be a complete statement of whatever is specified in the structured timing data, and either the code or the data may be used to interpret the Timing, with the exception that .repeat.bounds still applies over the code (and is not contained in the code).

Comments

BID etc. are defined as 'at institutionally specified times'. For example, an institution may choose that BID is "always at 7am and 6pm". If it is inappropriate for this choice to be made, the code BID should not be used. Instead, a distinct organization-specific code should be used in place of the HL7-defined BID code and/or a structured representation should be used (in this case, specifying the two event times).

Data type

TimingAbbreviation (preferred)

Binding

Code for a known / defined timing pattern.

Constraints

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

Mappings

rim: QSC.code

asNeeded[x]

S Σ

0..1

Element id

MedicationRequest.dosageInstruction.asNeeded[x]

Short description

Take "as needed" (for x)

Definition

The asNeeded structure can be used to define a simple “as required” (or “pro re nata” expressed as “PRN” for those who still prefer to use Latin abbreviations) instructions.

In this case use the asNeededBoolean option. The absence of asNeededBoolean is equivalent to where asNeededBoolean has a value of false.

The asNeededCodeableConcept option is used to bound the dosage instruction to a coded term. Any number of coded terms can be used from the SNOMED-CT hierarchy as a descendant of 404684003 Clinical Finding (finding). An extensive medication-as-needed-reason value-set is defined within FHIR which is a subset of the SNOMED-CT clinical findings hierarchy.

Comments

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

Binding

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.

SNOMEDCTMedicationAsNeededReasonCodes (example)

Constraints

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

Mappings

v2: TQ1-9
rim: .outboundRelationship[typeCode=PRCN].target[classCode=OBS, moodCode=EVN, code="as needed"].value=boolean or codable concept

asNeededBoolean

There are no (further) constraints on this element

Data type

asNeededCodeableConcept

There are no (further) constraints on this element

Data type

site

S Σ

0..1

Element id

MedicationRequest.dosageInstruction.site

Short description

Body site to administer to

Definition

Any site can be used from the SNOMED-CT hierarchy as a descendant of the concept 123037004 Body structure (body structure).

<!-- Site -->
<site>
    <coding>
        <system value="http://snomed.info/sct"/>
        <code value="59380008"/>
        <display value="Anterior abdominal wall structure"/>
    </coding>
</site>

Requirements

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

Comments

If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.

Data type

SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example)

Binding

A coded concept describing the site location the medicine enters into or onto the body.

Constraints

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

Mappings

v2: RXR-2
rim: .approachSiteCode

route

S Σ

0..1

Element id

MedicationRequest.dosageInstruction.route

Short description

How drug should enter body

Definition

Any route can be used from the SNOMED-CT hierarchy as a descendant of the concept 284009009 Route of administration value (qualifier value).

<!-- Route -->
<route>
    <coding>
        <system value="http://snomed.info/sct"/>
        <code value="78421000"/>
        <display value="intramuscular route"/>
    </coding>
</route>

Requirements

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

Data type

Binding

A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

SNOMEDCTRouteCodes (example)

Constraints

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

Mappings

v2: RXR-1
rim: .routeCode

method

S Σ

0..1

Element id

MedicationRequest.dosageInstruction.method

Short description

Technique for administering medication

Definition

The 999000041000001103 ePrescribing method simple reference set (foundation metadata concept) reference set collates the commonly used terms for method for use in the United Kingdom.

Whilst a FHIR value-set for method does exist, together with two separate hierarchies within SNOMED-CT (Dose form administration method and Dosing instruction fragment), it is recommended to use the ePrescribing reference set in the first instance.

<!-- Method -->
<method>
    <coding>
        <system value="http://snomed.info/sct"/>
        <code value="129326001"/>
        <display value="Injection"/>
    </coding>
</method>

Use of synonyms

In most instances it is anticipated that the UK Preferred term should be the term applied to SNOMED CT concepts However for some cases, for example the anatomically correct SNOMED-CT term may not be easily understood by the patient or clinician, the use of a synonym may be preferred.

Guidance for using terms that are not preferred terms is available within the published document Guidance on the use of CodeableConcept.

Requirements

A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV.

Comments

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

Data type

SNOMEDCTAdministrationMethodCodes (example)

Binding

A coded concept describing the technique by which the medicine is administered.

Constraints

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

Mappings

v2: RXR-4
rim: .doseQuantity

doseAndRate

0..*

Element id

MedicationRequest.dosageInstruction.doseAndRate

Short description

Amount of medication administered

Definition

Dose and Rate elements within the Dosage structure have been combined within the R4 standard, but their underlying use and purpose is the same as per R4.

A dose or rate of medication can be described via one of the following methods. In both instances when considering Units of Measure note that UCUM is preferred.

Sub-element: `Dosage.doseAndRate.doseQuantity`

The amount of medication per dose, as a simple coded quantity.

<!-- Example A: 1 capsule -->
<doseAndRate>
    <doseQuantity>
        <value value="1"/>
        <unit value="capsule"/>
        <system value="http://snomed.info/sct"/>
        <code value="732937005"/>
    </doseQuantity>
</doseAndRate>

<!-- Example B: 30 milligrams -->
<doseAndRate>
    <doseQuantity>
        <value value="30"/>
        <unit value="milligram"/>
        <system value="http://unitsofmeasure.org"/>
        <code value="mg"/>
    </doseQuantity>
</doseAndRate>

Sub-element: `Dosage.doseAndRate.doseRange`

A dose that may be in a given low / high range.

<!-- for a dose between 7.5 to 30 milligram -->
<doseAndRate>
    <doseRange>
        <low>
            <value value="7.5"/>
            <unit value="milligram"/>
            <code value="mg"/>
            <system value="http://unitsofmeasure.org"/>
        </low>
        <high>
            <value value="30"/>
            <unit value="milligram"/>
            <code value="mg"/>
            <system value="http://unitsofmeasure.org"/>
        </high>
    </doseRange>
</doseAndRate>

A rate-based quantity, such as 30 ml per hour, can be expressed as a rateRatio with coded numerator and denominator values.

Where the unit of measure for the ratio is defined within UCUM (see Common UCUM Units), for example, “milliliter per hour”, it can also be expressed using the simpler rateQuantity structure.

Sub-element: `Dosage.doseAndRate.rateRatio`

Where the rate is expressed as coded numerator and denominator values.

at a rate of 30ml/hour using rateRatio

<doseAndRate>
 <rateRatio>
  <numerator>
   <value value="30"/>
   <unit value="millilitre"/>
   <system value="http://unitsofmeasure.org"/>
   <code value="mL"/>
  </numerator>
  <denominator>
   <value value="1"/>
   <unit value="hour"/>
   <system value="http://unitsofmeasure.org"/>
   <code value="h"/>
  </denominator>
 </rateRatio>
</doseAndRate>

Sub-element: `Dosage.doseAndRate.rateQuantity`

Where the unit of measure applicable to a rate is defined within UCUM which is mathematically equivalent to defining the rate using the more complex rateRatio structure.

at a rate of 30ml/hour using rateQuantity

<rateQuantity>
 <value value="30"/>
 <unit value="milliliters per hour"/>
 <system value="http://unitsofmeasure.org"/>
 <code value="mL/h"/>
</rateQuantity>

at a rate of 1mcg/kg/hour using rateQuantity

<doseAndRate>
 <rateQuantity>
  <value value="1"/>
  <unit value="microgram per kilogram per hour"/>
  <system value="http://unitsofmeasure.org"/>
  <code value="ug/kg/h"/>
 </rateQuantity>
</doseAndRate>

Sub-element: `Dosage.doseAndRate.rateRange`

Where the unit of measure applicable to a rate range is defined within UCUM the rateRange structure can be used.

give at 1-2 litres per minute using rateRange

<doseAndRate>
 <rateRange>
  <low>
   <value value="1"/>
   <unit value="liter per minute"/>
   <system value="http://unitsofmeasure.org"/>
   <code value="L/min"/>
  </low>
  <high>
   <value value="2"/>
   <unit value="liter per minute"/>
   <system value="http://unitsofmeasure.org"/>
   <code value="L/min"/>
  </high>
 </rateRange>
</doseAndRate>

Data type

Constraints

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

Mappings

v2: TQ1-2

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.doseAndRate.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.doseAndRate.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

type

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.doseAndRate.type

Short description

The kind of dose or rate specified

Definition

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

Requirements

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

Data type

Binding

The kind of dose or rate specified.

DoseAndRateType (example)

Constraints

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

Mappings

v2: RXO-21; RXE-23

dose[x]

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.doseAndRate.dose[x]

Short description

Amount of medication per dose

Definition

Amount of medication per dose.

Requirements

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

Comments

Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.

Constraints

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

Mappings

v2: RXO-2, RXE-3
rim: .doseQuantity

doseRange

Data type

doseQuantity

Data type

rate[x]

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.doseAndRate.rate[x]

Short description

Amount of medication per unit of time

Definition

Amount of medication per unit of time.

Requirements

Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

Comments

It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate.

It is possible to specify a rate over time (for example, 100 ml/hour) using either the rateRatio and rateQuantity. The rateQuantity approach requires systems to have the capability to parse UCUM grammer where ml/hour is included rather than a specific ratio where the time is specified as the denominator. Where a rate such as 500ml over 2 hours is specified, the use of rateRatio may be more semantically correct than specifying using a rateQuantity of 250 mg/hour.

Constraints

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

Mappings

v2: RXE22, RXE23, RXE-24
rim: .rateQuantity

rateRatio

There are no (further) constraints on this element

Data type

rateRange

There are no (further) constraints on this element

Data type

rateQuantity

There are no (further) constraints on this element

Data type

maxDosePerPeriod

S Σ

0..1

Element id

MedicationRequest.dosageInstruction.maxDosePerPeriod

Short description

Upper limit on medication per unit of time

Definition

<div class="nhsd-a-box nhsd-a-box--bg-light-blue nhsd-!t-margin-bottom-6 nhsd-t-body"> Used to define a maxiumum dose over a given time period. </div>

An example would be a Sumatriptan 6mg injection which can be repeated after an hour but not again over a 24 hour period. The maxDosePerPeriod is defined as 12mg/24hours.

The maxDosePerPeriod is defined for each dosage instruction. For a multi-sequence instruction it would therefore be possible to define different maximum dosing periods within different sequences of the complete instruction.

<div class="nhsd-a-box nhsd-a-box--bg-light-yellow nhsd-!t-margin-bottom-6 nhsd-t-body"> A real-world example of where this would be required has not yet been identified. </div>

Maximum dose per period of 12mg/24 hour

<maxDosePerPeriod>
    <numerator>
        <value value="12"/>
        <unit value="milligram"/>
        <system value="http://unitsofmeasure.org"/>
        <code value="mg"/>
    </numerator>
    <denominator>
        <value value="24"/>
        <unit value="hour"/>
        <system value="http://unitsofmeasure.org"/>
        <code value="h"/>
    </denominator>
</maxDosePerPeriod>

Requirements

The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours.

Comments

This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".

Data type

Constraints

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

Mappings

v2: RXO-23, RXE-19
rim: .maxDoseQuantity

maxDosePerAdministration

0..1

Element id

MedicationRequest.dosageInstruction.maxDosePerAdministration

Short description

Upper limit on medication per administration

Definition

<div class="nhsd-a-box nhsd-a-box--bg-light-blue nhsd-!t-margin-bottom-6 nhsd-t-body"> Used to define a maximum dose for a single administration. </div>

An example would be Anagrelide for which a single dose should not exceed 2.5 mg. The maxDosePerAdministration is defined as 2.5mg.

In many scenarios it is expected that the dosage.doseRange would be used instead of maxDosePerAdministration.

The maxDosePerAdministration is defined for each dosage instruction. For a multi-sequence instruction it would therefore be possible to define different maximum dose administrations within different sequences of the complete instruction.

<div class="nhsd-a-box nhsd-a-box--bg-light-yellow nhsd-!t-margin-bottom-6 nhsd-t-body"> A real-world example of where this would be required has not yet been identified. </div>

Maximum dose per administration of 2.5mg

<maxDosePerAdministration>
    <value value="2.5"/>
    <unit value="milligram"/>
    <system value="http://unitsofmeasure.org"/>
    <code value="mg"/>
</maxDosePerAdministration>

Requirements

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

Comments

This is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg.

Data type

Constraints

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

Mappings

rim: not supported

maxDosePerLifetime

0..1

Element id

MedicationRequest.dosageInstruction.maxDosePerLifetime

Short description

Upper limit on medication per lifetime of the patient

Definition

<div class="callout-box--info"> Used to define the maximum cumulative dose over the lifetime of a patient. </div>

An example would be Daunorubicin which may have a maximum cumulative dose of 600mg/m2 (based on the size of the patient). The maxDosePerLifetime is defined as 600 mg/m2.

The maxDosePerLifetime can be defined for each dosage instruction; which, for a multi-sequence instruction is illogical, as any maxDosePerLifetime is equally applicable to all dosage sequence that relate to the single medication coded concept.

<div class="nhsd-a-box nhsd-a-box--bg-light-yellow nhsd-!t-margin-bottom-6 nhsd-t-body"> <strong>Note:</strong> If a <code>maxDosePerLifetime</code> statement is required with a multi-sequence instruction, it is recommended to define it within the last / final sequence to ensure that the information is presented at the end of a the complete instruction, rather than th middle which could be overlooked. </div>

Maximum dose over lifetime of the patient of 600 mg/m2

<maxDosePerLifetime>
    <value value="600"/>
    <unit value="milligram per square metre"/>
    <system value="http://unitsofmeasure.org"/>
    <code value="mg/m2"/>
</maxDosePerLifetime>

Requirements

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

Data type

Constraints

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

Mappings

rim: not supported

dispenseRequest

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest

Short description

Medication supply authorization

Definition

Indicates the specific details for the dispense or medication supply part of a medication request (also known as a Medication Prescription or Medication Order). Note that this information is not always sent with the order. There may be in some settings (e.g. hospitals) institutional or system support for completing the dispense details in the pharmacy department.

Data type

Constraints

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

Mappings

script10.6: Message/Body/NewRx/MedicationPrescribed/ExpirationDate
rim: component.supplyEvent

0..0

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

1..*

Element id

MedicationRequest.dispenseRequest.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Constraints

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

Mappings

rim: n/a

performerSiteType

S C

1..1

Element id

MedicationRequest.dispenseRequest.extension:performerSiteType

Short description

type of dispensing organisation

Alternate names

extensions, user content

Definition

Used to indicate type of pharmacist

Comments

Data type

https://fhir.nhs.uk/StructureDefinition/Extension-DM-PerformerSiteType

Extension URL

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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

Mappings

rim: n/a
rim: N/A

modifierExtension

Σ ?! C

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.modifierExtension

Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

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

Requirements

Comments

Data type

Constraints

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

Mappings

rim: N/A

initialFill

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.initialFill

Short description

First fill details

Definition

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

Comments

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

Data type

Constraints

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

Mappings

rim: SubstanceAdministration -> ActRelationship[sequenceNumber = '1'] -> Supply

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.initialFill.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.initialFill.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Constraints

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

Mappings

rim: n/a

modifierExtension

Σ ?! C

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.initialFill.modifierExtension

Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

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

Requirements

Comments

Data type

Constraints

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

Mappings

rim: N/A

quantity

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.initialFill.quantity

Short description

First fill quantity

Definition

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

Data type

Constraints

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

Mappings

rim: Supply.quantity[moodCode=RQO]

duration

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.initialFill.duration

Short description

First fill duration

Definition

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

Data type

Constraints

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

Mappings

rim: Supply.effectivetime[moodCode=RQO]

dispenseInterval

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.dispenseInterval

Short description

Minimum period of time between dispenses

Definition

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

Data type

Constraints

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

Mappings

rim: Supply.effectivetime[moodCode=RQO]

validityPeriod

0..1

Element id

MedicationRequest.dispenseRequest.validityPeriod

Short description

Time period supply is authorized for

Definition

The validityPeriod attribute defines the validity period for the prescription authorisation. This period must start (the validityPeriod.start) at the date of prescribing and cannot exceed 12 months (the validityPeriod.end). Typically, most repeatable prescriptions will be authorised for a validity period of either 6 or 12 months.

"dispenseRequest": {
          "validityPeriod": {
            "start": "2020-06-10",
            "end": "2020-12-07"
          },
          ...
      }

Requirements

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

Comments

It reflects the prescribers' perspective for the validity of the prescription. Dispenses must not be made against the prescription outside of this period. The lower-bound of the Dispensing Window signifies the earliest date that the prescription can be filled for the first time. If an upper-bound is not specified then the Prescription is open-ended or will default to a stale-date based on regulations.

Data type

Constraints

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

Mappings

script10.6: Message/Body/NewRx/MedicationPrescribed/Refills
rim: effectiveTime

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.validityPeriod.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.validityPeriod.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

start

Σ C

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.validityPeriod.start

Short description

Starting time with inclusive boundary

Definition

The start of the period. The boundary is inclusive.

Comments

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

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: per-1

Constraints

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

Mappings

v2: DR.1
rim: ./low

end

Σ C

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.validityPeriod.end

Short description

End time with inclusive boundary, if not ongoing

Definition

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

Comments

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

Meaning when missing

If the end of the period is missing, it means that the period is ongoing

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: per-1

Constraints

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

Mappings

v2: DR.2
rim: ./high

numberOfRepeatsAllowed

0..1

Element id

MedicationRequest.dispenseRequest.numberOfRepeatsAllowed

Short description

Number of refills authorized

Definition

The number of repeat issues authorised if specified. <br> <b>MUST</b> be present where a continuous or continuous-repeat-dispensing is authorised for a defined number of issues. <br> <b>MUST</b> NOT be specified where the number of repeat issues has not been defined. Therefore, the numberOfRepeats allowed is the total number of allowed issues. See also <a href="#repeatInformation">extension repeatInformation</a>

For continuous orders and continuous-repeat-dispensing with intent=reflex-order (i.e., orders sent from EPS to pharmacists) this <b>MUST</b> be zero. The numberOfRepeatsAllowed in the extension to basedOn can be used to convey this information to inform patients that they need to re-order the medication.

Example for a continuous issue:


"dispenseRequest": {
        "numberOfRepeatsAllowed": 0
    }

Example for a continuous-repeat-dispensing issue with intent of original-order:


"dispenseRequest": {
        "numberOfRepeatsAllowed": 2
    }

This will result in a total of three issues of the medication.

Comments

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

Data type

Constraints

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

Mappings

script10.6: Message/Body/NewRx/MedicationPrescribed/Quantity
v2: RXE-12-Number of Refills
rim: repeatNumber

quantity

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.quantity

Short description

Amount of medication to supply per dispense

Definition

The amount that is to be dispensed for one fill.

Data type

Constraints

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

Mappings

script10.6: Message/Body/NewRx/MedicationPrescribed/DaysSupply
v2: RXD-4-Actual Dispense Amount / RXD-5.1-Actual Dispense Units.code / RXD-5.3-Actual Dispense Units.name of coding system
rim: quantity

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.quantity.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.quantity.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

value

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.quantity.value

Short description

Numerical value (with implicit precision)

Definition

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

Requirements

Precision is handled implicitly in almost all cases of measurement.

Comments

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

Data type

Constraints

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

Mappings

v2: SN.2 / CQ - N/A
rim: PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value

comparator

Σ ?!

0..0

codeBinding

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.quantity.comparator

Short description

< | <= | >= | > - how to understand the value

Definition

Not allowed to be used in this context

Requirements

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

Meaning when missing

If there is no comparator, then there is no modification of the value

Data type

Binding

How the Quantity should be understood and represented.

Constraints

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

Mappings

v2: SN.1 / CQ.1
rim: IVL properties

unit

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.quantity.unit

Short description

Unit representation

Definition

A human-readable form of the unit.

Requirements

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

Data type

Constraints

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

Mappings

v2: (see OBX.6 etc.) / CQ.2
rim: PQ.unit

system

Σ C

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.quantity.system

Short description

System that defines coded unit form

Definition

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

Requirements

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

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: qty-3

Constraints

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

Mappings

v2: (see OBX.6 etc.) / CQ.2
rim: CO.codeSystem, PQ.translation.codeSystem

code

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.quantity.code

Short description

Coded form of the unit

Definition

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

Requirements

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

Comments

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

Data type

Constraints

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

Mappings

v2: (see OBX.6 etc.) / CQ.2
rim: PQ.code, MO.currency, PQ.translation.code

expectedSupplyDuration

0..1

Element id

MedicationRequest.dispenseRequest.expectedSupplyDuration

Short description

Days Supply

Definition

The expectedSupplyDuration entity is required for repeat dispensing (repeatable) prescriptions only.

The expectedSupplyDuration element defines the expected duration, in days, of each issue of the prescription. A default value of 28 can be used which must be amendable by the prescriber when required. The value must be an integer value greater than zero. A sensible upper limit validation should be included within the System. If this value is omitted, the Spine will assume a value of 28.

"dispenseRequest": {
          ...
          "expectedSupplyDuration": {
            "value": 28,
            "unit": "days",
            "system": "http://unitsofmeasure.org",
            "code": "d"
          }
      }

Comments

In some situations, this attribute may be used instead of quantity to identify the amount supplied by how long it is expected to last, rather than the physical quantity issued, e.g. 90 days supply of medication (based on an ordered dosage). When possible, it is always better to specify quantity, as this tends to be more precise. expectedSupplyDuration will always be an estimate that can be influenced by external factors.

Data type

Constraints

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

Mappings

script10.6: Message/Body/NewRx/MedicationPrescribed/Substitutions
rim: expectedUseTime

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.expectedSupplyDuration.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.expectedSupplyDuration.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

value

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.expectedSupplyDuration.value

Short description

Numerical value (with implicit precision)

Definition

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

Requirements

Precision is handled implicitly in almost all cases of measurement.

Comments

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

Data type

Constraints

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

Mappings

v2: SN.2 / CQ - N/A
rim: PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value

comparator

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.expectedSupplyDuration.comparator

Short description

< | <= | >= | > - how to understand the value

Definition

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

Requirements

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

Meaning when missing

If there is no comparator, then there is no modification of the value

Data type

Binding

How the Quantity should be understood and represented.

Constraints

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

Mappings

v2: SN.1 / CQ.1
rim: IVL properties

unit

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.expectedSupplyDuration.unit

Short description

Unit representation

Definition

A human-readable form of the unit.

Requirements

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

Data type

Constraints

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

Mappings

v2: (see OBX.6 etc.) / CQ.2
rim: PQ.unit

system

Σ C

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.expectedSupplyDuration.system

Short description

System that defines coded unit form

Definition

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

Requirements

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

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: qty-3

Constraints

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

Mappings

v2: (see OBX.6 etc.) / CQ.2
rim: CO.codeSystem, PQ.translation.codeSystem

code

1..1

codeAuto Value

Element id

MedicationRequest.dispenseRequest.expectedSupplyDuration.code

Short description

Coded form of the unit

Definition

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

Requirements

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

Comments

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

Data type

Constraints

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

Auto value

Mappings

v2: (see OBX.6 etc.) / CQ.2
rim: PQ.code, MO.currency, PQ.translation.code

performer

0..1

Element id

MedicationRequest.dispenseRequest.performer

Short description

Intended dispenser

Definition

For non token based prescriptions the destination pharmacy MUST be recorded in the dispenseRequest.performer.identifier and a identifier reference (not a resource reference) with an ANANA/ODS Code MUST used.

The extension https://fhir.nhs.uk/StructureDefinition/Extension-DM-PerformerSiteType MUST be present.

Patients pharmacy preferences may be sourced from PDS.

Patients pharmacy preferences may be overriden by an 'one-off pharmacy nomination' by populating the dispenseRequest.performer.identifier with the ODS/ANANA code of the destination pharmacy.

"dispenseRequest": {
        "extension":  [
            {
                "url": "https://fhir.nhs.uk/StructureDefinition/Extension-DM-PerformerSiteType",
                "valueCoding": {
                    "system": "https://fhir.nhs.uk/CodeSystem/dispensing-site-preference",
                    "code": "0004"
                }
            },
        ],
        "performer": {
            "identifier": {
                "system": "https://fhir.nhs.uk/Id/ods-organization-code",
                "value": "FX748"
            }
        },

Data type

Constraints

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

Mappings

w5: FiveWs.who
rim: .outboundRelationship[typeCode=COMP].target[classCode=SPLY, moodCode=RQO] .participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.performer.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.performer.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

dispensingPractitioner

S C

0..1

Element id

MedicationRequest.dispenseRequest.performer.extension:dispensingPractitioner

Short description

practitioner who released(/downloaded) the prescription

Alternate names

extensions, user content

Definition

Details of the dispenser who is actioning the MedicationRequest

       "dispenseRequest": { 
                    "performer": {
                        "extension":  [
                            {
                                "url": "https://fhir.nhs.uk/StructureDefinition/Extension-DM-DispensingPerformer",
                                "valueReference": {
                                    "reference": "urn:uuid:25f3dd9f-5838-44a7-930e-c78ae3ecadd6",
                                    "display": "LOTTIE POTTS"
                                }
                            }
                        ],
                        "identifier": {
                            "system": "https://fhir.nhs.uk/Id/ods-organization-code",
                            "value": "VNE51"
                        },
                        "display": "The Simple Pharmacy"
                    }
                },

Comments

Data type

https://fhir.nhs.uk/StructureDefinition/Extension-DM-DispensingPerformer

Extension URL

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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

Mappings

rim: n/a
rim: N/A

reference

Σ C

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.performer.reference

Short description

Literal reference, Relative, internal or absolute URL

Definition

Comments

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ref-1

Constraints

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

Mappings

rim: N/A

type

0..1

uriBinding

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.performer.type

Short description

Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Comments

Data type

Binding

Aa resource (or, for logical models, the URI of the logical model).

Constraints

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

Mappings

rim: N/A

identifier

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.performer.identifier

Short description

Logical reference, when literal reference is not known

Definition

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Data type

Constraints

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

Mappings

rim: .identifier

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.performer.identifier.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.performer.identifier.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.performer.identifier.use

Short description

usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Requirements

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

Comments

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

Data type

Binding

Identifies the purpose for this identifier, if known .

Constraints

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

Mappings

v2: N/A
rim: Role.code or implied by context

type

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.performer.identifier.type

Short description

Description of identifier

Definition

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

Requirements

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

Comments

Data type

Binding

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

Constraints

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

Mappings

v2: CX.5
rim: Role.code or implied by context

system

1..1

uriAuto Value

Element id

MedicationRequest.dispenseRequest.performer.identifier.system

Short description

The namespace for the identifier value

Definition

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

Requirements

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

Comments

Identifier.system is always case sensitive.

Data type

Constraints

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

Auto value

https://fhir.nhs.uk/Id/ods-organization-code

Examples
General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

value

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.performer.identifier.value

Short description

The value that is unique

Definition

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

Comments

Data type

Constraints

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

Examples
General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

period

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.performer.identifier.period

Short description

Time period when id is/was valid for use

Definition

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

Data type

Constraints

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

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

assigner

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.performer.identifier.assigner

Short description

Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Comments

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

Data type

Constraints

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

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

display

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.performer.display

Short description

Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Data type

Constraints

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

Mappings

rim: N/A

substitution

1..1

Element id

MedicationRequest.substitution

Short description

Any restrictions on medication substitution

Definition

Within UK healthcare, substitution is not the norm and so this element will normally be set to a default of false.

Substitution being set to false is a mandatory requirement for EPS..

Substituition is a mandatory requirement for EPS.

<div markdown="span" class="alert alert-warning" role="alert"><i class="fa fa-information"></i><h4>Important Note:</h4> Within UK healthcare, substitution is not the norm so the international FHIR definition where "If nothing is specified substitution may be done." does not align with UK healthcare prescribing best practice.<br/> <p>It could be unwise to assume all UK implementations will prevent substitution if not explicitly stated, especially if the same clinical system has been previously implemented outside the UK. <br/></p> <p>UK Core has profiled this element as MANDATORY and MUST have a default boolean value of <code>false</code> to denote substitution is not allowed.</p> </div> <h3 id="allowing-substitution">Allowing substitution</h3> <p>Where substitution to be be allowed, set to <code>true</code>. The inclusion of the coded reason is optional as the valueset defined in FHIR is of limited benefit to UK healthcare.</p>


"substitution": {
        "allowedBoolean": false
    }

Data type

Constraints

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

Mappings

script10.6: specific values within Message/Body/NewRx/MedicationPrescribed/Substitutions
rim: subjectOf.substitutionPersmission

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.substitution.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.substitution.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Constraints

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

Mappings

rim: n/a

modifierExtension

Σ ?! C

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.substitution.modifierExtension

Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

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

Requirements

Comments

Data type

Constraints

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

Mappings

rim: N/A

allowed[x]

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.substitution.allowed[x]

Short description

Whether substitution is allowed or not

Definition

The purpose of this element is to allow the prescriber to dispense a different drug from what was prescribed.

Comments

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

Constraints

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

Mappings

script10.6: specific values within Message/Body/NewRx/MedicationPrescribed/Substitutions
v2: RXO-9-Allow Substitutions / RXE-9-Substitution Status
rim: code

allowedBoolean

Data type

reason

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.substitution.reason

Short description

Why should (not) substitution be made

Definition

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

Data type

v3.SubstanceAdminSubstitutionReason (example)

Binding

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

Constraints

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

Mappings

script10.6: not mapped
v2: RXE-9 Substition status
rim: reasonCode

priorPrescription

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription

Short description

An order/prescription that is being replaced

Definition

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

Data type

Constraints

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

Mappings

workflow: Request.replaces
script10.6: not mapped
rim: .outboundRelationship[typeCode=?RPLC or ?SUCC]/target[classCode=SBADM,moodCode=RQO]

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

reference

Σ C

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription.reference

Short description

Literal reference, Relative, internal or absolute URL

Definition

Comments

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ref-1

Constraints

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

Mappings

rim: N/A

type

0..1

uriBinding

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription.type

Short description

Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Comments

Data type

Binding

Aa resource (or, for logical models, the URI of the logical model).

Constraints

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

Mappings

rim: N/A

identifier

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription.identifier

Short description

Logical reference, when literal reference is not known

Definition

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Data type

Constraints

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

Mappings

rim: .identifier

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription.identifier.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription.identifier.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription.identifier.use

Short description

usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Requirements

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

Comments

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

Data type

Binding

Identifies the purpose for this identifier, if known .

Constraints

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

Mappings

v2: N/A
rim: Role.code or implied by context

type

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription.identifier.type

Short description

Description of identifier

Definition

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

Requirements

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

Comments

Data type

Binding

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

Constraints

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

Mappings

v2: CX.5
rim: Role.code or implied by context

system

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription.identifier.system

Short description

The namespace for the identifier value

Definition

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

Requirements

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

Comments

Identifier.system is always case sensitive.

Data type

Constraints

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

Examples
General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

value

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription.identifier.value

Short description

The value that is unique

Definition

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

Comments

Data type

Constraints

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

Examples
General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

period

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription.identifier.period

Short description

Time period when id is/was valid for use

Definition

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

Data type

Constraints

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

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

assigner

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription.identifier.assigner

Short description

Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Comments

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

Data type

Constraints

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

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

display

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription.display

Short description

Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Data type

Constraints

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

Mappings

rim: N/A

detectedIssue

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue

Short description

Clinical Issue with action

Alternate names

Contraindication, Drug Utilization Review (DUR), Alert

Definition

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

Comments

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

Data type

Constraints

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

Mappings

rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=ALRT,moodCode=EVN].value

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

reference

Σ C

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue.reference

Short description

Literal reference, Relative, internal or absolute URL

Definition

Comments

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ref-1

Constraints

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

Mappings

rim: N/A

type

0..1

uriBinding

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue.type

Short description

Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Comments

Data type

Binding

Aa resource (or, for logical models, the URI of the logical model).

Constraints

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

Mappings

rim: N/A

identifier

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue.identifier

Short description

Logical reference, when literal reference is not known

Definition

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Data type

Constraints

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

Mappings

rim: .identifier

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue.identifier.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue.identifier.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue.identifier.use

Short description

usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Requirements

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

Comments

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

Data type

Binding

Identifies the purpose for this identifier, if known .

Constraints

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

Mappings

v2: N/A
rim: Role.code or implied by context

type

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue.identifier.type

Short description

Description of identifier

Definition

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

Requirements

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

Comments

Data type

Binding

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

Constraints

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

Mappings

v2: CX.5
rim: Role.code or implied by context

system

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue.identifier.system

Short description

The namespace for the identifier value

Definition

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

Requirements

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

Comments

Identifier.system is always case sensitive.

Data type

Constraints

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

Examples
General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

value

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue.identifier.value

Short description

The value that is unique

Definition

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

Comments

Data type

Constraints

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

Examples
General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

period

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue.identifier.period

Short description

Time period when id is/was valid for use

Definition

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

Data type

Constraints

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

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

assigner

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue.identifier.assigner

Short description

Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Comments

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

Data type

Constraints

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

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

display

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue.display

Short description

Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Data type

Constraints

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

Mappings

rim: N/A

eventHistory

0..*

Element id

MedicationRequest.eventHistory

Short description

A list of events of interest in the lifecycle

Definition

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

Comments

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

Data type

Constraints

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

Mappings

workflow: Request.relevantHistory
rim: .inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

reference

Σ C

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory.reference

Short description

Literal reference, Relative, internal or absolute URL

Definition

Comments

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ref-1

Constraints

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

Mappings

rim: N/A

type

0..1

uriBinding

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory.type

Short description

Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Comments

Data type

Binding

Aa resource (or, for logical models, the URI of the logical model).

Constraints

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

Mappings

rim: N/A

identifier

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory.identifier

Short description

Logical reference, when literal reference is not known

Definition

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Data type

Constraints

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

Mappings

rim: .identifier

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory.identifier.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory.identifier.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory.identifier.use

Short description

usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Requirements

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

Comments

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

Data type

Binding

Identifies the purpose for this identifier, if known .

Constraints

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

Mappings

v2: N/A
rim: Role.code or implied by context

type

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory.identifier.type

Short description

Description of identifier

Definition

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

Requirements

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

Comments

Data type

Binding

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

Constraints

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

Mappings

v2: CX.5
rim: Role.code or implied by context

system

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory.identifier.system

Short description

The namespace for the identifier value

Definition

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

Requirements

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

Comments

Identifier.system is always case sensitive.

Data type

Constraints

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

Examples
General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

value

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory.identifier.value

Short description

The value that is unique

Definition

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

Comments

Data type

Constraints

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

Examples
General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

period

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory.identifier.period

Short description

Time period when id is/was valid for use

Definition

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

Data type

Constraints

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

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

assigner

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory.identifier.assigner

Short description

Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Comments

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

Data type

Constraints

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

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

display

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory.display

Short description

Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Data type

Constraints

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

Mappings

rim: N/A

Differential from UK Core MedicationRequest

NHSDigitalMedicationRequest (MedicationRequest)

Element id

MedicationRequest

Short description

Ordering of medication for patient or group

Alternate names

Prescription, Order

Definition

Data type

Constraints

dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
contained.contained.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
contained.meta.security.empty()
dom-6: A resource should have narrative for robust management
text.`div`.exists()
eps-1: medication[x] - Only one of medicationReference or medicationCodeableConcept should be provided
(medicationReference.exists() and medicationCodeableConcept.exists().not()) or (medicationReference.exists().not() and medicationCodeableConcept.exists())
eps-5: Extension(responsiblePractitioner) - An identifier or resource reference must be provided
extension('https://fhir.nhs.uk/StructureDefinition/Extension-DM-ResponsiblePractitioner').exists().not() or (extension('https://fhir.nhs.uk/StructureDefinition/Extension-DM-ResponsiblePractitioner').value.reference.exists() or extension('https://fhir.nhs.uk/StructureDefinition/Extension-DM-ResponsiblePractitioner').value.system.exists())
eps-7: For continuous-repeat-dispensing intent must be reflex-order or original-order
(courseOfTherapyType.coding.code != 'continuous-repeat-dispensing') or ((courseOfTherapyType.coding.code = 'continuous-repeat-dispensing') and ((intent ='original-order') or (intent ='reflex-order')))
eps-8: For continuous intent must be instance-order or original-order
(courseOfTherapyType.coding.code != 'continuous') or ((courseOfTherapyType.coding.code = 'continuous') and ((intent ='original-order') or (intent ='instance-order')))
eps-9: dispenseRequest.numberOfRepeatsAllowed should be populated for continuous and continuous-repeat-dispensing MedicationRequests.
(courseOfTherapyType.coding.code.startsWith('acute')) or (courseOfTherapyType.coding.code.startsWith('continuous') and dispenseRequest.exists() and dispenseRequest.numberOfRepeatsAllowed.exists())
eps-10: For continuous-repeat-dispensing (intent=reflex-order) basedOn must be populated
(courseOfTherapyType.coding.code = 'acute') or (courseOfTherapyType.coding.code = 'continuous') or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing' and intent !='reflex-order') or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing' and intent ='reflex-order' and dispenseRequest.exists() and basedOn.exists())
eps-11: For continuous-repeat-dispensing (intent=reflex-order) or continous orders, numberOfRepeatsAllowed must be empty or equal to 0
(courseOfTherapyType.coding.code = 'acute') or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing' and intent !='reflex-order') or ((courseOfTherapyType.coding.code = 'continuous' or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing' and intent ='reflex-order')) and (dispenseRequest.numberOfRepeatsAllowed.exists().not() or (dispenseRequest.numberOfRepeatsAllowed.exists() and dispenseRequest.numberOfRepeatsAllowed = 0)))
eps-12: For continuous issues basedOn should be populated
(courseOfTherapyType.coding.code = 'acute') or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing') or (courseOfTherapyType.coding.code = 'continuous' and dispenseRequest.exists() and basedOn.exists())
eps-13: Extension repeatInformation.numberOfPrescriptionsIssued should not be present for continuous-repeat-dispensing that are not intent=reflex-order
(courseOfTherapyType.coding.code != 'continuous-repeat-dispensing') or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing' and intent='reflex-order') or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing' and intent!='reflex-order' and extension('https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation').exists().not()) or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing' and intent!='reflex-order' and extension('https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation').exists() and extension('https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation').extension('numberOfPrescriptionsIssued').exists().not())
eps-14: Extension repeatInformation.numberOfPrescriptionsIssued should be present for continuous-repeat-dispensing that have intent=reflex-order
(courseOfTherapyType.coding.code != 'continuous-repeat-dispensing') or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing' and intent != 'reflex-order') or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing' and intent='reflex-order' and extension('https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation').exists() and extension('https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation').extension('numberOfPrescriptionsIssued').exists())
eps-15: Extension repeatInformation.numberOfPrescriptionsIssued is recommend to be present for continuous issues
(courseOfTherapyType.coding.code != 'continuous') or (courseOfTherapyType.coding.code = 'continuous' and extension('https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation').exists() and extension('https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation').extension('numberOfPrescriptionsIssued').exists())
eps-16: Extension repeatInformation.numberOfPrescriptionsIssued should not be present for acute issues
(courseOfTherapyType.coding.code != 'acute') or (courseOfTherapyType.coding.code = 'acute' and extension('https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation').exists().not())

Mappings

rim: Entity. Role, or Act
workflow: Request
script10.6: Message/Body/NewRx
rim: CombinedMedicationRequest

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.id

Short description

Logical id of this artifact

Definition

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

Comments

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

Data type

There are no (further) constraints on this element

Element id

MedicationRequest.meta

Short description

Metadata about the resource

Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

Data type

Constraints

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

implicitRules

Σ ?!

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.implicitRules

Short description

A set of rules under which this content was created

Definition

Comments

Data type

Constraints

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

language

0..1

codeBinding

There are no (further) constraints on this element

Element id

MedicationRequest.language

Short description

Language of the resource content

Definition

The base language in which the resource is written.

Comments

Data type

Binding

A human language.

CommonLanguages (preferred)

Binding extensions

maxValueSet	AllLanguages

Constraints

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

text

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.text

Short description

Text summary of the resource, for human interpretation

Alternate names

narrative, html, xhtml, display

Definition

Comments

Data type

Constraints

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

Mappings

rim: Act.text?

contained

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.contained

Short description

Contained, inline Resources

Alternate names

inline resources, anonymous resources, contained resources

Definition

Comments

Data type

Mappings

rim: N/A

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation

Slicing

Unordered, Open, by url(Value)

Constraints

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

Mappings

rim: N/A

medicationRepeatInformation

S C

0..1

Extension(Complex)

Element id

MedicationRequest.extension:medicationRepeatInformation

Short description

Continous and Continuous Repeat Dispensing

Alternate names

extensions, user content

Definition

This extension <b>SHOULD</b> be present for continuous and continuous-repeat-dispensing therapy types.

Field	Description
numberOfPrescriptionsIssued	Running total of number of issues made against a repeat authorisation. Including this issue.
~~numberOfRepeatPrescriptionsAllowed~~	Retired. See <a href="#numberOfRepeatsAllowed">numberOfRepeatsAllowed</a>
authorisationExpiryDate	The date a repeat prescription authorisation will expire.

"extension": [
  {
       "url": "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation",
       "extension": [
           {
               "url": "numberOfPrescriptionsIssued",
               "valueUnsignedInt": 3
           },
           {
               "url": "authorisationExpiryDate",
               "valueDateTime": "2020-08-07"
           }
       ]
   }
]

Comments

Data type

Extension(Complex)

Extension URL

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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

Mappings

rim: N/A
rim: n/a

responsiblePractitioner

S C

0..1

Element id

MedicationRequest.extension:responsiblePractitioner

Short description

Responsible Practitioner for the prescription

Alternate names

extensions, user content

Definition

Must only be populated if the requester can not be responsible for the prescription, i.e. they would not be named as the prescriber on the FP10.

"extension": [
        
    {
        "url": "https://fhir.nhs.uk/StructureDefinition/Extension-DM-ResponsiblePractitioner",
        "valueReference": {
            "reference": "urn:uuid:a5acefc1-f8ca-4989-a5ac-34ae36741466",
            "display": "DR SAZ RAZ"
        }
    }
],

Comments

Data type

https://fhir.nhs.uk/StructureDefinition/Extension-DM-ResponsiblePractitioner

Extension URL

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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

Mappings

rim: N/A
rim: n/a

prescriptionEndorsement

S C

0..*

Element id

MedicationRequest.extension:prescriptionEndorsement

Short description

NHS BSA Prescription Endorsements

Alternate names

extensions, user content

Definition

The codes are contained in the valueset

Code	Display
CC	Contraceptive
FS	Sexual Health
ACBS	Advisory Committee on Borderline Substances. Part XV Drug Tariff
SLS	Selected List Scheme. Part XVIIIB Drug Tariff
AF	Food replacement/food supplement products

"resourceType": "MedicationRequest",
    "extension":  [
      {
          "url": "https://fhir.nhs.uk/StructureDefinition/Extension-DM-PrescriptionEndorsement",
          "valueCodeableConcept": {
              "coding":  [
                {
                    "system": "https://fhir.nhs.uk/CodeSystem/medicationrequest-endorsement",
                    "code": "SLS",
                    "display": "Selected List Scheme"
                }
            ]
        }
    }
  ],

Comments

Data type

https://fhir.nhs.uk/StructureDefinition/Extension-DM-PrescriptionEndorsement

Extension URL

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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

Mappings

rim: N/A
rim: n/a

prescriptionTaskStatusReason

S C

0..*

Extension(Complex)

Element id

MedicationRequest.extension:prescriptionTaskStatusReason

Short description

Prescription task status reason

Alternate names

extensions, user content

Definition

The status history within EPS is primarily a technical Status and the statusReason will reflect current clinical status of the order.

Comments

Data type

Extension(Complex)

Extension URL

https://fhir.nhs.uk/StructureDefinition/Extension-DM-PrescriptionStatusHistory

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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

Mappings

rim: N/A
rim: n/a

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

1..*

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

statusDate

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:statusDate

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Constraints

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

Mappings

rim: n/a

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:statusDate.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:statusDate.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

url

1..1

uriAuto Value

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:statusDate.url

Short description

identifies the meaning of the extension

Definition

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

Comments

Data type

Auto value

statusDate

Mappings

rim: N/A

value[x]

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:statusDate.value[x]

Short description

Value of extension

Definition

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

Constraints

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

Mappings

rim: N/A

valueDateTime

There are no (further) constraints on this element

Data type

status

1..1

ExtensionBinding

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

TaskMedicationRequestStatusReason (required)

Binding

Constraints

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

Mappings

rim: n/a

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

url

1..1

uriAuto Value

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.url

Short description

identifies the meaning of the extension

Definition

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

Comments

Data type

Auto value

status

Mappings

rim: N/A

value[x]

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.value[x]

Short description

Value of extension

Definition

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

Constraints

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

Mappings

rim: N/A

valueCoding

There are no (further) constraints on this element

Data type

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.value[x].id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.value[x].extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

system

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.value[x].system

Short description

Identity of the terminology system

Definition

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

Requirements

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

Comments

Data type

Constraints

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

Mappings

v2: C*E.3
rim: ./codeSystem
orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

version

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.value[x].version

Short description

Version of the system - if relevant

Definition

Comments

Data type

Constraints

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

Mappings

v2: C*E.7
rim: ./codeSystemVersion
orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.value[x].code

Short description

Symbol in syntax defined by the system

Definition

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

Requirements

Need to refer to a particular code in the system.

Data type

Constraints

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

Mappings

v2: C*E.1
rim: ./code
orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

display

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.value[x].display

Short description

Representation defined by the system

Definition

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

Requirements

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

Data type

Constraints

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

Mappings

v2: C*E.2 - but note this is not well followed
rim: CV.displayName
orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

userSelected

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.value[x].userSelected

Short description

If this coding was chosen directly by the user

Definition

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

Requirements

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

Comments

Data type

Constraints

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

Mappings

v2: Sometimes implied by being first
rim: CD.codingRationale
orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]

url

1..1

uriAuto Value

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.url

Short description

identifies the meaning of the extension

Definition

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

Comments

Data type

Auto value

https://fhir.nhs.uk/StructureDefinition/Extension-DM-PrescriptionStatusHistory

Mappings

rim: N/A

value[x]

0..0

There are no (further) constraints on this element

Element id

MedicationRequest.extension:prescriptionTaskStatusReason.value[x]

Short description

Value of extension

Definition

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

Constraints

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

Mappings

rim: N/A

NHSBSAprescriptionType

S C

0..1

Element id

MedicationRequest.extension:NHSBSAprescriptionType

Short description

NHS BSA Prescription Type

Alternate names

extensions, user content

Definition

The vocabulary for the ‘PrescriptionType’ vocabulary is defined within the NHSBSA Overprint Specification.

The System must populate the ‘PrescriptionType’ attribute for the appropriate combination of prescriber and care setting. Retired codes within this vocabulary must not be used

"extension":  [
    {
        "url": "https://fhir.nhs.uk/StructureDefinition/Extension-DM-PrescriptionType",
        "valueCoding": {
            "system": "https://fhir.nhs.uk/CodeSystem/prescription-type",
            "code": "1201",
            "display": "Outpatient Homecare Prescriber - Medical Prescriber"
        }
    }
    ]

Comments

Data type

https://fhir.nhs.uk/StructureDefinition/Extension-DM-PrescriptionType

Extension URL

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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

Mappings

rim: N/A
rim: n/a

controlledDrug

S C

0..1

Extension(Complex)

Element id

MedicationRequest.extension:controlledDrug

Short description

Optional Controlled Drug Extensions

Alternate names

extensions, user content

Definition

Sch.	Code	Signing Legal Requirement	EPS Scope	Expiry Date	Quantity Representation	Repeat Dispensing Allowed	RD 1st Issue Expiry	RD Subsequent Expiry
1	CD1	Invalid to prescribe	Out of scope	N/A	N/A	N/A	N/A
2	CD2	Hand signature or electronic signature	In scope	28 days	Words and Figures	No	N/A	N/A
3	CD3	Hand signature or electronic signature	In scope	28 days	Words and Figures	No	N/A	N/A
4	CD4-1 CD4-2	Hand signature or electronic signature	In scope	28 days	Figures	Yes	28 days	Up to 12 months
5	CD5	Hand signature or electronic signature	In scope	6 Months	Figures	Yes	6 months	Up to 12 months

It is a legal requirement to state the prescribed quantity as words in the quantityWords

{
    "url": "https://fhir.nhs.uk/StructureDefinition/Extension-DM-ControlledDrug",
    "extension": [
        {
            "url": "quantityWords",
            "valueString": "twenty eight"
        },
        {
            "url": "schedule",
            "valueCoding": {
                "system": "https://fhir.nhs.uk/CodeSystem/medicationrequest-controlled-drug",
                "code": "CD2",
                "display": "Schedule 2"
            }
        }
    ]
}

Comments

Data type

Extension(Complex)

Extension URL

https://fhir.nhs.uk/StructureDefinition/Extension-DM-ControlledDrug

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
eps-cd1: Extension(controlledDrug) - For schedule 2 or 3 Controlled Drugs, the quantity must be expressed in words
(((extension('schedule').value.code='CD2' and extension('quantityWords').exists()) or (extension('schedule').value.code='CD3' and extension('quantityWords').exists()) or (extension('schedule').value.code != 'CD2' and extension('schedule').value.code != 'CD3')) and extension('scheduled').exists()) or (extension('scheduled').exists().not())

Mappings

rim: N/A
rim: n/a

dispensingInformation

S C

0..1

Extension(Complex)

Element id

MedicationRequest.extension:dispensingInformation

Short description

For EPS use only

Alternate names

extensions, user content

Definition

This extension is used in continuous-repeat-dispensing prescriptions sent by EPS to dispensing systems to convey information on prior dispensed medications.

"extension":  [
                {
                    "url": "https://fhir.nhs.uk/StructureDefinition/Extension-EPS-DispensingInformation",
                    "extension":  [
                        {
                            "url": "dispenseStatus",
                            "valueCoding": {
                                "system": "https://fhir.nhs.uk/CodeSystem/medicationdispense-type",
                                "code": "0001",
                                "display": "Item fully dispensed"
                            }
                        },
                        {
                            "url": "dateLastDispensed",
                            "valueDateTime": "2018-04-22T09:57:03+00:00"
                        }
                    ]
                }
            ],

Comments

Data type

Extension(Complex)

Extension URL

https://fhir.nhs.uk/StructureDefinition/Extension-EPS-DispensingInformation

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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

Mappings

rim: N/A
rim: n/a

modifierExtension

?! C

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.modifierExtension

Short description

Extensions that cannot be ignored

Alternate names

extensions, user content

Definition

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

Requirements

Comments

Data type

Constraints

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

Mappings

rim: N/A

identifier

1..*

Element id

MedicationRequest.identifier

Short description

Each MedicationRequest MUST be identified by an Universal Unique Identifiers (UUIDs) with a system of https://fhir.nhs.uk/Id/prescription-order-item-number

Definition

UUID example (for illustration purposes only);

a54219b8-f741-4c47-b662-e4f8dfa49ab6

 "identifier":  [
    {
        "system": "https://fhir.nhs.uk/Id/prescription-order-item-number",
        "value": "a54219b8-f741-4c47-b662-e4f8dfa49ab6"
    }
]

Comments

This is a business identifier, not a resource identifier.

Data type

Slicing

Unordered, Open, by system(Value)

Constraints

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

Mappings

workflow: Request.identifier
script10.6: Message/Header/PrescriberOrderNumber
w5: FiveWs.identifier
v2: ORC-2-Placer Order Number / ORC-3-Filler Order Number
rim: .id

(All Slices)

The requirements in this element apply to all slices

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.identifier.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.identifier.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element id

MedicationRequest.identifier.use

Short description

usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Requirements

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

Comments

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

Data type

Binding

Identifies the purpose for this identifier, if known .

Constraints

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

Mappings

v2: N/A
rim: Role.code or implied by context

type

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element id

MedicationRequest.identifier.type

Short description

Description of identifier

Definition

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

Requirements

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

Comments

Data type

Binding

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

Constraints

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

Mappings

v2: CX.5
rim: Role.code or implied by context

system

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.identifier.system

Short description

The namespace for the identifier value

Definition

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

Requirements

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

Comments

Identifier.system is always case sensitive.

Data type

Constraints

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

Examples
General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

value

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.identifier.value

Short description

The value that is unique

Definition

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

Comments

Data type

Constraints

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

Examples
General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

period

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.identifier.period

Short description

Time period when id is/was valid for use

Definition

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

Data type

Constraints

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

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

assigner

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.identifier.assigner

Short description

Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Comments

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

Data type

Constraints

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

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

prescriptionOrderItem

1..1

Element id

MedicationRequest.identifier:prescriptionOrderItem

Short description

Prescription Order Item

Definition

Unique Id of the MedicationRequest within EPS

Comments

This is a business identifier, not a resource identifier.

Data type

Constraints

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

Mappings

workflow: Request.identifier
script10.6: Message/Header/PrescriberOrderNumber
w5: FiveWs.identifier
v2: ORC-2-Placer Order Number / ORC-3-Filler Order Number
rim: .id

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.identifier:prescriptionOrderItem.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.identifier:prescriptionOrderItem.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element id

MedicationRequest.identifier:prescriptionOrderItem.use

Short description

usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Requirements

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

Comments

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

Data type

Binding

Identifies the purpose for this identifier, if known .

Constraints

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

Mappings

v2: N/A
rim: Role.code or implied by context

type

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element id

MedicationRequest.identifier:prescriptionOrderItem.type

Short description

Description of identifier

Definition

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

Requirements

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

Comments

Data type

Binding

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

Constraints

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

Mappings

v2: CX.5
rim: Role.code or implied by context

system

1..1

uriAuto Value

Element id

MedicationRequest.identifier:prescriptionOrderItem.system

Short description

The namespace for the identifier value

Definition

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

Requirements

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

Comments

Identifier.system is always case sensitive.

Data type

Constraints

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

Auto value

https://fhir.nhs.uk/Id/prescription-order-item-number

Examples
General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

value

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.identifier:prescriptionOrderItem.value

Short description

The value that is unique

Definition

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

Comments

Data type

Constraints

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

Examples
General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

period

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.identifier:prescriptionOrderItem.period

Short description

Time period when id is/was valid for use

Definition

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

Data type

Constraints

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

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

assigner

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.identifier:prescriptionOrderItem.assigner

Short description

Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Comments

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

Data type

Constraints

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

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

status

S Σ ?!

1..1

codeBinding

Element id

MedicationRequest.status

Short description

active | cancelled | stopped

Definition

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

code	Definition
active	The prescription is 'actionable', but not all actions that are implied by it have occurred yet. It has not been dispensed or filled.
cancelled	The prescription is to be cancelled or it has been cancelled been withdrawn before any administrations have occurred. Prescriptions in the process of being cancelled will be regarded as active until all actions are complete.
stopped	Actions implied by the prescription are to be permanently halted, before all of the administrations occurred. This should not be used if the original order was entered in error
completed	All actions that are implied by the prescription have occurred.

Logical medicationRequest status transitions

Comments

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

Data type

medicationrequest Status (required)

Binding

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

Constraints

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

Mappings

workflow: Request.status
script10.6: no mapping
w5: FiveWs.status
rim: .statusCode

statusReason

0..1

CodeableConceptBinding

Element id

MedicationRequest.statusReason

Short description

Reason for current status

Definition

This is generally only used for exception statuses such as suspended or cancelled. It is the clinical status reason for the cancellation.

This is mandatory for 'prescription-order-update' messages.

"statusReason": {
    "coding": [
        {
            "system": "https://fhir.nhs.uk/CodeSystem/medicationrequest-status-reason",
            "code": "0001",
            "display": "Prescribing Error"
        }
    ]
},

Comments

This is generally only used for "exception" statuses such as "suspended" or "cancelled". The reason why the MedicationRequest was created at all is captured in reasonCode, not here.

Data type

MedicationRequestStatusReason (required)

Binding

Identifies the reasons for a given status.

Constraints

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

Mappings

workflow: Request.statusReason
rim: .inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.statusReason.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.statusReason.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

coding

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.statusReason.coding

Short description

Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Requirements

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

Comments

Data type

Constraints

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

Mappings

v2: C*E.1-8, C*E.10-22
rim: union(., ./translation)
orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.statusReason.coding.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.statusReason.coding.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

system

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.statusReason.coding.system

Short description

Identity of the terminology system

Definition

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

Requirements

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

Comments

Data type

Constraints

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

Mappings

v2: C*E.3
rim: ./codeSystem
orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

version

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.statusReason.coding.version

Short description

Version of the system - if relevant

Definition

Comments

Data type

Constraints

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

Mappings

v2: C*E.7
rim: ./codeSystemVersion
orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

code

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.statusReason.coding.code

Short description

Symbol in syntax defined by the system

Definition

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

Requirements

Need to refer to a particular code in the system.

Data type

Constraints

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

Mappings

v2: C*E.1
rim: ./code
orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

display

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.statusReason.coding.display

Short description

Representation defined by the system

Definition

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

Requirements

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

Data type

Constraints

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

Mappings

v2: C*E.2 - but note this is not well followed
rim: CV.displayName
orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

userSelected

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.statusReason.coding.userSelected

Short description

If this coding was chosen directly by the user

Definition

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

Requirements

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

Comments

Data type

Constraints

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

Mappings

v2: Sometimes implied by being first
rim: CD.codingRationale
orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]

text

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.statusReason.text

Short description

Plain text representation of the concept

Definition

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

Requirements

Comments

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

Data type

Constraints

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

Mappings

v2: C*E.9. But note many systems use C*E.2 for this
rim: ./originalText[mediaType/code="text/plain"]/data
orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

intent

Σ ?!

1..1

codeBinding

Element id

MedicationRequest.intent

Short description

Definition

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

Comments

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

code	display	courseOfTherapyType	Definition
order	Order	acute	The request represents a request/demand and authorization for action
original-order	Original Order	continuous-repeat-dispensing continuous	The request represents the original authorization for the medication request.
reflex-order	Reflex Order	continuous-repeat-dispensing	The request represents an automatically generated supplemental authorization (by EPS) for action based on a parent authorization together with initial results of the action taken against that parent authorization.
instance-order	Instance Order	continuous	The request represents an instance for the particular order.

Data type

medicationRequest Intent (required)

Binding

The kind of medication order.

Constraints

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

Mappings

workflow: Request.intent
w5: FiveWs.class
rim: .moodCode (nuances beyond PRP/PLAN/RQO would need to be elsewhere)

Sequential Instructions

Where the value of sequence is an incremental integer it defines a sequential instruction.

Concurrent Instructions

Where the same integer value of sequence is defines it means a concurrent instruction.

Requirements

Data type

integer

Constraints

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

Mappings

v2: TQ1-1
rim: .text

text

S Σ

0..1

Element id

MedicationRequest.dosageInstruction.text

Short description

The complete dosage instruction as a human readable string.

Definition

The complete dosage instruction as a human readable string.

For example;

<text value="1 tablet - every 6 hours - oral" />

Where additional dosage instructions need to be conveyed that cannot be described using any other element of the Dosage structure, then append these to the end of the translated dosage text.

For example;

<text value="{the dosage elements translated as text} - infuse as rapidly as possibly via intraperitoneal port" />

For example, the instruction “immediately following drug {X}”), where {X} is the name of a drug, is neither suitable as a additionalInstruction nor patientInstruction.

For example;

<text value="500 milligrams - once - oral - immediately following drug {X}" />

Requirements

Data type

Constraints

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

Mappings

v2: RXO-6; RXE-21
rim: .text

additionalInstruction

S Σ

0..*

Element id

MedicationRequest.dosageInstruction.additionalInstruction

Short description

Additional dosage instructions that can be either SNOMED-CT coded terms or free-text instructions.

Definition

Patient instructions for taking the drug are contained with in the patientInstruction and additionalInstruction as per the guidance in Dosage Structure Overview

"dosageInstruction": [
    {
        "text": "10 milligram, Inject, Subcutaneous route, once weekly",
        "additionalInstruction": [
            "coding": [
                {
                    "system": "http://snomed.info/sct",
                    "code": "421769005",
                    "display": "Follow directions"
                }
            ],
        ],
        "patientInstruction": "As directed"
    }
]

Requirements

Additional instruction is intended to be coded, but where no code exists, the element could include text. For example, "Swallow with plenty of water" which might or might not be coded.

Comments

Information about administration or preparation of the medication (e.g. "infuse as rapidly as possibly via intraperitoneal port" or "immediately following drug x") should be populated in dosage.text.

Data type

SNOMEDCTAdditionalDosageInstructions (example)

Binding

A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".

Constraints

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

Mappings

v2: RXO-7
rim: .text

patientInstruction

S Σ

0..1

Element id

MedicationRequest.dosageInstruction.patientInstruction

Short description

Patient or consumer oriented instructions

Definition

Patient instructions for taking the drug are contained with in the patientInstruction and additionalInstruction as per the guidance in Dosage Structure Overview

"dosageInstruction": [
    {
        "text": "10 milligram, Inject, Subcutaneous route, once weekly",
        "additionalInstruction": [
            "coding": [
                {
                    "system": "http://snomed.info/sct",
                    "code": "421769005",
                    "display": "Follow directions"
                }
            ],
        ],
        "patientInstruction": "As directed"
    }
]

Data type

Constraints

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

Mappings

v2: RXO-7
rim: .text

timing

S Σ

0..1

Element id

MedicationRequest.dosageInstruction.timing

Short description

When medication should be administered

Definition

Adding constraints, bounds or limits to a dosage instruction.

Requirements

Comments

This attribute might not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.

Data type

Constraints

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

Mappings

rim: .effectiveTime

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

modifierExtension

Σ ?! C

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.modifierExtension

Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

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

Requirements

Comments

Data type

Constraints

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

Mappings

rim: N/A

event

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.event

Short description

When the event occurs

Definition

Identifies specific times when the event occurs.

Requirements

In a Medication Administration Record, for instance, you need to take a general specification, and turn it into a precise specification.

Data type

Constraints

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

Mappings

rim: QLIST<TS>

repeat

Σ C

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat

Short description

When the event is to occur

Definition

A set of rules that describe when the event is scheduled.

Requirements

Many timing schedules are determined by regular repetitions.

Data type

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
tim-1: if there's a duration, there needs to be duration units
duration.empty() or durationUnit.exists()
tim-2: if there's a period, there needs to be period units
period.empty() or periodUnit.exists()
tim-4: duration SHALL be a non-negative value
duration.exists() implies duration >= 0
tim-5: period SHALL be a non-negative value
period.exists() implies period >= 0
tim-6: If there's a periodMax, there must be a period
periodMax.empty() or period.exists()
tim-7: If there's a durationMax, there must be a duration
durationMax.empty() or duration.exists()
tim-8: If there's a countMax, there must be a count
countMax.empty() or count.exists()
tim-9: If there's an offset, there must be a when (and not C, CM, CD, CV)
offset.empty() or (when.exists() and ((when in ('C' | 'CM' | 'CD' | 'CV')).not()))
tim-10: If there's a timeOfDay, there cannot be a when, or vice versa
timeOfDay.empty() or when.empty()

Mappings

rim: Implies PIVL or EIVL

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

bounds[x]

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.bounds[x]

Short description

Length/Range of lengths, or (Start and/or end) limits

Definition

Either a duration for the length of the timing schedule, a range of possible length, or outer bounds for start and/or end limits of the timing schedule.

Constraints

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

Mappings

rim: IVL(TS) used in a QSI

boundsDuration

Data type

boundsRange

Data type

boundsPeriod

Data type

count

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.count

Short description

Number of times to repeat

Definition

Requirements

Repetitions may be limited by end time or total occurrences.

Comments

If you have both bounds and count, then this should be understood as within the bounds period, until count times happens.

Data type

Constraints

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

Mappings

rim: PIVL.count

countMax

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.countMax

Short description

Maximum number of times to repeat

Definition

If present, indicates that the count is a range - so to perform the action between [count] and [countMax] times.

Data type

Constraints

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

Mappings

rim: PIVL.count

duration

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.duration

Short description

How long when it happens

Definition

How long this thing happens for when it happens. If durationMax is present, this element indicates the lower bound of the allowed range of the duration.

Requirements

Some activities are not instantaneous and need to be maintained for a period of time.

Comments

Data type

Constraints

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

Mappings

rim: PIVL.phase

durationMax

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.durationMax

Short description

How long when it happens (Max)

Definition

If present, indicates that the duration is a range - so to perform the action between [duration] and [durationMax] time length.

Requirements

Some activities are not instantaneous and need to be maintained for a period of time.

Comments

Data type

Constraints

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

Mappings

rim: PIVL.phase

durationUnit

0..1

codeBinding

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.durationUnit

Short description

s | min | h | d | wk | mo | a - unit of time (UCUM)

Definition

The units of time for the duration, in UCUM units.

Data type

Binding

A unit of time (units from UCUM).

Constraints

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

Mappings

rim: PIVL.phase.unit

frequency

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.frequency

Short description

Event occurs frequency times per period

Definition

The number of times to repeat the action within the specified period. If frequencyMax is present, this element indicates the lower bound of the allowed range of the frequency.

Meaning when missing

If no frequency is stated, the assumption is that the event occurs once per period, but systems SHOULD always be specific about this

Data type

Constraints

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

Mappings

rim: PIVL.phase

frequencyMax

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.frequencyMax

Short description

Event occurs up to frequencyMax times per period

Definition

If present, indicates that the frequency is a range - so to repeat between [frequency] and [frequencyMax] times within the period or period range.

Data type

Constraints

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

Mappings

rim: PIVL.phase

period

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.period

Short description

Event occurs frequency times per period

Definition

Data type

Constraints

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

Mappings

rim: PIVL.phase

periodMax

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.periodMax

Short description

Upper limit of period (3-4 hours)

Definition

If present, indicates that the period is a range from [period] to [periodMax], allowing expressing concepts such as "do this once every 3-5 days.

Data type

Constraints

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

Mappings

rim: PIVL.phase

periodUnit

0..1

codeBinding

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.periodUnit

Short description

s | min | h | d | wk | mo | a - unit of time (UCUM)

Definition

The units of time for the period in UCUM units.

Data type

Binding

A unit of time (units from UCUM).

Constraints

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

Mappings

rim: PIVL.phase.unit

dayOfWeek

0..*

codeBinding

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.dayOfWeek

Short description

mon | tue | wed | thu | fri | sat | sun

Definition

If one or more days of week is provided, then the action happens only on the specified day(s).

Comments

If no days are specified, the action is assumed to happen every day as otherwise specified. The elements frequency and period cannot be used as well as dayOfWeek.

Data type

Binding

DaysOfWeek (required)

Constraints

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

Mappings

rim: n/a

timeOfDay

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.timeOfDay

Short description

Time of day for action

Definition

Specified time of day for action to take place.

Comments

Data type

Constraints

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

Mappings

rim: n/a

when

0..*

codeBinding

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.when

Short description

Code for time period of occurrence

Definition

An approximate time period during the day, potentially linked to an event of daily living that indicates when the action should occur.

Requirements

Timings are frequently determined by occurrences such as waking, eating and sleep.

Comments

When more than one event is listed, the event is tied to the union of the specified events.

Data type

Binding

Real world event relating to the schedule.

EventTiming (required)

Constraints

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

Mappings

rim: EIVL.event

offset

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.repeat.offset

Short description

Minutes from event (before or after)

Definition

The number of minutes from the event. If the event code does not indicate whether the minutes is before or after the event, then the offset is assumed to be after the event.

Data type

Constraints

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

Mappings

rim: EIVL.offset

code

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.timing.code

Short description

BID | TID | QID | AM | PM | QD | QOD | +

Definition

Comments

Data type

TimingAbbreviation (preferred)

Binding

Code for a known / defined timing pattern.

Constraints

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

Mappings

rim: QSC.code

asNeeded[x]

S Σ

0..1

Element id

MedicationRequest.dosageInstruction.asNeeded[x]

Short description

Take "as needed" (for x)

Definition

The asNeeded structure can be used to define a simple “as required” (or “pro re nata” expressed as “PRN” for those who still prefer to use Latin abbreviations) instructions.

In this case use the asNeededBoolean option. The absence of asNeededBoolean is equivalent to where asNeededBoolean has a value of false.

Comments

Binding

SNOMEDCTMedicationAsNeededReasonCodes (example)

Constraints

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

Mappings

v2: TQ1-9
rim: .outboundRelationship[typeCode=PRCN].target[classCode=OBS, moodCode=EVN, code="as needed"].value=boolean or codable concept

asNeededBoolean

There are no (further) constraints on this element

Data type

asNeededCodeableConcept

There are no (further) constraints on this element

Data type

site

S Σ

0..1

Element id

MedicationRequest.dosageInstruction.site

Short description

Body site to administer to

Definition

Any site can be used from the SNOMED-CT hierarchy as a descendant of the concept 123037004 Body structure (body structure).

<!-- Site -->
<site>
    <coding>
        <system value="http://snomed.info/sct"/>
        <code value="59380008"/>
        <display value="Anterior abdominal wall structure"/>
    </coding>
</site>

Requirements

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

Comments

Data type

SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example)

Binding

A coded concept describing the site location the medicine enters into or onto the body.

Constraints

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

Mappings

v2: RXR-2
rim: .approachSiteCode

route

S Σ

0..1

Element id

MedicationRequest.dosageInstruction.route

Short description

How drug should enter body

Definition

Any route can be used from the SNOMED-CT hierarchy as a descendant of the concept 284009009 Route of administration value (qualifier value).

<!-- Route -->
<route>
    <coding>
        <system value="http://snomed.info/sct"/>
        <code value="78421000"/>
        <display value="intramuscular route"/>
    </coding>
</route>

Requirements

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

Data type

Binding

A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

SNOMEDCTRouteCodes (example)

Constraints

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

Mappings

v2: RXR-1
rim: .routeCode

method

S Σ

0..1

Element id

MedicationRequest.dosageInstruction.method

Short description

Technique for administering medication

Definition

The 999000041000001103 ePrescribing method simple reference set (foundation metadata concept) reference set collates the commonly used terms for method for use in the United Kingdom.

<!-- Method -->
<method>
    <coding>
        <system value="http://snomed.info/sct"/>
        <code value="129326001"/>
        <display value="Injection"/>
    </coding>
</method>

Use of synonyms

Guidance for using terms that are not preferred terms is available within the published document Guidance on the use of CodeableConcept.

Requirements

A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV.

Comments

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

Data type

SNOMEDCTAdministrationMethodCodes (example)

Binding

A coded concept describing the technique by which the medicine is administered.

Constraints

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

Mappings

v2: RXR-4
rim: .doseQuantity

doseAndRate

0..*

Element id

MedicationRequest.dosageInstruction.doseAndRate

Short description

Amount of medication administered

Definition

Dose and Rate elements within the Dosage structure have been combined within the R4 standard, but their underlying use and purpose is the same as per R4.

A dose or rate of medication can be described via one of the following methods. In both instances when considering Units of Measure note that UCUM is preferred.

Sub-element: `Dosage.doseAndRate.doseQuantity`

The amount of medication per dose, as a simple coded quantity.

<!-- Example A: 1 capsule -->
<doseAndRate>
    <doseQuantity>
        <value value="1"/>
        <unit value="capsule"/>
        <system value="http://snomed.info/sct"/>
        <code value="732937005"/>
    </doseQuantity>
</doseAndRate>

<!-- Example B: 30 milligrams -->
<doseAndRate>
    <doseQuantity>
        <value value="30"/>
        <unit value="milligram"/>
        <system value="http://unitsofmeasure.org"/>
        <code value="mg"/>
    </doseQuantity>
</doseAndRate>

Sub-element: `Dosage.doseAndRate.doseRange`

A dose that may be in a given low / high range.

<!-- for a dose between 7.5 to 30 milligram -->
<doseAndRate>
    <doseRange>
        <low>
            <value value="7.5"/>
            <unit value="milligram"/>
            <code value="mg"/>
            <system value="http://unitsofmeasure.org"/>
        </low>
        <high>
            <value value="30"/>
            <unit value="milligram"/>
            <code value="mg"/>
            <system value="http://unitsofmeasure.org"/>
        </high>
    </doseRange>
</doseAndRate>

A rate-based quantity, such as 30 ml per hour, can be expressed as a rateRatio with coded numerator and denominator values.

Where the unit of measure for the ratio is defined within UCUM (see Common UCUM Units), for example, “milliliter per hour”, it can also be expressed using the simpler rateQuantity structure.

Sub-element: `Dosage.doseAndRate.rateRatio`

Where the rate is expressed as coded numerator and denominator values.

at a rate of 30ml/hour using rateRatio

<doseAndRate>
 <rateRatio>
  <numerator>
   <value value="30"/>
   <unit value="millilitre"/>
   <system value="http://unitsofmeasure.org"/>
   <code value="mL"/>
  </numerator>
  <denominator>
   <value value="1"/>
   <unit value="hour"/>
   <system value="http://unitsofmeasure.org"/>
   <code value="h"/>
  </denominator>
 </rateRatio>
</doseAndRate>

Sub-element: `Dosage.doseAndRate.rateQuantity`

Where the unit of measure applicable to a rate is defined within UCUM which is mathematically equivalent to defining the rate using the more complex rateRatio structure.

at a rate of 30ml/hour using rateQuantity

<rateQuantity>
 <value value="30"/>
 <unit value="milliliters per hour"/>
 <system value="http://unitsofmeasure.org"/>
 <code value="mL/h"/>
</rateQuantity>

at a rate of 1mcg/kg/hour using rateQuantity

<doseAndRate>
 <rateQuantity>
  <value value="1"/>
  <unit value="microgram per kilogram per hour"/>
  <system value="http://unitsofmeasure.org"/>
  <code value="ug/kg/h"/>
 </rateQuantity>
</doseAndRate>

Sub-element: `Dosage.doseAndRate.rateRange`

Where the unit of measure applicable to a rate range is defined within UCUM the rateRange structure can be used.

give at 1-2 litres per minute using rateRange

<doseAndRate>
 <rateRange>
  <low>
   <value value="1"/>
   <unit value="liter per minute"/>
   <system value="http://unitsofmeasure.org"/>
   <code value="L/min"/>
  </low>
  <high>
   <value value="2"/>
   <unit value="liter per minute"/>
   <system value="http://unitsofmeasure.org"/>
   <code value="L/min"/>
  </high>
 </rateRange>
</doseAndRate>

Data type

Constraints

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

Mappings

v2: TQ1-2

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.doseAndRate.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.doseAndRate.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

type

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.doseAndRate.type

Short description

The kind of dose or rate specified

Definition

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

Requirements

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

Data type

Binding

The kind of dose or rate specified.

DoseAndRateType (example)

Constraints

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

Mappings

v2: RXO-21; RXE-23

dose[x]

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.doseAndRate.dose[x]

Short description

Amount of medication per dose

Definition

Amount of medication per dose.

Requirements

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

Comments

Constraints

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

Mappings

v2: RXO-2, RXE-3
rim: .doseQuantity

doseRange

Data type

doseQuantity

Data type

rate[x]

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dosageInstruction.doseAndRate.rate[x]

Short description

Amount of medication per unit of time

Definition

Amount of medication per unit of time.

Requirements

Comments

Constraints

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

Mappings

v2: RXE22, RXE23, RXE-24
rim: .rateQuantity

rateRatio

There are no (further) constraints on this element

Data type

rateRange

There are no (further) constraints on this element

Data type

rateQuantity

There are no (further) constraints on this element

Data type

maxDosePerPeriod

S Σ

0..1

Element id

MedicationRequest.dosageInstruction.maxDosePerPeriod

Short description

Upper limit on medication per unit of time

Definition

<div class="nhsd-a-box nhsd-a-box--bg-light-blue nhsd-!t-margin-bottom-6 nhsd-t-body"> Used to define a maxiumum dose over a given time period. </div>

An example would be a Sumatriptan 6mg injection which can be repeated after an hour but not again over a 24 hour period. The maxDosePerPeriod is defined as 12mg/24hours.

<div class="nhsd-a-box nhsd-a-box--bg-light-yellow nhsd-!t-margin-bottom-6 nhsd-t-body"> A real-world example of where this would be required has not yet been identified. </div>

Maximum dose per period of 12mg/24 hour

<maxDosePerPeriod>
    <numerator>
        <value value="12"/>
        <unit value="milligram"/>
        <system value="http://unitsofmeasure.org"/>
        <code value="mg"/>
    </numerator>
    <denominator>
        <value value="24"/>
        <unit value="hour"/>
        <system value="http://unitsofmeasure.org"/>
        <code value="h"/>
    </denominator>
</maxDosePerPeriod>

Requirements

The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours.

Comments

This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".

Data type

Constraints

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

Mappings

v2: RXO-23, RXE-19
rim: .maxDoseQuantity

maxDosePerAdministration

0..1

Element id

MedicationRequest.dosageInstruction.maxDosePerAdministration

Short description

Upper limit on medication per administration

Definition

<div class="nhsd-a-box nhsd-a-box--bg-light-blue nhsd-!t-margin-bottom-6 nhsd-t-body"> Used to define a maximum dose for a single administration. </div>

An example would be Anagrelide for which a single dose should not exceed 2.5 mg. The maxDosePerAdministration is defined as 2.5mg.

In many scenarios it is expected that the dosage.doseRange would be used instead of maxDosePerAdministration.

<div class="nhsd-a-box nhsd-a-box--bg-light-yellow nhsd-!t-margin-bottom-6 nhsd-t-body"> A real-world example of where this would be required has not yet been identified. </div>

Maximum dose per administration of 2.5mg

<maxDosePerAdministration>
    <value value="2.5"/>
    <unit value="milligram"/>
    <system value="http://unitsofmeasure.org"/>
    <code value="mg"/>
</maxDosePerAdministration>

Requirements

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

Comments

Data type

Constraints

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

Mappings

rim: not supported

maxDosePerLifetime

0..1

Element id

MedicationRequest.dosageInstruction.maxDosePerLifetime

Short description

Upper limit on medication per lifetime of the patient

Definition

<div class="callout-box--info"> Used to define the maximum cumulative dose over the lifetime of a patient. </div>

An example would be Daunorubicin which may have a maximum cumulative dose of 600mg/m2 (based on the size of the patient). The maxDosePerLifetime is defined as 600 mg/m2.

Maximum dose over lifetime of the patient of 600 mg/m2

<maxDosePerLifetime>
    <value value="600"/>
    <unit value="milligram per square metre"/>
    <system value="http://unitsofmeasure.org"/>
    <code value="mg/m2"/>
</maxDosePerLifetime>

Requirements

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

Data type

Constraints

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

Mappings

rim: not supported

dispenseRequest

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest

Short description

Medication supply authorization

Definition

Data type

Constraints

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

Mappings

script10.6: Message/Body/NewRx/MedicationPrescribed/ExpirationDate
rim: component.supplyEvent

0..0

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

1..*

Element id

MedicationRequest.dispenseRequest.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Constraints

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

Mappings

rim: n/a

performerSiteType

S C

1..1

Element id

MedicationRequest.dispenseRequest.extension:performerSiteType

Short description

type of dispensing organisation

Alternate names

extensions, user content

Definition

Used to indicate type of pharmacist

Comments

Data type

https://fhir.nhs.uk/StructureDefinition/Extension-DM-PerformerSiteType

Extension URL

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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

Mappings

rim: n/a
rim: N/A

modifierExtension

Σ ?! C

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.modifierExtension

Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

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

Requirements

Comments

Data type

Constraints

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

Mappings

rim: N/A

initialFill

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.initialFill

Short description

First fill details

Definition

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

Comments

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

Data type

Constraints

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

Mappings

rim: SubstanceAdministration -> ActRelationship[sequenceNumber = '1'] -> Supply

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.initialFill.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.initialFill.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Constraints

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

Mappings

rim: n/a

modifierExtension

Σ ?! C

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.initialFill.modifierExtension

Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

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

Requirements

Comments

Data type

Constraints

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

Mappings

rim: N/A

quantity

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.initialFill.quantity

Short description

First fill quantity

Definition

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

Data type

Constraints

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

Mappings

rim: Supply.quantity[moodCode=RQO]

duration

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.initialFill.duration

Short description

First fill duration

Definition

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

Data type

Constraints

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

Mappings

rim: Supply.effectivetime[moodCode=RQO]

dispenseInterval

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.dispenseInterval

Short description

Minimum period of time between dispenses

Definition

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

Data type

Constraints

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

Mappings

rim: Supply.effectivetime[moodCode=RQO]

validityPeriod

0..1

Element id

MedicationRequest.dispenseRequest.validityPeriod

Short description

Time period supply is authorized for

Definition

"dispenseRequest": {
          "validityPeriod": {
            "start": "2020-06-10",
            "end": "2020-12-07"
          },
          ...
      }

Requirements

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

Comments

Data type

Constraints

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

Mappings

script10.6: Message/Body/NewRx/MedicationPrescribed/Refills
rim: effectiveTime

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.validityPeriod.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.validityPeriod.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

start

Σ C

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.validityPeriod.start

Short description

Starting time with inclusive boundary

Definition

The start of the period. The boundary is inclusive.

Comments

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

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: per-1

Constraints

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

Mappings

v2: DR.1
rim: ./low

end

Σ C

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.validityPeriod.end

Short description

End time with inclusive boundary, if not ongoing

Definition

Comments

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

Meaning when missing

If the end of the period is missing, it means that the period is ongoing

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: per-1

Constraints

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

Mappings

v2: DR.2
rim: ./high

numberOfRepeatsAllowed

0..1

Element id

MedicationRequest.dispenseRequest.numberOfRepeatsAllowed

Short description

Number of refills authorized

Definition

Example for a continuous issue:


"dispenseRequest": {
        "numberOfRepeatsAllowed": 0
    }

Example for a continuous-repeat-dispensing issue with intent of original-order:


"dispenseRequest": {
        "numberOfRepeatsAllowed": 2
    }

This will result in a total of three issues of the medication.

Comments

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

Data type

Constraints

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

Mappings

script10.6: Message/Body/NewRx/MedicationPrescribed/Quantity
v2: RXE-12-Number of Refills
rim: repeatNumber

quantity

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.quantity

Short description

Amount of medication to supply per dispense

Definition

The amount that is to be dispensed for one fill.

Data type

Constraints

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

Mappings

script10.6: Message/Body/NewRx/MedicationPrescribed/DaysSupply
v2: RXD-4-Actual Dispense Amount / RXD-5.1-Actual Dispense Units.code / RXD-5.3-Actual Dispense Units.name of coding system
rim: quantity

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.quantity.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.quantity.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

value

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.quantity.value

Short description

Numerical value (with implicit precision)

Definition

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

Requirements

Precision is handled implicitly in almost all cases of measurement.

Comments

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

Data type

Constraints

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

Mappings

v2: SN.2 / CQ - N/A
rim: PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value

comparator

Σ ?!

0..0

codeBinding

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.quantity.comparator

Short description

< | <= | >= | > - how to understand the value

Definition

Not allowed to be used in this context

Requirements

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

Meaning when missing

If there is no comparator, then there is no modification of the value

Data type

Binding

How the Quantity should be understood and represented.

Constraints

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

Mappings

v2: SN.1 / CQ.1
rim: IVL properties

unit

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.quantity.unit

Short description

Unit representation

Definition

A human-readable form of the unit.

Requirements

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

Data type

Constraints

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

Mappings

v2: (see OBX.6 etc.) / CQ.2
rim: PQ.unit

system

Σ C

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.quantity.system

Short description

System that defines coded unit form

Definition

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

Requirements

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

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: qty-3

Constraints

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

Mappings

v2: (see OBX.6 etc.) / CQ.2
rim: CO.codeSystem, PQ.translation.codeSystem

code

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.quantity.code

Short description

Coded form of the unit

Definition

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

Requirements

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

Comments

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

Data type

Constraints

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

Mappings

v2: (see OBX.6 etc.) / CQ.2
rim: PQ.code, MO.currency, PQ.translation.code

expectedSupplyDuration

0..1

Element id

MedicationRequest.dispenseRequest.expectedSupplyDuration

Short description

Days Supply

Definition

The expectedSupplyDuration entity is required for repeat dispensing (repeatable) prescriptions only.

"dispenseRequest": {
          ...
          "expectedSupplyDuration": {
            "value": 28,
            "unit": "days",
            "system": "http://unitsofmeasure.org",
            "code": "d"
          }
      }

Comments

Data type

Constraints

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

Mappings

script10.6: Message/Body/NewRx/MedicationPrescribed/Substitutions
rim: expectedUseTime

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.expectedSupplyDuration.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.expectedSupplyDuration.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

value

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.expectedSupplyDuration.value

Short description

Numerical value (with implicit precision)

Definition

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

Requirements

Precision is handled implicitly in almost all cases of measurement.

Comments

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

Data type

Constraints

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

Mappings

v2: SN.2 / CQ - N/A
rim: PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value

comparator

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.expectedSupplyDuration.comparator

Short description

< | <= | >= | > - how to understand the value

Definition

Requirements

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

Meaning when missing

If there is no comparator, then there is no modification of the value

Data type

Binding

How the Quantity should be understood and represented.

Constraints

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

Mappings

v2: SN.1 / CQ.1
rim: IVL properties

unit

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.expectedSupplyDuration.unit

Short description

Unit representation

Definition

A human-readable form of the unit.

Requirements

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

Data type

Constraints

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

Mappings

v2: (see OBX.6 etc.) / CQ.2
rim: PQ.unit

system

Σ C

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.expectedSupplyDuration.system

Short description

System that defines coded unit form

Definition

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

Requirements

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

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: qty-3

Constraints

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

Mappings

v2: (see OBX.6 etc.) / CQ.2
rim: CO.codeSystem, PQ.translation.codeSystem

code

1..1

codeAuto Value

Element id

MedicationRequest.dispenseRequest.expectedSupplyDuration.code

Short description

Coded form of the unit

Definition

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

Requirements

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

Comments

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

Data type

Constraints

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

Auto value

Mappings

v2: (see OBX.6 etc.) / CQ.2
rim: PQ.code, MO.currency, PQ.translation.code

performer

0..1

Element id

MedicationRequest.dispenseRequest.performer

Short description

Intended dispenser

Definition

The extension https://fhir.nhs.uk/StructureDefinition/Extension-DM-PerformerSiteType MUST be present.

Patients pharmacy preferences may be sourced from PDS.

Patients pharmacy preferences may be overriden by an 'one-off pharmacy nomination' by populating the dispenseRequest.performer.identifier with the ODS/ANANA code of the destination pharmacy.

"dispenseRequest": {
        "extension":  [
            {
                "url": "https://fhir.nhs.uk/StructureDefinition/Extension-DM-PerformerSiteType",
                "valueCoding": {
                    "system": "https://fhir.nhs.uk/CodeSystem/dispensing-site-preference",
                    "code": "0004"
                }
            },
        ],
        "performer": {
            "identifier": {
                "system": "https://fhir.nhs.uk/Id/ods-organization-code",
                "value": "FX748"
            }
        },

Data type

Constraints

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

Mappings

w5: FiveWs.who
rim: .outboundRelationship[typeCode=COMP].target[classCode=SPLY, moodCode=RQO] .participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.performer.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.performer.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

dispensingPractitioner

S C

0..1

Element id

MedicationRequest.dispenseRequest.performer.extension:dispensingPractitioner

Short description

practitioner who released(/downloaded) the prescription

Alternate names

extensions, user content

Definition

Details of the dispenser who is actioning the MedicationRequest

       "dispenseRequest": { 
                    "performer": {
                        "extension":  [
                            {
                                "url": "https://fhir.nhs.uk/StructureDefinition/Extension-DM-DispensingPerformer",
                                "valueReference": {
                                    "reference": "urn:uuid:25f3dd9f-5838-44a7-930e-c78ae3ecadd6",
                                    "display": "LOTTIE POTTS"
                                }
                            }
                        ],
                        "identifier": {
                            "system": "https://fhir.nhs.uk/Id/ods-organization-code",
                            "value": "VNE51"
                        },
                        "display": "The Simple Pharmacy"
                    }
                },

Comments

Data type

https://fhir.nhs.uk/StructureDefinition/Extension-DM-DispensingPerformer

Extension URL

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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

Mappings

rim: n/a
rim: N/A

reference

Σ C

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.performer.reference

Short description

Literal reference, Relative, internal or absolute URL

Definition

Comments

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ref-1

Constraints

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

Mappings

rim: N/A

type

0..1

uriBinding

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.performer.type

Short description

Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Comments

Data type

Binding

Aa resource (or, for logical models, the URI of the logical model).

Constraints

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

Mappings

rim: N/A

identifier

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.performer.identifier

Short description

Logical reference, when literal reference is not known

Definition

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Data type

Constraints

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

Mappings

rim: .identifier

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.performer.identifier.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.performer.identifier.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.performer.identifier.use

Short description

usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Requirements

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

Comments

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

Data type

Binding

Identifies the purpose for this identifier, if known .

Constraints

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

Mappings

v2: N/A
rim: Role.code or implied by context

type

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.performer.identifier.type

Short description

Description of identifier

Definition

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

Requirements

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

Comments

Data type

Binding

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

Constraints

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

Mappings

v2: CX.5
rim: Role.code or implied by context

system

1..1

uriAuto Value

Element id

MedicationRequest.dispenseRequest.performer.identifier.system

Short description

The namespace for the identifier value

Definition

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

Requirements

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

Comments

Identifier.system is always case sensitive.

Data type

Constraints

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

Auto value

https://fhir.nhs.uk/Id/ods-organization-code

Examples
General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

value

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.performer.identifier.value

Short description

The value that is unique

Definition

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

Comments

Data type

Constraints

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

Examples
General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

period

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.performer.identifier.period

Short description

Time period when id is/was valid for use

Definition

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

Data type

Constraints

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

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

assigner

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.performer.identifier.assigner

Short description

Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Comments

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

Data type

Constraints

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

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

display

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.dispenseRequest.performer.display

Short description

Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Data type

Constraints

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

Mappings

rim: N/A

substitution

1..1

Element id

MedicationRequest.substitution

Short description

Any restrictions on medication substitution

Definition

Within UK healthcare, substitution is not the norm and so this element will normally be set to a default of false.

Substitution being set to false is a mandatory requirement for EPS..

Substituition is a mandatory requirement for EPS.


"substitution": {
        "allowedBoolean": false
    }

Data type

Constraints

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

Mappings

script10.6: specific values within Message/Body/NewRx/MedicationPrescribed/Substitutions
rim: subjectOf.substitutionPersmission

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.substitution.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.substitution.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Constraints

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

Mappings

rim: n/a

modifierExtension

Σ ?! C

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.substitution.modifierExtension

Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

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

Requirements

Comments

Data type

Constraints

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

Mappings

rim: N/A

allowed[x]

1..1

There are no (further) constraints on this element

Element id

MedicationRequest.substitution.allowed[x]

Short description

Whether substitution is allowed or not

Definition

The purpose of this element is to allow the prescriber to dispense a different drug from what was prescribed.

Comments

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

Constraints

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

Mappings

script10.6: specific values within Message/Body/NewRx/MedicationPrescribed/Substitutions
v2: RXO-9-Allow Substitutions / RXE-9-Substitution Status
rim: code

allowedBoolean

Data type

reason

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.substitution.reason

Short description

Why should (not) substitution be made

Definition

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

Data type

v3.SubstanceAdminSubstitutionReason (example)

Binding

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

Constraints

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

Mappings

script10.6: not mapped
v2: RXE-9 Substition status
rim: reasonCode

priorPrescription

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription

Short description

An order/prescription that is being replaced

Definition

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

Data type

Constraints

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

Mappings

workflow: Request.replaces
script10.6: not mapped
rim: .outboundRelationship[typeCode=?RPLC or ?SUCC]/target[classCode=SBADM,moodCode=RQO]

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

reference

Σ C

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription.reference

Short description

Literal reference, Relative, internal or absolute URL

Definition

Comments

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ref-1

Constraints

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

Mappings

rim: N/A

type

0..1

uriBinding

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription.type

Short description

Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Comments

Data type

Binding

Aa resource (or, for logical models, the URI of the logical model).

Constraints

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

Mappings

rim: N/A

identifier

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription.identifier

Short description

Logical reference, when literal reference is not known

Definition

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Data type

Constraints

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

Mappings

rim: .identifier

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription.identifier.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription.identifier.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription.identifier.use

Short description

usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Requirements

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

Comments

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

Data type

Binding

Identifies the purpose for this identifier, if known .

Constraints

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

Mappings

v2: N/A
rim: Role.code or implied by context

type

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription.identifier.type

Short description

Description of identifier

Definition

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

Requirements

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

Comments

Data type

Binding

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

Constraints

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

Mappings

v2: CX.5
rim: Role.code or implied by context

system

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription.identifier.system

Short description

The namespace for the identifier value

Definition

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

Requirements

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

Comments

Identifier.system is always case sensitive.

Data type

Constraints

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

Examples
General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

value

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription.identifier.value

Short description

The value that is unique

Definition

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

Comments

Data type

Constraints

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

Examples
General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

period

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription.identifier.period

Short description

Time period when id is/was valid for use

Definition

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

Data type

Constraints

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

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

assigner

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription.identifier.assigner

Short description

Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Comments

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

Data type

Constraints

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

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

display

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.priorPrescription.display

Short description

Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Data type

Constraints

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

Mappings

rim: N/A

detectedIssue

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue

Short description

Clinical Issue with action

Alternate names

Contraindication, Drug Utilization Review (DUR), Alert

Definition

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

Comments

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

Data type

Constraints

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

Mappings

rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=ALRT,moodCode=EVN].value

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

reference

Σ C

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue.reference

Short description

Literal reference, Relative, internal or absolute URL

Definition

Comments

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ref-1

Constraints

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

Mappings

rim: N/A

type

0..1

uriBinding

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue.type

Short description

Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Comments

Data type

Binding

Aa resource (or, for logical models, the URI of the logical model).

Constraints

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

Mappings

rim: N/A

identifier

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue.identifier

Short description

Logical reference, when literal reference is not known

Definition

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Data type

Constraints

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

Mappings

rim: .identifier

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue.identifier.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue.identifier.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue.identifier.use

Short description

usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Requirements

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

Comments

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

Data type

Binding

Identifies the purpose for this identifier, if known .

Constraints

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

Mappings

v2: N/A
rim: Role.code or implied by context

type

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue.identifier.type

Short description

Description of identifier

Definition

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

Requirements

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

Comments

Data type

Binding

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

Constraints

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

Mappings

v2: CX.5
rim: Role.code or implied by context

system

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue.identifier.system

Short description

The namespace for the identifier value

Definition

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

Requirements

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

Comments

Identifier.system is always case sensitive.

Data type

Constraints

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

Examples
General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

value

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue.identifier.value

Short description

The value that is unique

Definition

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

Comments

Data type

Constraints

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

Examples
General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

period

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue.identifier.period

Short description

Time period when id is/was valid for use

Definition

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

Data type

Constraints

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

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

assigner

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue.identifier.assigner

Short description

Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Comments

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

Data type

Constraints

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

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

display

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.detectedIssue.display

Short description

Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Data type

Constraints

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

Mappings

rim: N/A

eventHistory

0..*

Element id

MedicationRequest.eventHistory

Short description

A list of events of interest in the lifecycle

Definition

Comments

Data type

Constraints

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

Mappings

workflow: Request.relevantHistory
rim: .inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

reference

Σ C

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory.reference

Short description

Literal reference, Relative, internal or absolute URL

Definition

Comments

Data type

Conditions

The cardinality or value of this element may be affected by these constraints: ref-1

Constraints

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

Mappings

rim: N/A

type

0..1

uriBinding

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory.type

Short description

Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Comments

Data type

Binding

Aa resource (or, for logical models, the URI of the logical model).

Constraints

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

Mappings

rim: N/A

identifier

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory.identifier

Short description

Logical reference, when literal reference is not known

Definition

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Data type

Constraints

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

Mappings

rim: .identifier

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory.identifier.id

Short description

Unique id for inter-element referencing

Definition

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

Data type

Mappings

rim: n/a

extension

0..*

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory.identifier.extension

Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

Comments

Data type

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

use

Σ ?!

0..1

codeBinding

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory.identifier.use

Short description

usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Requirements

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

Comments

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

Data type

Binding

Identifies the purpose for this identifier, if known .

Constraints

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

Mappings

v2: N/A
rim: Role.code or implied by context

type

0..1

CodeableConceptBinding

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory.identifier.type

Short description

Description of identifier

Definition

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

Requirements

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

Comments

Data type

Binding

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

Constraints

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

Mappings

v2: CX.5
rim: Role.code or implied by context

system

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory.identifier.system

Short description

The namespace for the identifier value

Definition

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

Requirements

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

Comments

Identifier.system is always case sensitive.

Data type

Constraints

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

Examples
General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

value

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory.identifier.value

Short description

The value that is unique

Definition

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

Comments

Data type

Constraints

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

Examples
General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

period

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory.identifier.period

Short description

Time period when id is/was valid for use

Definition

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

Data type

Constraints

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

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

assigner

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory.identifier.assigner

Short description

Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Comments

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

Data type

Constraints

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

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

display

0..1

There are no (further) constraints on this element

Element id

MedicationRequest.eventHistory.display

Short description

Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Data type

Constraints

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

Mappings

rim: N/A

MedicationRequest

Short Ordering of medication for patient or group

Definition

Cardinality 0..*

Alias Prescription, Order

Constraints

dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
contained.contained.empty()
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
contained.meta.security.empty()
dom-6: A resource should have narrative for robust management
text.`div`.exists()
eps-1: medication[x] - Only one of medicationReference or medicationCodeableConcept should be provided
(medicationReference.exists() and medicationCodeableConcept.exists().not()) or (medicationReference.exists().not() and medicationCodeableConcept.exists())
eps-5: Extension(responsiblePractitioner) - An identifier or resource reference must be provided
extension('https://fhir.nhs.uk/StructureDefinition/Extension-DM-ResponsiblePractitioner').exists().not() or (extension('https://fhir.nhs.uk/StructureDefinition/Extension-DM-ResponsiblePractitioner').value.reference.exists() or extension('https://fhir.nhs.uk/StructureDefinition/Extension-DM-ResponsiblePractitioner').value.system.exists())
eps-7: For continuous-repeat-dispensing intent must be reflex-order or original-order
(courseOfTherapyType.coding.code != 'continuous-repeat-dispensing') or ((courseOfTherapyType.coding.code = 'continuous-repeat-dispensing') and ((intent ='original-order') or (intent ='reflex-order')))
eps-8: For continuous intent must be instance-order or original-order
(courseOfTherapyType.coding.code != 'continuous') or ((courseOfTherapyType.coding.code = 'continuous') and ((intent ='original-order') or (intent ='instance-order')))
eps-9: dispenseRequest.numberOfRepeatsAllowed should be populated for continuous and continuous-repeat-dispensing MedicationRequests.
(courseOfTherapyType.coding.code.startsWith('acute')) or (courseOfTherapyType.coding.code.startsWith('continuous') and dispenseRequest.exists() and dispenseRequest.numberOfRepeatsAllowed.exists())
eps-10: For continuous-repeat-dispensing (intent=reflex-order) basedOn must be populated
(courseOfTherapyType.coding.code = 'acute') or (courseOfTherapyType.coding.code = 'continuous') or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing' and intent !='reflex-order') or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing' and intent ='reflex-order' and dispenseRequest.exists() and basedOn.exists())
eps-11: For continuous-repeat-dispensing (intent=reflex-order) or continous orders, numberOfRepeatsAllowed must be empty or equal to 0
(courseOfTherapyType.coding.code = 'acute') or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing' and intent !='reflex-order') or ((courseOfTherapyType.coding.code = 'continuous' or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing' and intent ='reflex-order')) and (dispenseRequest.numberOfRepeatsAllowed.exists().not() or (dispenseRequest.numberOfRepeatsAllowed.exists() and dispenseRequest.numberOfRepeatsAllowed = 0)))
eps-12: For continuous issues basedOn should be populated
(courseOfTherapyType.coding.code = 'acute') or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing') or (courseOfTherapyType.coding.code = 'continuous' and dispenseRequest.exists() and basedOn.exists())
eps-13: Extension repeatInformation.numberOfPrescriptionsIssued should not be present for continuous-repeat-dispensing that are not intent=reflex-order
(courseOfTherapyType.coding.code != 'continuous-repeat-dispensing') or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing' and intent='reflex-order') or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing' and intent!='reflex-order' and extension('https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation').exists().not()) or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing' and intent!='reflex-order' and extension('https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation').exists() and extension('https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation').extension('numberOfPrescriptionsIssued').exists().not())
eps-14: Extension repeatInformation.numberOfPrescriptionsIssued should be present for continuous-repeat-dispensing that have intent=reflex-order
(courseOfTherapyType.coding.code != 'continuous-repeat-dispensing') or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing' and intent != 'reflex-order') or (courseOfTherapyType.coding.code = 'continuous-repeat-dispensing' and intent='reflex-order' and extension('https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation').exists() and extension('https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation').extension('numberOfPrescriptionsIssued').exists())
eps-15: Extension repeatInformation.numberOfPrescriptionsIssued is recommend to be present for continuous issues
(courseOfTherapyType.coding.code != 'continuous') or (courseOfTherapyType.coding.code = 'continuous' and extension('https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation').exists() and extension('https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation').extension('numberOfPrescriptionsIssued').exists())
eps-16: Extension repeatInformation.numberOfPrescriptionsIssued should not be present for acute issues
(courseOfTherapyType.coding.code != 'acute') or (courseOfTherapyType.coding.code = 'acute' and extension('https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation').exists().not())

Mappings

rim: Entity. Role, or Act
workflow: Request
script10.6: Message/Body/NewRx
rim: CombinedMedicationRequest

MedicationRequest.id

Short Logical id of this artifact

Definition

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

Cardinality 0..1

Summary True

Comments

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

MedicationRequest.meta

Short Metadata about the resource

Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

Cardinality 0..1

Summary True

Constraints

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

MedicationRequest.implicitRules

Short A set of rules under which this content was created

Definition

Cardinality 0..1

Modifier True

Summary True

Comments

Constraints

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

MedicationRequest.language

Short Language of the resource content

Definition

The base language in which the resource is written.

Cardinality 0..1

A human language.

CommonLanguages (preferred)

Binding extensions

maxValueSet	AllLanguages

Comments

Constraints

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

MedicationRequest.text

Short Text summary of the resource, for human interpretation

Definition

Cardinality 0..1

Alias narrative, html, xhtml, display

Comments

Constraints

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

Mappings

rim: Act.text?

MedicationRequest.contained

Short Contained, inline Resources

Definition

Cardinality 0..*

Alias inline resources, anonymous resources, contained resources

Comments

Mappings

rim: N/A

MedicationRequest.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Constraints

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

Mappings

rim: N/A

MedicationRequest.extension:medicationRepeatInformation

Short Continous and Continuous Repeat Dispensing

Definition

This extension <b>SHOULD</b> be present for continuous and continuous-repeat-dispensing therapy types.

Field	Description
numberOfPrescriptionsIssued	Running total of number of issues made against a repeat authorisation. Including this issue.
~~numberOfRepeatPrescriptionsAllowed~~	Retired. See <a href="#numberOfRepeatsAllowed">numberOfRepeatsAllowed</a>
authorisationExpiryDate	The date a repeat prescription authorisation will expire.

"extension": [
  {
       "url": "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation",
       "extension": [
           {
               "url": "numberOfPrescriptionsIssued",
               "valueUnsignedInt": 3
           },
           {
               "url": "authorisationExpiryDate",
               "valueDateTime": "2020-08-07"
           }
       ]
   }
]

Cardinality 0..1

Type Extension(Complex)

Must Support True

Alias extensions, user content

Comments

Conditions The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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

Mappings

rim: N/A
rim: n/a

MedicationRequest.extension:responsiblePractitioner

Short Responsible Practitioner for the prescription

Definition

Must only be populated if the requester can not be responsible for the prescription, i.e. they would not be named as the prescriber on the FP10.

"extension": [
        
    {
        "url": "https://fhir.nhs.uk/StructureDefinition/Extension-DM-ResponsiblePractitioner",
        "valueReference": {
            "reference": "urn:uuid:a5acefc1-f8ca-4989-a5ac-34ae36741466",
            "display": "DR SAZ RAZ"
        }
    }
],

Cardinality 0..1

Type Extension(Reference(NHSDigitalPractitionerRole))

Must Support True

Alias extensions, user content

Comments

Conditions The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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

Mappings

rim: N/A
rim: n/a

MedicationRequest.extension:prescriptionEndorsement

Short NHS BSA Prescription Endorsements

Definition

The codes are contained in the valueset

Code	Display
CC	Contraceptive
FS	Sexual Health
ACBS	Advisory Committee on Borderline Substances. Part XV Drug Tariff
SLS	Selected List Scheme. Part XVIIIB Drug Tariff
AF	Food replacement/food supplement products

"resourceType": "MedicationRequest",
    "extension":  [
      {
          "url": "https://fhir.nhs.uk/StructureDefinition/Extension-DM-PrescriptionEndorsement",
          "valueCodeableConcept": {
              "coding":  [
                {
                    "system": "https://fhir.nhs.uk/CodeSystem/medicationrequest-endorsement",
                    "code": "SLS",
                    "display": "Selected List Scheme"
                }
            ]
        }
    }
  ],

Cardinality 0..*

Type Extension(CodeableConcept)

Must Support True

Alias extensions, user content

Comments

Conditions The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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

Mappings

rim: N/A
rim: n/a

MedicationRequest.extension:prescriptionTaskStatusReason

Short Prescription task status reason

Definition

The status history within EPS is primarily a technical Status and the statusReason will reflect current clinical status of the order.

Cardinality 0..*

Type Extension(Complex)

Must Support True

Alias extensions, user content

Comments

Conditions The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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

Mappings

rim: N/A
rim: n/a

MedicationRequest.extension:prescriptionTaskStatusReason.id

Short Unique id for inter-element referencing

Definition

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

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.extension:prescriptionTaskStatusReason.extension

Short Additional content defined by implementations

Definition

Cardinality 1..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

MedicationRequest.extension:prescriptionTaskStatusReason.extension:statusDate

Short Additional content defined by implementations

Definition

Cardinality 0..1

Alias extensions, user content

Comments

Constraints

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

Mappings

rim: n/a

MedicationRequest.extension:prescriptionTaskStatusReason.extension:statusDate.id

Short Unique id for inter-element referencing

Definition

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

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.extension:prescriptionTaskStatusReason.extension:statusDate.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

MedicationRequest.extension:prescriptionTaskStatusReason.extension:statusDate.url

Short identifies the meaning of the extension

Definition

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

Cardinality 1..1

Comments

Auto Value

statusDate

Mappings

rim: N/A

MedicationRequest.extension:prescriptionTaskStatusReason.extension:statusDate.value[x]

Short Value of extension

Definition

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

Cardinality 0..1

Constraints

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

Mappings

rim: N/A

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status

Short Additional content defined by implementations

Definition

Cardinality 1..1

TaskMedicationRequestStatusReason (required)

Alias extensions, user content

Comments

Constraints

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

Mappings

rim: n/a

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.id

Short Unique id for inter-element referencing

Definition

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

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.url

Short identifies the meaning of the extension

Definition

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

Cardinality 1..1

Comments

Auto Value

status

Mappings

rim: N/A

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.value[x]

Short Value of extension

Definition

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

Cardinality 0..1

Constraints

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

Mappings

rim: N/A

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.value[x].id

Short Unique id for inter-element referencing

Definition

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

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.value[x].extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.value[x].system

Short Identity of the terminology system

Definition

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

Cardinality 1..1

Summary True

Requirements

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

Comments

Constraints

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

Mappings

v2: C*E.3
rim: ./codeSystem
orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.value[x].version

Short Version of the system - if relevant

Definition

Cardinality 0..1

Summary True

Comments

Constraints

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

Mappings

v2: C*E.7
rim: ./codeSystemVersion
orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.value[x].code

Short Symbol in syntax defined by the system

Definition

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

Cardinality 1..1

Summary True

Requirements

Need to refer to a particular code in the system.

Constraints

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

Mappings

v2: C*E.1
rim: ./code
orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.value[x].display

Short Representation defined by the system

Definition

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

Cardinality 0..1

Summary True

Requirements

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

Constraints

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

Mappings

v2: C*E.2 - but note this is not well followed
rim: CV.displayName
orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

MedicationRequest.extension:prescriptionTaskStatusReason.extension:status.value[x].userSelected

Short If this coding was chosen directly by the user

Definition

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

Cardinality 0..1

Summary True

Requirements

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

Comments

Constraints

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

Mappings

v2: Sometimes implied by being first
rim: CD.codingRationale
orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]

MedicationRequest.extension:prescriptionTaskStatusReason.url

Short identifies the meaning of the extension

Definition

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

Cardinality 1..1

Comments

Auto Value

https://fhir.nhs.uk/StructureDefinition/Extension-DM-PrescriptionStatusHistory

Mappings

rim: N/A

MedicationRequest.extension:prescriptionTaskStatusReason.value[x]

Short Value of extension

Definition

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

Cardinality 0..0

Type base64Binary, boolean, canonical(), code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference(), SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta

Constraints

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

Mappings

rim: N/A

MedicationRequest.extension:NHSBSAprescriptionType

Short NHS BSA Prescription Type

Definition

The vocabulary for the ‘PrescriptionType’ vocabulary is defined within the NHSBSA Overprint Specification.

The System must populate the ‘PrescriptionType’ attribute for the appropriate combination of prescriber and care setting. Retired codes within this vocabulary must not be used

"extension":  [
    {
        "url": "https://fhir.nhs.uk/StructureDefinition/Extension-DM-PrescriptionType",
        "valueCoding": {
            "system": "https://fhir.nhs.uk/CodeSystem/prescription-type",
            "code": "1201",
            "display": "Outpatient Homecare Prescriber - Medical Prescriber"
        }
    }
    ]

Cardinality 0..1

Type Extension(Coding)

Must Support True

Alias extensions, user content

Comments

Conditions The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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

Mappings

rim: N/A
rim: n/a

MedicationRequest.extension:controlledDrug

Short Optional Controlled Drug Extensions

Definition

Sch.	Code	Signing Legal Requirement	EPS Scope	Expiry Date	Quantity Representation	Repeat Dispensing Allowed	RD 1st Issue Expiry	RD Subsequent Expiry
1	CD1	Invalid to prescribe	Out of scope	N/A	N/A	N/A	N/A
2	CD2	Hand signature or electronic signature	In scope	28 days	Words and Figures	No	N/A	N/A
3	CD3	Hand signature or electronic signature	In scope	28 days	Words and Figures	No	N/A	N/A
4	CD4-1 CD4-2	Hand signature or electronic signature	In scope	28 days	Figures	Yes	28 days	Up to 12 months
5	CD5	Hand signature or electronic signature	In scope	6 Months	Figures	Yes	6 months	Up to 12 months

It is a legal requirement to state the prescribed quantity as words in the quantityWords

{
    "url": "https://fhir.nhs.uk/StructureDefinition/Extension-DM-ControlledDrug",
    "extension": [
        {
            "url": "quantityWords",
            "valueString": "twenty eight"
        },
        {
            "url": "schedule",
            "valueCoding": {
                "system": "https://fhir.nhs.uk/CodeSystem/medicationrequest-controlled-drug",
                "code": "CD2",
                "display": "Schedule 2"
            }
        }
    ]
}

Cardinality 0..1

Type Extension(Complex)

Must Support True

Alias extensions, user content

Comments

Conditions The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
eps-cd1: Extension(controlledDrug) - For schedule 2 or 3 Controlled Drugs, the quantity must be expressed in words
(((extension('schedule').value.code='CD2' and extension('quantityWords').exists()) or (extension('schedule').value.code='CD3' and extension('quantityWords').exists()) or (extension('schedule').value.code != 'CD2' and extension('schedule').value.code != 'CD3')) and extension('scheduled').exists()) or (extension('scheduled').exists().not())

Mappings

rim: N/A
rim: n/a

MedicationRequest.extension:dispensingInformation

Short For EPS use only

Definition

This extension is used in continuous-repeat-dispensing prescriptions sent by EPS to dispensing systems to convey information on prior dispensed medications.

"extension":  [
                {
                    "url": "https://fhir.nhs.uk/StructureDefinition/Extension-EPS-DispensingInformation",
                    "extension":  [
                        {
                            "url": "dispenseStatus",
                            "valueCoding": {
                                "system": "https://fhir.nhs.uk/CodeSystem/medicationdispense-type",
                                "code": "0001",
                                "display": "Item fully dispensed"
                            }
                        },
                        {
                            "url": "dateLastDispensed",
                            "valueDateTime": "2018-04-22T09:57:03+00:00"
                        }
                    ]
                }
            ],

Cardinality 0..1

Type Extension(Complex)

Must Support True

Alias extensions, user content

Comments

Conditions The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

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

Mappings

rim: N/A
rim: n/a

MedicationRequest.modifierExtension

Short Extensions that cannot be ignored

Definition

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

Cardinality 0..*

Modifier True

Alias extensions, user content

Requirements

Comments

Constraints

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

Mappings

rim: N/A

MedicationRequest.identifier

Short Each MedicationRequest MUST be identified by an Universal Unique Identifiers (UUIDs) with a system of https://fhir.nhs.uk/Id/prescription-order-item-number

Definition

UUID example (for illustration purposes only);

a54219b8-f741-4c47-b662-e4f8dfa49ab6

 "identifier":  [
    {
        "system": "https://fhir.nhs.uk/Id/prescription-order-item-number",
        "value": "a54219b8-f741-4c47-b662-e4f8dfa49ab6"
    }
]

Cardinality 1..*

Must Support True

Comments

This is a business identifier, not a resource identifier.

Unordered, Open, by system(Value)

Constraints

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

Mappings

workflow: Request.identifier
script10.6: Message/Header/PrescriberOrderNumber
w5: FiveWs.identifier
v2: ORC-2-Placer Order Number / ORC-3-Filler Order Number
rim: .id

MedicationRequest.identifier.id

Short Unique id for inter-element referencing

Definition

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

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.identifier.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

MedicationRequest.identifier.use

Short usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Cardinality 0..1

Identifies the purpose for this identifier, if known .

Modifier True

Summary True

Requirements

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

Comments

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

Constraints

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

Mappings

v2: N/A
rim: Role.code or implied by context

MedicationRequest.identifier.type

Short Description of identifier

Definition

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

Cardinality 0..1

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

Summary True

Requirements

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

Comments

Constraints

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

Mappings

v2: CX.5
rim: Role.code or implied by context

MedicationRequest.identifier.system

Short The namespace for the identifier value

Definition

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

Cardinality 0..1

Summary True

Requirements

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

Comments

Identifier.system is always case sensitive.

Constraints

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

Examples

General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

MedicationRequest.identifier.value

Short The value that is unique

Definition

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

Cardinality 0..1

Summary True

Comments

Constraints

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

Examples

General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

MedicationRequest.identifier.period

Short Time period when id is/was valid for use

Definition

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

Cardinality 0..1

Summary True

Constraints

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

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

MedicationRequest.identifier.assigner

Short Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Cardinality 0..1

Type Reference()

Summary True

Comments

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

Constraints

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

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

MedicationRequest.identifier:prescriptionOrderItem

Short Prescription Order Item

Definition

Unique Id of the MedicationRequest within EPS

Cardinality 1..1

Comments

This is a business identifier, not a resource identifier.

Constraints

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

Mappings

workflow: Request.identifier
script10.6: Message/Header/PrescriberOrderNumber
w5: FiveWs.identifier
v2: ORC-2-Placer Order Number / ORC-3-Filler Order Number
rim: .id

MedicationRequest.identifier:prescriptionOrderItem.id

Short Unique id for inter-element referencing

Definition

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

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.identifier:prescriptionOrderItem.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

MedicationRequest.identifier:prescriptionOrderItem.use

Short usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Cardinality 0..1

Identifies the purpose for this identifier, if known .

Modifier True

Summary True

Requirements

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

Comments

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

Constraints

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

Mappings

v2: N/A
rim: Role.code or implied by context

MedicationRequest.identifier:prescriptionOrderItem.type

Short Description of identifier

Definition

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

Cardinality 0..1

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

Summary True

Requirements

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

Comments

Constraints

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

Mappings

v2: CX.5
rim: Role.code or implied by context

MedicationRequest.identifier:prescriptionOrderItem.system

Short The namespace for the identifier value

Definition

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

Cardinality 1..1

Summary True

Requirements

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

Comments

Identifier.system is always case sensitive.

Constraints

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

Auto Value

https://fhir.nhs.uk/Id/prescription-order-item-number

Examples

General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

MedicationRequest.identifier:prescriptionOrderItem.value

Short The value that is unique

Definition

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

Cardinality 1..1

Summary True

Comments

Constraints

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

Examples

General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

MedicationRequest.identifier:prescriptionOrderItem.period

Short Time period when id is/was valid for use

Definition

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

Cardinality 0..1

Summary True

Constraints

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

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

MedicationRequest.identifier:prescriptionOrderItem.assigner

Short Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Cardinality 0..1

Type Reference()

Summary True

Comments

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

Constraints

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

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

MedicationRequest.status

Short active | cancelled | stopped

Definition

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

code	Definition
active	The prescription is 'actionable', but not all actions that are implied by it have occurred yet. It has not been dispensed or filled.
cancelled	The prescription is to be cancelled or it has been cancelled been withdrawn before any administrations have occurred. Prescriptions in the process of being cancelled will be regarded as active until all actions are complete.
stopped	Actions implied by the prescription are to be permanently halted, before all of the administrations occurred. This should not be used if the original order was entered in error
completed	All actions that are implied by the prescription have occurred.

Logical medicationRequest status transitions

Cardinality 1..1

medicationrequest Status (required)

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

Must Support True

Modifier True

Summary True

Comments

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

Constraints

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

Mappings

workflow: Request.status
script10.6: no mapping
w5: FiveWs.status
rim: .statusCode

MedicationRequest.statusReason

Short Reason for current status

Definition

This is generally only used for exception statuses such as suspended or cancelled. It is the clinical status reason for the cancellation.

This is mandatory for 'prescription-order-update' messages.

"statusReason": {
    "coding": [
        {
            "system": "https://fhir.nhs.uk/CodeSystem/medicationrequest-status-reason",
            "code": "0001",
            "display": "Prescribing Error"
        }
    ]
},

Cardinality 0..1

MedicationRequestStatusReason (required)

Identifies the reasons for a given status.

Must Support True

Comments

This is generally only used for "exception" statuses such as "suspended" or "cancelled". The reason why the MedicationRequest was created at all is captured in reasonCode, not here.

Constraints

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

Mappings

workflow: Request.statusReason
rim: .inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde

MedicationRequest.statusReason.id

Short Unique id for inter-element referencing

Definition

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

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.statusReason.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

MedicationRequest.statusReason.coding

Short Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Cardinality 1..1

Summary True

Requirements

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

Comments

Constraints

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

Mappings

v2: C*E.1-8, C*E.10-22
rim: union(., ./translation)
orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

MedicationRequest.statusReason.coding.id

Short Unique id for inter-element referencing

Definition

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

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.statusReason.coding.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

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

Mappings

rim: n/a

MedicationRequest.statusReason.coding.system

Short Identity of the terminology system

Definition

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

Cardinality 1..1

Summary True

Requirements

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

Comments

Constraints

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

Mappings

v2: C*E.3
rim: ./codeSystem
orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

MedicationRequest.statusReason.coding.version

Short Version of the system - if relevant

Definition

Cardinality 0..1

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: C*E.7
rim: ./codeSystemVersion
orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

MedicationRequest.statusReason.coding.code

Short Symbol in syntax defined by the system

Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Cardinality 1..1

Summary True

Requirements

Need to refer to a particular code in the system.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: C*E.1
rim: ./code
orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

MedicationRequest.statusReason.coding.display

Short Representation defined by the system

Definition

A representation of the meaning of the code in the system, following the rules of the system.

Cardinality 1..1

Summary True

Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: C*E.2 - but note this is not well followed
rim: CV.displayName
orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

MedicationRequest.statusReason.coding.userSelected

Short If this coding was chosen directly by the user

Definition

Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

Cardinality 0..1

Summary True

Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: Sometimes implied by being first
rim: CD.codingRationale
orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]

MedicationRequest.statusReason.text

Short Plain text representation of the concept

Definition

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

Cardinality 0..1

Summary True

Requirements

Comments

Very often the text is the same as a displayName of one of the codings.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: C*E.9. But note many systems use C*E.2 for this
rim: ./originalText[mediaType/code="text/plain"]/data
orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

MedicationRequest.intent

Definition

Whether the request is a proposal, plan, or an original order.

Cardinality 1..1

medicationRequest Intent (required)

The kind of medication order.

Modifier True

Summary True

Comments

Indicates the type of order. A code specifying the current state of the order. Generally, this will be active or completed state.

code	display	courseOfTherapyType	Definition
order	Order	acute	The request represents a request/demand and authorization for action
original-order	Original Order	continuous-repeat-dispensing continuous	The request represents the original authorization for the medication request.
reflex-order	Reflex Order	continuous-repeat-dispensing	The request represents an automatically generated supplemental authorization (by EPS) for action based on a parent authorization together with initial results of the action taken against that parent authorization.
instance-order	Instance Order	continuous	The request represents an instance for the particular order.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

workflow: Request.intent
w5: FiveWs.class
rim: .moodCode (nuances beyond PRP/PLAN/RQO would need to be elsewhere)

MedicationRequest.category

Short Type of medication usage

Definition

In primary care the code of community should be used. In secondary care the category will often match the Episode/Spell type.

Code	System	Display
leave	https://fhir.nhs.uk/CodeSystem/medicationrequest-category	Leave
outpatient	http://terminology.hl7.org/CodeSystem/medicationrequest-category	Outpatient
discharge	http://terminology.hl7.org/CodeSystem/medicationrequest-category	Discharge
community	http://terminology.hl7.org/CodeSystem/medicationrequest-category	Community
inpatient	http://terminology.hl7.org/CodeSystem/medicationrequest-category	Inpatient

"category": [
    {
        "coding": [
            {
                "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                "code": "outpatient",
                "display": "Outpatient"
            }
        ]
    }
],

Cardinality 0..*

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.

(extensible)

Must Support True

Comments

The category can be used to include where the medication is expected to be consumed or other types of requests.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

script10.6: Message/Body/NewRx/MedicationPrescribed/Directions or Message/Body/NewRx/MedicationPrescribed/StructuredSIG
w5: FiveWs.class
rim: .inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="type of medication usage"].value

MedicationRequest.category.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.category.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.category.coding

Short Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Cardinality 1..1

Summary True

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Unordered, Open, by system(Value)

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: C*E.1-8, C*E.10-22
rim: union(., ./translation)
orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

MedicationRequest.category.coding:patientClassFHIR

Short Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Cardinality 0..1

MedicationRequestCategory (required)

Summary True

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: C*E.1-8, C*E.10-22
rim: union(., ./translation)
orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

MedicationRequest.category.coding:patientClassFHIR.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.category.coding:patientClassFHIR.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.category.coding:patientClassFHIR.system

Short Identity of the terminology system

Definition

The identification of the code system that defines the meaning of the symbol in the code.

Cardinality 1..1

Summary True

Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Auto Value

http://terminology.hl7.org/CodeSystem/medicationrequest-category

Mappings

v2: C*E.3
rim: ./codeSystem
orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

MedicationRequest.category.coding:patientClassFHIR.version

Short Version of the system - if relevant

Definition

Cardinality 0..1

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: C*E.7
rim: ./codeSystemVersion
orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

MedicationRequest.category.coding:patientClassFHIR.code

Short Symbol in syntax defined by the system

Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Cardinality 1..1

Summary True

Requirements

Need to refer to a particular code in the system.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: C*E.1
rim: ./code
orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

MedicationRequest.category.coding:patientClassFHIR.display

Short Representation defined by the system

Definition

A representation of the meaning of the code in the system, following the rules of the system.

Cardinality 0..1

Summary True

Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: C*E.2 - but note this is not well followed
rim: CV.displayName
orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

MedicationRequest.category.coding:patientClassFHIR.userSelected

Short If this coding was chosen directly by the user

Definition

Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

Cardinality 0..1

Summary True

Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: Sometimes implied by being first
rim: CD.codingRationale
orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]

MedicationRequest.category.coding:patientClassUK

Short Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Cardinality 0..1

MedicationRequestCategory (required)

Summary True

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: C*E.1-8, C*E.10-22
rim: union(., ./translation)
orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

MedicationRequest.category.coding:patientClassUK.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.category.coding:patientClassUK.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.category.coding:patientClassUK.system

Short Identity of the terminology system

Definition

The identification of the code system that defines the meaning of the symbol in the code.

Cardinality 1..1

Summary True

Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Auto Value

https://fhir.nhs.uk/CodeSystem/medicationrequest-category

Mappings

v2: C*E.3
rim: ./codeSystem
orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

MedicationRequest.category.coding:patientClassUK.version

Short Version of the system - if relevant

Definition

Cardinality 0..1

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: C*E.7
rim: ./codeSystemVersion
orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

MedicationRequest.category.coding:patientClassUK.code

Short Symbol in syntax defined by the system

Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Cardinality 1..1

Summary True

Requirements

Need to refer to a particular code in the system.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: C*E.1
rim: ./code
orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

MedicationRequest.category.coding:patientClassUK.display

Short Representation defined by the system

Definition

A representation of the meaning of the code in the system, following the rules of the system.

Cardinality 0..1

Summary True

Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: C*E.2 - but note this is not well followed
rim: CV.displayName
orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

MedicationRequest.category.coding:patientClassUK.userSelected

Short If this coding was chosen directly by the user

Definition

Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

Cardinality 0..1

Summary True

Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: Sometimes implied by being first
rim: CD.codingRationale
orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]

MedicationRequest.category.text

Short Plain text representation of the concept

Definition

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

Cardinality 0..1

Summary True

Requirements

Comments

Very often the text is the same as a displayName of one of the codings.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: C*E.9. But note many systems use C*E.2 for this
rim: ./originalText[mediaType/code="text/plain"]/data
orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

MedicationRequest.priority

Short routine | urgent | asap | stat

Definition

Indicates how quickly the Medication Request should be addressed with respect to other requests.

Cardinality 0..1

Identifies the level of importance to be assigned to actioning the request.

RequestPriority (required)

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

workflow: Request.priority
w5: FiveWs.grade
rim: .priorityCode

MedicationRequest.doNotPerform

Short True if request is prohibiting action

Definition

If true indicates that the provider is asking for the medication request not to occur.

Cardinality 0..1

Modifier True

Summary True

Comments

If do not perform is not specified, the request is a positive request e.g. "do perform".

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: SubstanceAdministration.actionNegationInd

MedicationRequest.reported[x]

Short Reported rather than primary record

Definition

Indicates if this record was captured as a secondary 'reported' record rather than as an original primary source-of-truth record. It may also indicate the source of the report.

Cardinality 0..1

Type boolean, Reference( | | | | )

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: .participation[typeCode=INF].role

MedicationRequest.medication[x]

Short Medication to be taken

Definition

Only Virtual Medical Products (VMP) and Actual Medical Products (AMP) can be used.

Cardinality 1..1

Type NHSDigitalMedicationRequestCodeableConcept, Reference(NHSDigitalMedicationRequestMedication)

NHS Digital Medication Code (extensible)

A coded concept identifying substance or product that can be ordered.

Must Support True

Summary True

Comments

Any code from the SnomedCT UK DMD subset for VMP, AMP and VTM concepts

<table> <thead> <th data-no-sort width="25%"> dm+d Category </th> <th data-no-sort width="50%"> dm+d Description </th> <th data-no-sort width="25%"> UK SNOMED Members Of </th>

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

workflow: Request.code
script10.6: Message/Body/NewRx/MedicationPrescribed Medication.code.coding.code = Message/Body/NewRx/MedicationPrescribed/DrugCoded/ProductCode Medication.code.coding.system = Message/Body/NewRx/MedicationPrescribed/DrugCoded/ProductCodeQualifier Medication.code.coding.display = Message/Body/NewRx/MedicationPrescribed/DrugDescription
w5: FiveWs.what[x]
v2: RXE-2-Give Code / RXO-1-Requested Give Code / RXC-2-Component Code
rim: consumable.administrableMedication

MedicationRequest.subject

Short Who or group medication request is for

Definition

A resource reference to a Patient with a traced NHS Number is required, an untraced NHS Number MUST NOT be used.

 "subject": {
                    "type": "Patient",
                    "reference": "urn:uuid:bde9eba6-079f-4210-8108-6ea8db58de8c",
                    "display": "Miss Bernie Kanfeld"
                }

Cardinality 1..1

Type Reference(NHSDigitalPatientPDS)

Must Support True

Summary True

Comments

The subject on a medication request is mandatory. For the secondary use case where the actual subject is not provided, there still must be an anonymized subject specified.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
patient-nhs: Length of the supplied NHS Number is wrong.
identifier.where(system='https://fhir.nhs.uk/Id/nhs-number').exists().not() or (identifier.where(system='https://fhir.nhs.uk/Id/nhs-number').exists() and identifier.where(system='https://fhir.nhs.uk/Id/nhs-number').value.matches('^([0-9]{10})$'))

Mappings

workflow: Request.subject
script10.6: Message/Body/NewRx/Patient (need detail to link to specific patient … Patient.Identification in SCRIPT)
w5: FiveWs.subject[x]
v2: PID-3-Patient ID List
rim: .participation[typeCode=AUT].role
w5: FiveWs.subject

MedicationRequest.subject.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.subject.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.subject.reference

Short Literal reference, Relative, internal or absolute URL

Definition

Cardinality 0..1

Summary True

Comments

Conditions The cardinality or value of this element may be affected by these constraints: ref-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.subject.type

Short Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Cardinality 0..1

Aa resource (or, for logical models, the URI of the logical model).

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.subject.identifier

Short Logical reference, when literal reference is not known

Definition

Cardinality 0..1

Summary True

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: .identifier

MedicationRequest.subject.identifier.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.subject.identifier.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.subject.identifier.use

Short usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Cardinality 0..1

Identifies the purpose for this identifier, if known .

Modifier True

Summary True

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: N/A
rim: Role.code or implied by context

MedicationRequest.subject.identifier.type

Short Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Cardinality 0..1

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Summary True

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.5
rim: Role.code or implied by context

MedicationRequest.subject.identifier.system

Short The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Cardinality 1..1

Summary True

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Auto Value

https://fhir.nhs.uk/Id/nhs-number

Examples

General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

MedicationRequest.subject.identifier.value

Short The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Cardinality 1..1

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

MedicationRequest.subject.identifier.period

Short Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Cardinality 0..1

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

MedicationRequest.subject.identifier.assigner

Short Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Cardinality 0..1

Type Reference()

Summary True

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

MedicationRequest.subject.display

Short Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Cardinality 0..1

Summary True

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.encounter

Short Encounter created as part of encounter/admission/stay

Definition

Encounter is required for secondary care prescriptions.

Cardinality 0..1

Type Reference(NHSDigitalEncounter)

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

workflow: Request.context
script10.6: no mapping
w5: FiveWs.context
v2: PV1-19-Visit Number
rim: .inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code="type of encounter or episode"]

MedicationRequest.encounter.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.encounter.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.encounter.reference

Short Literal reference, Relative, internal or absolute URL

Definition

Cardinality 0..1

Summary True

Comments

Conditions The cardinality or value of this element may be affected by these constraints: ref-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.encounter.type

Short Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Cardinality 0..1

Aa resource (or, for logical models, the URI of the logical model).

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.encounter.identifier

Short Logical reference, when literal reference is not known

Definition

Cardinality 0..1

Summary True

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: .identifier

MedicationRequest.encounter.identifier.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.encounter.identifier.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.encounter.identifier.use

Short usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Cardinality 0..1

Identifies the purpose for this identifier, if known .

Modifier True

Summary True

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: N/A
rim: Role.code or implied by context

MedicationRequest.encounter.identifier.type

Short Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Cardinality 0..1

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Summary True

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.5
rim: Role.code or implied by context

MedicationRequest.encounter.identifier.system

Short The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Cardinality 0..1

Summary True

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

MedicationRequest.encounter.identifier.value

Short The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Cardinality 0..1

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

MedicationRequest.encounter.identifier.period

Short Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Cardinality 0..1

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

MedicationRequest.encounter.identifier.assigner

Short Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Cardinality 0..1

Type Reference()

Summary True

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

MedicationRequest.encounter.display

Short Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Cardinality 0..1

Summary True

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.supportingInformation

Short Information to support ordering of the medication

Definition

Include additional information (for example, patient height and weight) that supports the ordering of the medication.

Cardinality 0..*

Type Reference(Resource)

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

workflow: Request.supportingInfo
w5: FiveWs.context
rim: .outboundRelationship[typeCode=PERT].target[A_SupportingClinicalStatement CMET minimal with many different choices of classCodes(ORG, ENC, PROC, SPLY, SBADM, OBS) and each of the act class codes draws from one or more of the following moodCodes (EVN, DEF, INT PRMS, RQO, PRP, APT, ARQ, GOL)]

MedicationRequest.supportingInformation.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.supportingInformation.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.supportingInformation.reference

Short Literal reference, Relative, internal or absolute URL

Definition

Cardinality 0..1

Summary True

Comments

Conditions The cardinality or value of this element may be affected by these constraints: ref-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.supportingInformation.type

Short Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Cardinality 0..1

Aa resource (or, for logical models, the URI of the logical model).

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.supportingInformation.identifier

Short Logical reference, when literal reference is not known

Definition

Cardinality 0..1

Summary True

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: .identifier

MedicationRequest.supportingInformation.identifier.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.supportingInformation.identifier.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.supportingInformation.identifier.use

Short usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Cardinality 0..1

Identifies the purpose for this identifier, if known .

Modifier True

Summary True

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: N/A
rim: Role.code or implied by context

MedicationRequest.supportingInformation.identifier.type

Short Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Cardinality 0..1

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Summary True

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.5
rim: Role.code or implied by context

MedicationRequest.supportingInformation.identifier.system

Short The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Cardinality 0..1

Summary True

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

MedicationRequest.supportingInformation.identifier.value

Short The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Cardinality 0..1

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

MedicationRequest.supportingInformation.identifier.period

Short Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Cardinality 0..1

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

MedicationRequest.supportingInformation.identifier.assigner

Short Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Cardinality 0..1

Type Reference()

Summary True

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

MedicationRequest.supportingInformation.display

Short Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Cardinality 0..1

Summary True

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.authoredOn

Short When request was initially authored

Definition

The date (and perhaps time) when the prescription was initially written or authored on.

Cardinality 0..1

Must Support True

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

workflow: Request.authoredOn
script10.6: Message/Body/NewRx/MedicationPrescribed/WrittenDate
w5: FiveWs.recorded
v2: RXE-32-Original Order Date/Time / ORC-9-Date/Time of Transaction
rim: author.time

MedicationRequest.requester

Short Who/What requested the Request

Definition

The requester must contain a resource reference to the Practitioner who has electronically signed the prescription.

If the requester can not take responsibility for the prescription, i.e. they would not be the prescriber on the FP10. Then the extension responsiblePractitioner must be populated.

"requester": {
    "reference": "urn:uuid:56166769-c1c4-4d07-afa8-132b5dfca666"
},

Cardinality 1..1

Type Reference(NHSDigitalPractitionerRole)

Must Support True

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
eps-3: requester - An identifier reference or resource reference must be provided
(reference.exists() or (identifier.exists()))

Mappings

workflow: Request.requester
w5: FiveWs.author
rim: .participation[typeCode=AUT].role

MedicationRequest.requester.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.requester.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.requester.reference

Short Literal reference, Relative, internal or absolute URL

Definition

Cardinality 1..1

Summary True

Comments

Conditions The cardinality or value of this element may be affected by these constraints: ref-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.requester.type

Short Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Cardinality 0..1

Aa resource (or, for logical models, the URI of the logical model).

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.requester.identifier

Short Logical reference, when literal reference is not known

Definition

Cardinality 0..1

Summary True

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: .identifier

MedicationRequest.requester.identifier.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.requester.identifier.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.requester.identifier.use

Short usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Cardinality 0..1

Identifies the purpose for this identifier, if known .

Modifier True

Summary True

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: N/A
rim: Role.code or implied by context

MedicationRequest.requester.identifier.type

Short Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Cardinality 0..1

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Summary True

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.5
rim: Role.code or implied by context

MedicationRequest.requester.identifier.system

Short The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Cardinality 0..1

Summary True

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

MedicationRequest.requester.identifier.value

Short The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Cardinality 0..1

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

MedicationRequest.requester.identifier.period

Short Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Cardinality 0..1

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

MedicationRequest.requester.identifier.assigner

Short Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Cardinality 0..1

Type Reference()

Summary True

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

MedicationRequest.requester.display

Short Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Cardinality 0..1

Summary True

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.performer

Short Intended performer of administration

Definition

The specified desired performer of the medication treatment (e.g. the performer of the medication administration).

Cardinality 0..1

Type Reference(NHSDigitalOrganization | NHSDigitalPractitionerRole | NHSDigitalPractitioner)

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

workflow: Request.performer
w5: FiveWs.actor
rim: .participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]

MedicationRequest.performer.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.performer.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.performer.reference

Short Literal reference, Relative, internal or absolute URL

Definition

Cardinality 0..1

Summary True

Comments

Conditions The cardinality or value of this element may be affected by these constraints: ref-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.performer.type

Short Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Cardinality 0..1

Aa resource (or, for logical models, the URI of the logical model).

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.performer.identifier

Short Logical reference, when literal reference is not known

Definition

Cardinality 0..1

Summary True

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: .identifier

MedicationRequest.performer.identifier.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.performer.identifier.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.performer.identifier.use

Short usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Cardinality 0..1

Identifies the purpose for this identifier, if known .

Modifier True

Summary True

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: N/A
rim: Role.code or implied by context

MedicationRequest.performer.identifier.type

Short Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Cardinality 0..1

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Summary True

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.5
rim: Role.code or implied by context

MedicationRequest.performer.identifier.system

Short The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Cardinality 0..1

Summary True

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

MedicationRequest.performer.identifier.value

Short The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Cardinality 0..1

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

MedicationRequest.performer.identifier.period

Short Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Cardinality 0..1

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

MedicationRequest.performer.identifier.assigner

Short Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Cardinality 0..1

Type Reference()

Summary True

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

MedicationRequest.performer.display

Short Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Cardinality 0..1

Summary True

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.performerType

Short Desired kind of performer of the medication administration

Definition

Indicates the type of performer of the administration of the medication.

Cardinality 0..1

ProcedurePerformerRoleCodes (example)

Identifies the type of individual that is desired to administer the medication.

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

workflow: Request.performerType
rim: .participation[typeCode=PRF].role[scoper.determinerCode=KIND].code

MedicationRequest.recorder

Short Person who entered the request

Definition

The person who entered the order on behalf of another individual for example in the case of a verbal or a telephone order.

Cardinality 0..1

Type Reference(NHSDigitalPractitioner)

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
eps-4: recorder - An identifier reference or resource reference must be provided
(reference.exists() or (identifier.exists()))

Mappings

w5: FiveWs.who
rim: .participation[typeCode=TRANS].role[classCode=ASSIGNED].code (HealthcareProviderType)

MedicationRequest.recorder.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.recorder.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.recorder.reference

Short Literal reference, Relative, internal or absolute URL

Definition

Cardinality 0..1

Summary True

Comments

Conditions The cardinality or value of this element may be affected by these constraints: ref-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.recorder.type

Short Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Cardinality 0..1

Aa resource (or, for logical models, the URI of the logical model).

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.recorder.identifier

Short Logical reference, when literal reference is not known

Definition

Cardinality 0..1

Summary True

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: .identifier

MedicationRequest.recorder.identifier.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.recorder.identifier.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.recorder.identifier.use

Short usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Cardinality 0..1

Identifies the purpose for this identifier, if known .

Modifier True

Summary True

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: N/A
rim: Role.code or implied by context

MedicationRequest.recorder.identifier.type

Short Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Cardinality 0..1

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Summary True

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.5
rim: Role.code or implied by context

MedicationRequest.recorder.identifier.system

Short The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Cardinality 0..1

Summary True

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

MedicationRequest.recorder.identifier.value

Short The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Cardinality 0..1

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

MedicationRequest.recorder.identifier.period

Short Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Cardinality 0..1

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

MedicationRequest.recorder.identifier.assigner

Short Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Cardinality 0..1

Type Reference()

Summary True

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

MedicationRequest.recorder.display

Short Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Cardinality 0..1

Summary True

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.reasonCode

Short Reason or indication for ordering or not ordering the medication

Definition

The reason or the indication for ordering or not ordering the medication.

Cardinality 0..*

Condition/Problem/DiagnosisCodes (example)

A coded concept indicating why the medication was ordered.

Comments

This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonReference.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

workflow: Request.reasonCode
script10.6: Message/Body/NewRx/MedicationPrescribed/Diagnosis/Primary/Value
w5: FiveWs.why[x]
v2: ORC-16-Order Control Code Reason /RXE-27-Give Indication/RXO-20-Indication / RXD-21-Indication / RXG-22-Indication / RXA-19-Indication
rim: reason.observation.reasonCode

MedicationRequest.reasonReference

Short Condition or observation that supports why the prescription is being written

Definition

Condition or observation that supports why the medication was ordered.

Cardinality 0..*

Type Reference( | )

Comments

This is a reference to a condition or observation that is the reason for the medication order. If only a code exists, use reasonCode.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

workflow: Request.reasonReference
script10.6: no mapping
w5: FiveWs.why[x]
rim: reason.observation[code=ASSERTION].value

MedicationRequest.reasonReference.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.reasonReference.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.reasonReference.reference

Short Literal reference, Relative, internal or absolute URL

Definition

Cardinality 0..1

Summary True

Comments

Conditions The cardinality or value of this element may be affected by these constraints: ref-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.reasonReference.type

Short Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Cardinality 0..1

Aa resource (or, for logical models, the URI of the logical model).

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.reasonReference.identifier

Short Logical reference, when literal reference is not known

Definition

Cardinality 0..1

Summary True

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: .identifier

MedicationRequest.reasonReference.identifier.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.reasonReference.identifier.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.reasonReference.identifier.use

Short usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Cardinality 0..1

Identifies the purpose for this identifier, if known .

Modifier True

Summary True

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: N/A
rim: Role.code or implied by context

MedicationRequest.reasonReference.identifier.type

Short Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Cardinality 0..1

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Summary True

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.5
rim: Role.code or implied by context

MedicationRequest.reasonReference.identifier.system

Short The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Cardinality 0..1

Summary True

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

MedicationRequest.reasonReference.identifier.value

Short The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Cardinality 0..1

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

MedicationRequest.reasonReference.identifier.period

Short Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Cardinality 0..1

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

MedicationRequest.reasonReference.identifier.assigner

Short Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Cardinality 0..1

Type Reference()

Summary True

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

MedicationRequest.reasonReference.display

Short Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Cardinality 0..1

Summary True

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.instantiatesCanonical

Short Instantiates FHIR protocol or definition

Definition

The URL pointing to a protocol, guideline, orderset, or other definition that is adhered to in whole or in part by this MedicationRequest.

Cardinality 0..*

Type canonical()

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

workflow: Request.instantiates
rim: .outboundRelationship[typeCode=DEFN].target

MedicationRequest.instantiatesUri

Short Instantiates external protocol or definition

Definition

The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this MedicationRequest.

Cardinality 0..*

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: .outboundRelationship[typeCode=DEFN].target

MedicationRequest.basedOn

Short What request fulfills

Definition

Example for a reflex-order (continuous-repeat-dispensing):

 "basedOn": [
        {
            "extension": [
                {
                    "url": "https://fhir.nhs.uk/StructureDefinition/Extension-EPS-RepeatInformation",
                    "extension": [
                        {
                            "url": "numberOfRepeatsAllowed",
                            "valueInteger": 6
                        }
                    ]
                }
            ],
            "identifier": {
                "system": "https://fhir.nhs.uk/Id/prescription-order-item-number",
                "value": "A7B86F8D-1D59-FC28-E050-D20AE3A215F0"
            }
        }
    ]

Example for a instance-order (continuous). Note this references an example MedicationRequest from GP Connect:

 "basedOn": [
        {
            "extension": [
                {
                    "url": "https://fhir.nhs.uk/StructureDefinition/Extension-EPS-RepeatInformation",
                    "extension": [
                        {
                            "url": "numberOfRepeatsAllowed",
                            "valueInteger": 5
                        }
                    ]
                }
            ],
            "identifier": {
                "system": "https://provider.nhs.uk/data-identifier",
                "value": "53426283749629"
            }
        }
    ]

Cardinality 0..*

Type Reference(ImmunizationRecommendation | NHSDigitalMedicationRequest)

Must Support True

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

workflow: Request.basedOn
rim: .outboundRelationship[typeCode=FLFS].target[classCode=SBADM or PROC or PCPR or OBS, moodCode=RQO orPLAN or PRP]

MedicationRequest.basedOn.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.basedOn.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.basedOn.extension:repeatInformation

Short Additional repeatInformation

Definition

The extension numberOfRepeatsIssued should not be populated.

The meaning of numberOfRepeatsAllowed is the same as the dispensingRequest.numberOfRepeatsAllowed i.e.

"extension": [
                {
                    "url": "https://fhir.nhs.uk/StructureDefinition/Extension-EPS-RepeatInformation",
                    "extension": [
                        {
                            "url": "numberOfRepeatsAllowed",
                            "valueInteger": 2
                        }
                    ]
                }
            ]

Cardinality 0..1

Type Extension(Complex)

Must Support True

Alias extensions, user content

Comments

Conditions The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a
rim: N/A

MedicationRequest.basedOn.extension:orignalPrescriptionId

Short Optional Extensions Element

Definition

The original prescription id, used in repeats. This is taken from the same extension in the original MedicationRequest.groupIdentifier.

  "extension":  [
        {
            "url": "https://fhir.nhs.uk/StructureDefinition/Extension-DM-PrescriptionId",
            "valueIdentifier": {
                "system": "https://fhir.nhs.uk/Id/prescription",
                "value": "ad945a29-85f8-439a-b590-6789719adc16"
            }
        }
    ],

Cardinality 0..1

Type Extension(Identifier)

Alias extensions, user content

Comments

Conditions The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a
rim: N/A

MedicationRequest.basedOn.reference

Short Literal reference, Relative, internal or absolute URL

Definition

Cardinality 0..1

Summary True

Comments

Conditions The cardinality or value of this element may be affected by these constraints: ref-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.basedOn.type

Short Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Cardinality 0..1

Aa resource (or, for logical models, the URI of the logical model).

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.basedOn.identifier

Short Logical reference, when literal reference is not known

Definition

Cardinality 0..1

Summary True

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: .identifier

MedicationRequest.basedOn.identifier.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.basedOn.identifier.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.basedOn.identifier.use

Short usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Cardinality 0..1

Identifies the purpose for this identifier, if known .

Modifier True

Summary True

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: N/A
rim: Role.code or implied by context

MedicationRequest.basedOn.identifier.type

Short Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Cardinality 0..1

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Summary True

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.5
rim: Role.code or implied by context

MedicationRequest.basedOn.identifier.system

Short The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Cardinality 0..1

Summary True

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

MedicationRequest.basedOn.identifier.value

Short The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Cardinality 0..1

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

MedicationRequest.basedOn.identifier.period

Short Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Cardinality 0..1

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

MedicationRequest.basedOn.identifier.assigner

Short Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Cardinality 0..1

Type Reference()

Summary True

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

MedicationRequest.basedOn.display

Short Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Cardinality 0..1

Summary True

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.groupIdentifier

Short groupIdentifier (Short Form Prescription ID)

Definition

<RandomNumber>-<PracticeODSCode/ClinicODSCode>-<PracticeSequence/ClinicSequence><CheckDigit>

Where;

<RandomNumber> is a locally generated random number each time a Prescription ID is generated of length 6 hexadecimal characters.

<CheckDigit> is calculated on the entire ID using the ISO/IEC 7064:2003 MOD 37-2 standard. The check digit algorithm is identical to that using for EPS Release 1.

Note. Hyphens are always included to separate the ID into 3 blocks of 6 characters.

Note. The implementation of the MOD 37-2 standard uses a “+” character for char 36 opposed to a “*” character.

Short Form Prescription ID example (for illustration purposes only);

83C40E-A23856-00123W

"groupIdentifier": {
    ...
    "system": "https://fhir.nhs.uk/Id/prescription-order-number",
    "value": "DC2C66-A1B2C3-23407B"
},

Cardinality 1..1

Must Support True

Summary True

Requirements

Comments

ITK HL7v3 Mapping = The groupIdentifier is equivalent to ParentPrescription.id (prescription-order-number). The extension is used to carry the ParentPrescription.id (UUID).

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

workflow: Request.groupIdentifier
rim: .outboundRelationship(typeCode=COMP].target[classCode=SBADM, moodCode=INT].id

MedicationRequest.groupIdentifier.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.groupIdentifier.extension

Short Additional content defined by implementations

Definition

Cardinality 1..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.groupIdentifier.extension:PrescriptionOrderUUID

Short UUID order number for grouped MedciationRequests

Definition

UUID example (for illustration purposes only);

34026084-A445-84AD-2D01-97D69ED25865

"groupIdentifier": {
    "extension":  [
        {
            "url": "https://fhir.nhs.uk/StructureDefinition/Extension-DM-PrescriptionId",
            "valueIdentifier": {
                "system": "https://fhir.nhs.uk/Id/prescription",
                "value": "ad945a29-85f8-439a-b590-6789719adc16"
            }
        }
    ],
    "system": "https://fhir.nhs.uk/Id/prescription-order-number",
    "value": "DC2C66-A1B2C3-23407B"
},

Cardinality 1..1

Type Extension(Identifier)

Alias extensions, user content

Comments

Conditions The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a
rim: N/A

MedicationRequest.groupIdentifier.extension:PrescriptionOrderUUID.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.groupIdentifier.extension:PrescriptionOrderUUID.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.groupIdentifier.extension:PrescriptionOrderUUID.url

Short identifies the meaning of the extension

Definition

Source of the definition for the extension code - a logical name or a URL.

Cardinality 1..1

Comments

Auto Value

https://fhir.nhs.uk/StructureDefinition/Extension-DM-PrescriptionId

Mappings

rim: N/A

MedicationRequest.groupIdentifier.extension:PrescriptionOrderUUID.value[x]

Short Value of extension

Definition

Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

Cardinality 0..1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.groupIdentifier.extension:PrescriptionOrderUUID.value[x].id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.groupIdentifier.extension:PrescriptionOrderUUID.value[x].extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.groupIdentifier.extension:PrescriptionOrderUUID.value[x].use

Short usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Cardinality 0..1

Identifies the purpose for this identifier, if known .

Modifier True

Summary True

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: N/A
rim: Role.code or implied by context

MedicationRequest.groupIdentifier.extension:PrescriptionOrderUUID.value[x].type

Short Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Cardinality 0..1

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Summary True

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.5
rim: Role.code or implied by context

MedicationRequest.groupIdentifier.extension:PrescriptionOrderUUID.value[x].system

Short The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Cardinality 1..1

Summary True

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Auto Value

https://fhir.nhs.uk/Id/prescription

Examples

General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

MedicationRequest.groupIdentifier.extension:PrescriptionOrderUUID.value[x].value

Short The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Cardinality 1..1

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

MedicationRequest.groupIdentifier.extension:PrescriptionOrderUUID.value[x].period

Short Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Cardinality 0..1

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

MedicationRequest.groupIdentifier.extension:PrescriptionOrderUUID.value[x].assigner

Short Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Cardinality 0..1

Type Reference(Organization)

Summary True

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

MedicationRequest.groupIdentifier.use

Short usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Cardinality 0..1

Identifies the purpose for this identifier, if known .

Modifier True

Summary True

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: N/A
rim: Role.code or implied by context

MedicationRequest.groupIdentifier.type

Short Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Cardinality 0..1

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Summary True

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.5
rim: Role.code or implied by context

MedicationRequest.groupIdentifier.system

Short The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Cardinality 1..1

Summary True

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Auto Value

https://fhir.nhs.uk/Id/prescription-order-number

Examples

General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

MedicationRequest.groupIdentifier.value

Short The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Cardinality 1..1

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

MedicationRequest.groupIdentifier.period

Short Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Cardinality 0..1

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

MedicationRequest.groupIdentifier.assigner

Short Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Cardinality 0..1

Type Reference()

Summary True

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

MedicationRequest.courseOfTherapyType

Short A course of therapy for a medication request

Definition

"courseOfTherapyType": {
  "coding":  [
      {
          "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-course-of-therapy",
          "code": "acute",
          "display": "Short course (acute) therapy"
      }
  ]
},

Cardinality 1..1

Medication Request Course of Therapy Codes (required)

Identifies the overall pattern of medication administratio.

Must Support True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: Act.code where classCode = LIST and moodCode = EVN

MedicationRequest.courseOfTherapyType.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.courseOfTherapyType.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.courseOfTherapyType.coding

Short Code defined by a terminology system

Definition

A reference to a code defined by a terminology system.

Cardinality 1..1

Summary True

Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: C*E.1-8, C*E.10-22
rim: union(., ./translation)
orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding

MedicationRequest.courseOfTherapyType.coding.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.courseOfTherapyType.coding.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.courseOfTherapyType.coding.system

Short Identity of the terminology system

Definition

The identification of the code system that defines the meaning of the symbol in the code.

Cardinality 1..1

Summary True

Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: C*E.3
rim: ./codeSystem
orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem

MedicationRequest.courseOfTherapyType.coding.version

Short Version of the system - if relevant

Definition

Cardinality 0..1

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: C*E.7
rim: ./codeSystemVersion
orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

MedicationRequest.courseOfTherapyType.coding.code

Short Symbol in syntax defined by the system

Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Cardinality 1..1

Summary True

Requirements

Need to refer to a particular code in the system.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: C*E.1
rim: ./code
orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code

MedicationRequest.courseOfTherapyType.coding.display

Short Representation defined by the system

Definition

A representation of the meaning of the code in the system, following the rules of the system.

Cardinality 0..1

Summary True

Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: C*E.2 - but note this is not well followed
rim: CV.displayName
orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName

MedicationRequest.courseOfTherapyType.coding.userSelected

Short If this coding was chosen directly by the user

Definition

Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

Cardinality 0..1

Summary True

Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: Sometimes implied by being first
rim: CD.codingRationale
orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]

MedicationRequest.courseOfTherapyType.text

Short Plain text representation of the concept

Definition

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

Cardinality 0..1

Summary True

Requirements

Comments

Very often the text is the same as a displayName of one of the codings.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: C*E.9. But note many systems use C*E.2 for this
rim: ./originalText[mediaType/code="text/plain"]/data
orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText

MedicationRequest.insurance

Short Associated insurance coverage

Definition

Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be required for delivering the requested service.

Cardinality 0..*

Type Reference(Coverage | ClaimResponse)

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

workflow: Request.insurance
rim: .outboundRelationship[typeCode=COVBY].target

MedicationRequest.insurance.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.insurance.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.insurance.reference

Short Literal reference, Relative, internal or absolute URL

Definition

Cardinality 0..1

Summary True

Comments

Conditions The cardinality or value of this element may be affected by these constraints: ref-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.insurance.type

Short Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Cardinality 0..1

Aa resource (or, for logical models, the URI of the logical model).

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.insurance.identifier

Short Logical reference, when literal reference is not known

Definition

Cardinality 0..1

Summary True

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: .identifier

MedicationRequest.insurance.identifier.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.insurance.identifier.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.insurance.identifier.use

Short usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Cardinality 0..1

Identifies the purpose for this identifier, if known .

Modifier True

Summary True

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: N/A
rim: Role.code or implied by context

MedicationRequest.insurance.identifier.type

Short Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Cardinality 0..1

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Summary True

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.5
rim: Role.code or implied by context

MedicationRequest.insurance.identifier.system

Short The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Cardinality 0..1

Summary True

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

MedicationRequest.insurance.identifier.value

Short The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Cardinality 0..1

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

MedicationRequest.insurance.identifier.period

Short Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Cardinality 0..1

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

MedicationRequest.insurance.identifier.assigner

Short Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Cardinality 0..1

Type Reference()

Summary True

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

MedicationRequest.insurance.display

Short Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Cardinality 0..1

Summary True

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.note

Short Dispensing Note

Definition

Clinical information relating to a prescribed medication item that cannot be conveyed within dosage instructions is populated within note field.

Examples of dispensing notes are:

To explain changes in dosage, for example, “Dosage has been increased on advice of the hospital”.
"Tell patient to stop their statin whilst on this anitbiotic"
"hospital consultant has confirmed dual treatment"

"note": [
    {
      "text": "Tell patient to stop their statin whilst on this anitbiotic"
    }
  ],

Cardinality 0..*

Annotation

Must Support True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

workflow: Request.note
script10.6: Message/Body/NewRx/MedicationPrescribed/Note
rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=OBS,moodCode=EVN,code="annotation"].value

MedicationRequest.note.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.note.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.note.author[x]

Short Individual responsible for the annotation

Definition

The individual responsible for making the annotation.

Cardinality 0..1

Type Reference( | | | ), string

Summary True

Comments

Organization is used when there's no need for specific attribution as to who made the comment.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: N/A
rim: Act.participant[typeCode=AUT].role

MedicationRequest.note.time

Short When the annotation was made

Definition

Indicates when this particular annotation was made.

Cardinality 0..1

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: N/A
rim: Act.effectiveTime

MedicationRequest.note.text

Short The annotation - text content (as markdown)

Definition

The text of the annotation in markdown format.

Cardinality 1..1

markdown

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: N/A
rim: Act.text

MedicationRequest.dosageInstruction

Short How the medication is/was taken or should be taken

Definition

The content of the dosageInstruction should follow guidance in Digital Medicines Dosage.

"dosageInstruction": [
   {
        "text": "Inject 10 milligram, once a week, Subcutaneous route, for 10 weeks",
        "timing": {
            "repeat": {
                "boundsDuration": {
                    "value": 10,
                    "unit": "week",
                     "system": "http://unitsofmeasure.org",
                     "code": "wk"
                },
                 "frequency": 1,
                 "period": 1,
                "periodUnit": "wk"
             }
        },
        "route": {
            "coding": [
                {
                    "system": "http://snomed.info/sct",
                    "code": "34206005",
                    "display": "Subcutaneous route"
                }
            ]
        },
        "method": {
            "coding": [
                {
                    "system": "http://snomed.info/sct",
                    "code": "422145002",
                    "display": "Inject"
                }
            ]
        },
        "doseAndRate": [
            {
                "doseQuantity": {
                    "value": 10,
                    "unit": "milligram",
                    "system": "http://unitsofmeasure.org",
                    "code": "mg"
                }
            }
        ]
    }
]

Cardinality 1..*

NHSDigitalDosage

Must Support True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

workflow: Request.occurrence[x]
rim: see dosageInstruction mapping
rim: n/a
rim: .outboundRelationship[typeCode=COMP].target[classCode=SBADM, moodCode=INT]

MedicationRequest.dosageInstruction.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.dosageInstruction.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.dosageInstruction.modifierExtension

Short Extensions that cannot be ignored even if unrecognized

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Cardinality 0..*

Modifier True

Summary True

Alias extensions, user content, modifiers

Requirements

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: N/A

MedicationRequest.dosageInstruction.sequence

Short Multi-sequence dosage instructions.

Definition

Sequential Instructions

Where the value of sequence is an incremental integer it defines a sequential instruction.

Concurrent Instructions

Where the same integer value of sequence is defines it means a concurrent instruction.

Cardinality 0..1

integer

Must Support True

Summary True

Requirements

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: TQ1-1
rim: .text

MedicationRequest.dosageInstruction.text

Short The complete dosage instruction as a human readable string.

Definition

The complete dosage instruction as a human readable string.

For example;

<text value="1 tablet - every 6 hours - oral" />

Where additional dosage instructions need to be conveyed that cannot be described using any other element of the Dosage structure, then append these to the end of the translated dosage text.

For example;

<text value="{the dosage elements translated as text} - infuse as rapidly as possibly via intraperitoneal port" />

For example, the instruction “immediately following drug {X}”), where {X} is the name of a drug, is neither suitable as a additionalInstruction nor patientInstruction.

For example;

<text value="500 milligrams - once - oral - immediately following drug {X}" />

Cardinality 0..1

Must Support True

Summary True

Requirements

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: RXO-6; RXE-21
rim: .text

MedicationRequest.dosageInstruction.additionalInstruction

Short Additional dosage instructions that can be either SNOMED-CT coded terms or free-text instructions.

Definition

Patient instructions for taking the drug are contained with in the patientInstruction and additionalInstruction as per the guidance in Dosage Structure Overview

"dosageInstruction": [
    {
        "text": "10 milligram, Inject, Subcutaneous route, once weekly",
        "additionalInstruction": [
            "coding": [
                {
                    "system": "http://snomed.info/sct",
                    "code": "421769005",
                    "display": "Follow directions"
                }
            ],
        ],
        "patientInstruction": "As directed"
    }
]

Cardinality 0..*

SNOMEDCTAdditionalDosageInstructions (example)

A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".

Must Support True

Summary True

Requirements

Additional instruction is intended to be coded, but where no code exists, the element could include text. For example, "Swallow with plenty of water" which might or might not be coded.

Comments

Information about administration or preparation of the medication (e.g. "infuse as rapidly as possibly via intraperitoneal port" or "immediately following drug x") should be populated in dosage.text.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: RXO-7
rim: .text

MedicationRequest.dosageInstruction.patientInstruction

Short Patient or consumer oriented instructions

Definition

Patient instructions for taking the drug are contained with in the patientInstruction and additionalInstruction as per the guidance in Dosage Structure Overview

"dosageInstruction": [
    {
        "text": "10 milligram, Inject, Subcutaneous route, once weekly",
        "additionalInstruction": [
            "coding": [
                {
                    "system": "http://snomed.info/sct",
                    "code": "421769005",
                    "display": "Follow directions"
                }
            ],
        ],
        "patientInstruction": "As directed"
    }
]

Cardinality 0..1

Must Support True

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: RXO-7
rim: .text

MedicationRequest.dosageInstruction.timing

Short When medication should be administered

Definition

Adding constraints, bounds or limits to a dosage instruction.

Cardinality 0..1

Must Support True

Summary True

Requirements

Comments

This attribute might not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: .effectiveTime

MedicationRequest.dosageInstruction.timing.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.dosageInstruction.timing.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.dosageInstruction.timing.modifierExtension

Short Extensions that cannot be ignored even if unrecognized

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Cardinality 0..*

Modifier True

Summary True

Alias extensions, user content, modifiers

Requirements

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: N/A

MedicationRequest.dosageInstruction.timing.event

Short When the event occurs

Definition

Identifies specific times when the event occurs.

Cardinality 0..*

Summary True

Requirements

In a Medication Administration Record, for instance, you need to take a general specification, and turn it into a precise specification.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: QLIST<TS>

MedicationRequest.dosageInstruction.timing.repeat

Short When the event is to occur

Definition

A set of rules that describe when the event is scheduled.

Cardinality 0..1

Summary True

Requirements

Many timing schedules are determined by regular repetitions.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
tim-1: if there's a duration, there needs to be duration units
duration.empty() or durationUnit.exists()
tim-2: if there's a period, there needs to be period units
period.empty() or periodUnit.exists()
tim-4: duration SHALL be a non-negative value
duration.exists() implies duration >= 0
tim-5: period SHALL be a non-negative value
period.exists() implies period >= 0
tim-6: If there's a periodMax, there must be a period
periodMax.empty() or period.exists()
tim-7: If there's a durationMax, there must be a duration
durationMax.empty() or duration.exists()
tim-8: If there's a countMax, there must be a count
countMax.empty() or count.exists()
tim-9: If there's an offset, there must be a when (and not C, CM, CD, CV)
offset.empty() or (when.exists() and ((when in ('C' | 'CM' | 'CD' | 'CV')).not()))
tim-10: If there's a timeOfDay, there cannot be a when, or vice versa
timeOfDay.empty() or when.empty()

Mappings

rim: Implies PIVL or EIVL

MedicationRequest.dosageInstruction.timing.repeat.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.dosageInstruction.timing.repeat.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.dosageInstruction.timing.repeat.bounds[x]

Short Length/Range of lengths, or (Start and/or end) limits

Definition

Either a duration for the length of the timing schedule, a range of possible length, or outer bounds for start and/or end limits of the timing schedule.

Cardinality 0..1

Type Duration, NHSDigitalRange, Period

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: IVL(TS) used in a QSI

MedicationRequest.dosageInstruction.timing.repeat.count

Short Number of times to repeat

Definition

Cardinality 0..1

Summary True

Requirements

Repetitions may be limited by end time or total occurrences.

Comments

If you have both bounds and count, then this should be understood as within the bounds period, until count times happens.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: PIVL.count

MedicationRequest.dosageInstruction.timing.repeat.countMax

Short Maximum number of times to repeat

Definition

If present, indicates that the count is a range - so to perform the action between [count] and [countMax] times.

Cardinality 0..1

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: PIVL.count

MedicationRequest.dosageInstruction.timing.repeat.duration

Short How long when it happens

Definition

How long this thing happens for when it happens. If durationMax is present, this element indicates the lower bound of the allowed range of the duration.

Cardinality 0..1

Summary True

Requirements

Some activities are not instantaneous and need to be maintained for a period of time.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: PIVL.phase

MedicationRequest.dosageInstruction.timing.repeat.durationMax

Short How long when it happens (Max)

Definition

If present, indicates that the duration is a range - so to perform the action between [duration] and [durationMax] time length.

Cardinality 0..1

Summary True

Requirements

Some activities are not instantaneous and need to be maintained for a period of time.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: PIVL.phase

MedicationRequest.dosageInstruction.timing.repeat.durationUnit

Short s | min | h | d | wk | mo | a - unit of time (UCUM)

Definition

The units of time for the duration, in UCUM units.

Cardinality 0..1

A unit of time (units from UCUM).

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: PIVL.phase.unit

MedicationRequest.dosageInstruction.timing.repeat.frequency

Short Event occurs frequency times per period

Definition

The number of times to repeat the action within the specified period. If frequencyMax is present, this element indicates the lower bound of the allowed range of the frequency.

Cardinality 0..1

Summary True

Meaning when missing

If no frequency is stated, the assumption is that the event occurs once per period, but systems SHOULD always be specific about this

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: PIVL.phase

MedicationRequest.dosageInstruction.timing.repeat.frequencyMax

Short Event occurs up to frequencyMax times per period

Definition

If present, indicates that the frequency is a range - so to repeat between [frequency] and [frequencyMax] times within the period or period range.

Cardinality 0..1

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: PIVL.phase

MedicationRequest.dosageInstruction.timing.repeat.period

Short Event occurs frequency times per period

Definition

Cardinality 0..1

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: PIVL.phase

MedicationRequest.dosageInstruction.timing.repeat.periodMax

Short Upper limit of period (3-4 hours)

Definition

If present, indicates that the period is a range from [period] to [periodMax], allowing expressing concepts such as "do this once every 3-5 days.

Cardinality 0..1

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: PIVL.phase

MedicationRequest.dosageInstruction.timing.repeat.periodUnit

Short s | min | h | d | wk | mo | a - unit of time (UCUM)

Definition

The units of time for the period in UCUM units.

Cardinality 0..1

A unit of time (units from UCUM).

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: PIVL.phase.unit

MedicationRequest.dosageInstruction.timing.repeat.dayOfWeek

Short mon | tue | wed | thu | fri | sat | sun

Definition

If one or more days of week is provided, then the action happens only on the specified day(s).

Cardinality 0..*

DaysOfWeek (required)

Summary True

Comments

If no days are specified, the action is assumed to happen every day as otherwise specified. The elements frequency and period cannot be used as well as dayOfWeek.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a

MedicationRequest.dosageInstruction.timing.repeat.timeOfDay

Short Time of day for action

Definition

Specified time of day for action to take place.

Cardinality 0..*

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: n/a

MedicationRequest.dosageInstruction.timing.repeat.when

Short Code for time period of occurrence

Definition

An approximate time period during the day, potentially linked to an event of daily living that indicates when the action should occur.

Cardinality 0..*

Real world event relating to the schedule.

EventTiming (required)

Summary True

Requirements

Timings are frequently determined by occurrences such as waking, eating and sleep.

Comments

When more than one event is listed, the event is tied to the union of the specified events.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: EIVL.event

MedicationRequest.dosageInstruction.timing.repeat.offset

Short Minutes from event (before or after)

Definition

The number of minutes from the event. If the event code does not indicate whether the minutes is before or after the event, then the offset is assumed to be after the event.

Cardinality 0..1

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: EIVL.offset

MedicationRequest.dosageInstruction.timing.code

Short BID | TID | QID | AM | PM | QD | QOD | +

Definition

Cardinality 0..1

TimingAbbreviation (preferred)

Code for a known / defined timing pattern.

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: QSC.code

MedicationRequest.dosageInstruction.asNeeded[x]

Short Take "as needed" (for x)

Definition

The asNeeded structure can be used to define a simple “as required” (or “pro re nata” expressed as “PRN” for those who still prefer to use Latin abbreviations) instructions.

In this case use the asNeededBoolean option. The absence of asNeededBoolean is equivalent to where asNeededBoolean has a value of false.

Cardinality 0..1

Type boolean, CodeableConcept

SNOMEDCTMedicationAsNeededReasonCodes (example)

Must Support True

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: TQ1-9
rim: .outboundRelationship[typeCode=PRCN].target[classCode=OBS, moodCode=EVN, code="as needed"].value=boolean or codable concept

MedicationRequest.dosageInstruction.site

Short Body site to administer to

Definition

Any site can be used from the SNOMED-CT hierarchy as a descendant of the concept 123037004 Body structure (body structure).

<!-- Site -->
<site>
    <coding>
        <system value="http://snomed.info/sct"/>
        <code value="59380008"/>
        <display value="Anterior abdominal wall structure"/>
    </coding>
</site>

Cardinality 0..1

SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example)

A coded concept describing the site location the medicine enters into or onto the body.

Must Support True

Summary True

Requirements

A coded specification of the anatomic site where the medication first enters the body.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: RXR-2
rim: .approachSiteCode

MedicationRequest.dosageInstruction.route

Short How drug should enter body

Definition

Any route can be used from the SNOMED-CT hierarchy as a descendant of the concept 284009009 Route of administration value (qualifier value).

<!-- Route -->
<route>
    <coding>
        <system value="http://snomed.info/sct"/>
        <code value="78421000"/>
        <display value="intramuscular route"/>
    </coding>
</route>

Cardinality 0..1

A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

SNOMEDCTRouteCodes (example)

Must Support True

Summary True

Requirements

A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: RXR-1
rim: .routeCode

MedicationRequest.dosageInstruction.method

Short Technique for administering medication

Definition

The 999000041000001103 ePrescribing method simple reference set (foundation metadata concept) reference set collates the commonly used terms for method for use in the United Kingdom.

<!-- Method -->
<method>
    <coding>
        <system value="http://snomed.info/sct"/>
        <code value="129326001"/>
        <display value="Injection"/>
    </coding>
</method>

Use of synonyms

Guidance for using terms that are not preferred terms is available within the published document Guidance on the use of CodeableConcept.

Cardinality 0..1

SNOMEDCTAdministrationMethodCodes (example)

A coded concept describing the technique by which the medicine is administered.

Must Support True

Summary True

Requirements

A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV.

Comments

Terminologies used often pre-coordinate this term with the route and or form of administration.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: RXR-4
rim: .doseQuantity

MedicationRequest.dosageInstruction.doseAndRate

Short Amount of medication administered

Definition

Dose and Rate elements within the Dosage structure have been combined within the R4 standard, but their underlying use and purpose is the same as per R4.

A dose or rate of medication can be described via one of the following methods. In both instances when considering Units of Measure note that UCUM is preferred.

Sub-element: `Dosage.doseAndRate.doseQuantity`

The amount of medication per dose, as a simple coded quantity.

<!-- Example A: 1 capsule -->
<doseAndRate>
    <doseQuantity>
        <value value="1"/>
        <unit value="capsule"/>
        <system value="http://snomed.info/sct"/>
        <code value="732937005"/>
    </doseQuantity>
</doseAndRate>

<!-- Example B: 30 milligrams -->
<doseAndRate>
    <doseQuantity>
        <value value="30"/>
        <unit value="milligram"/>
        <system value="http://unitsofmeasure.org"/>
        <code value="mg"/>
    </doseQuantity>
</doseAndRate>

Sub-element: `Dosage.doseAndRate.doseRange`

A dose that may be in a given low / high range.

<!-- for a dose between 7.5 to 30 milligram -->
<doseAndRate>
    <doseRange>
        <low>
            <value value="7.5"/>
            <unit value="milligram"/>
            <code value="mg"/>
            <system value="http://unitsofmeasure.org"/>
        </low>
        <high>
            <value value="30"/>
            <unit value="milligram"/>
            <code value="mg"/>
            <system value="http://unitsofmeasure.org"/>
        </high>
    </doseRange>
</doseAndRate>

A rate-based quantity, such as 30 ml per hour, can be expressed as a rateRatio with coded numerator and denominator values.

Where the unit of measure for the ratio is defined within UCUM (see Common UCUM Units), for example, “milliliter per hour”, it can also be expressed using the simpler rateQuantity structure.

Sub-element: `Dosage.doseAndRate.rateRatio`

Where the rate is expressed as coded numerator and denominator values.

at a rate of 30ml/hour using rateRatio

<doseAndRate>
 <rateRatio>
  <numerator>
   <value value="30"/>
   <unit value="millilitre"/>
   <system value="http://unitsofmeasure.org"/>
   <code value="mL"/>
  </numerator>
  <denominator>
   <value value="1"/>
   <unit value="hour"/>
   <system value="http://unitsofmeasure.org"/>
   <code value="h"/>
  </denominator>
 </rateRatio>
</doseAndRate>

Sub-element: `Dosage.doseAndRate.rateQuantity`

Where the unit of measure applicable to a rate is defined within UCUM which is mathematically equivalent to defining the rate using the more complex rateRatio structure.

at a rate of 30ml/hour using rateQuantity

<rateQuantity>
 <value value="30"/>
 <unit value="milliliters per hour"/>
 <system value="http://unitsofmeasure.org"/>
 <code value="mL/h"/>
</rateQuantity>

at a rate of 1mcg/kg/hour using rateQuantity

<doseAndRate>
 <rateQuantity>
  <value value="1"/>
  <unit value="microgram per kilogram per hour"/>
  <system value="http://unitsofmeasure.org"/>
  <code value="ug/kg/h"/>
 </rateQuantity>
</doseAndRate>

Sub-element: `Dosage.doseAndRate.rateRange`

Where the unit of measure applicable to a rate range is defined within UCUM the rateRange structure can be used.

give at 1-2 litres per minute using rateRange

<doseAndRate>
 <rateRange>
  <low>
   <value value="1"/>
   <unit value="liter per minute"/>
   <system value="http://unitsofmeasure.org"/>
   <code value="L/min"/>
  </low>
  <high>
   <value value="2"/>
   <unit value="liter per minute"/>
   <system value="http://unitsofmeasure.org"/>
   <code value="L/min"/>
  </high>
 </rateRange>
</doseAndRate>

Cardinality 0..*

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: TQ1-2

MedicationRequest.dosageInstruction.doseAndRate.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.dosageInstruction.doseAndRate.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.dosageInstruction.doseAndRate.type

Short The kind of dose or rate specified

Definition

The kind of dose or rate specified, for example, ordered or calculated.

Cardinality 0..1

The kind of dose or rate specified.

DoseAndRateType (example)

Summary True

Requirements

If the type is not populated, assume to be "ordered".

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: RXO-21; RXE-23

MedicationRequest.dosageInstruction.doseAndRate.dose[x]

Short Amount of medication per dose

Definition

Amount of medication per dose.

Cardinality 0..1

Type NHSDigitalRange, SimpleQuantity

Summary True

Requirements

The amount of therapeutic or other substance given at one administration event.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: RXO-2, RXE-3
rim: .doseQuantity

MedicationRequest.dosageInstruction.doseAndRate.rate[x]

Short Amount of medication per unit of time

Definition

Amount of medication per unit of time.

Cardinality 0..1

Type Ratio, Range, SimpleQuantity

Summary True

Requirements

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: RXE22, RXE23, RXE-24
rim: .rateQuantity

MedicationRequest.dosageInstruction.maxDosePerPeriod

Short Upper limit on medication per unit of time

Definition

<div class="nhsd-a-box nhsd-a-box--bg-light-blue nhsd-!t-margin-bottom-6 nhsd-t-body"> Used to define a maxiumum dose over a given time period. </div>

An example would be a Sumatriptan 6mg injection which can be repeated after an hour but not again over a 24 hour period. The maxDosePerPeriod is defined as 12mg/24hours.

<div class="nhsd-a-box nhsd-a-box--bg-light-yellow nhsd-!t-margin-bottom-6 nhsd-t-body"> A real-world example of where this would be required has not yet been identified. </div>

Maximum dose per period of 12mg/24 hour

<maxDosePerPeriod>
    <numerator>
        <value value="12"/>
        <unit value="milligram"/>
        <system value="http://unitsofmeasure.org"/>
        <code value="mg"/>
    </numerator>
    <denominator>
        <value value="24"/>
        <unit value="hour"/>
        <system value="http://unitsofmeasure.org"/>
        <code value="h"/>
    </denominator>
</maxDosePerPeriod>

Cardinality 0..1

Must Support True

Summary True

Requirements

The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours.

Comments

This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: RXO-23, RXE-19
rim: .maxDoseQuantity

MedicationRequest.dosageInstruction.maxDosePerAdministration

Short Upper limit on medication per administration

Definition

<div class="nhsd-a-box nhsd-a-box--bg-light-blue nhsd-!t-margin-bottom-6 nhsd-t-body"> Used to define a maximum dose for a single administration. </div>

An example would be Anagrelide for which a single dose should not exceed 2.5 mg. The maxDosePerAdministration is defined as 2.5mg.

In many scenarios it is expected that the dosage.doseRange would be used instead of maxDosePerAdministration.

<div class="nhsd-a-box nhsd-a-box--bg-light-yellow nhsd-!t-margin-bottom-6 nhsd-t-body"> A real-world example of where this would be required has not yet been identified. </div>

Maximum dose per administration of 2.5mg

<maxDosePerAdministration>
    <value value="2.5"/>
    <unit value="milligram"/>
    <system value="http://unitsofmeasure.org"/>
    <code value="mg"/>
</maxDosePerAdministration>

Cardinality 0..1

Summary True

Requirements

The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: not supported

MedicationRequest.dosageInstruction.maxDosePerLifetime

Short Upper limit on medication per lifetime of the patient

Definition

<div class="callout-box--info"> Used to define the maximum cumulative dose over the lifetime of a patient. </div>

An example would be Daunorubicin which may have a maximum cumulative dose of 600mg/m2 (based on the size of the patient). The maxDosePerLifetime is defined as 600 mg/m2.

Maximum dose over lifetime of the patient of 600 mg/m2

<maxDosePerLifetime>
    <value value="600"/>
    <unit value="milligram per square metre"/>
    <system value="http://unitsofmeasure.org"/>
    <code value="mg/m2"/>
</maxDosePerLifetime>

Cardinality 0..1

Summary True

Requirements

The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: not supported

MedicationRequest.dispenseRequest

Short Medication supply authorization

Definition

Cardinality 1..1

Must Support True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

script10.6: Message/Body/NewRx/MedicationPrescribed/ExpirationDate
rim: component.supplyEvent

MedicationRequest.dispenseRequest.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..0

Mappings

rim: n/a

MedicationRequest.dispenseRequest.extension

Short Additional content defined by implementations

Definition

Cardinality 1..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.dispenseRequest.extension:performerSiteType

Short type of dispensing organisation

Definition

Used to indicate type of pharmacist

Cardinality 1..1

Type Extension(Coding)

Must Support True

Alias extensions, user content

Comments

Conditions The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a
rim: N/A

MedicationRequest.dispenseRequest.modifierExtension

Short Extensions that cannot be ignored even if unrecognized

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Cardinality 0..*

Modifier True

Summary True

Alias extensions, user content, modifiers

Requirements

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: N/A

MedicationRequest.dispenseRequest.initialFill

Short First fill details

Definition

Indicates the quantity or duration for the first dispense of the medication.

Cardinality 0..1

Comments

If populating this element, either the quantity or the duration must be included.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: SubstanceAdministration -> ActRelationship[sequenceNumber = '1'] -> Supply

MedicationRequest.dispenseRequest.initialFill.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.dispenseRequest.initialFill.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.dispenseRequest.initialFill.modifierExtension

Short Extensions that cannot be ignored even if unrecognized

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Cardinality 0..*

Modifier True

Summary True

Alias extensions, user content, modifiers

Requirements

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: N/A

MedicationRequest.dispenseRequest.initialFill.quantity

Short First fill quantity

Definition

The amount or quantity to provide as part of the first dispense.

Cardinality 0..1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: Supply.quantity[moodCode=RQO]

MedicationRequest.dispenseRequest.initialFill.duration

Short First fill duration

Definition

The length of time that the first dispense is expected to last.

Cardinality 0..1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: Supply.effectivetime[moodCode=RQO]

MedicationRequest.dispenseRequest.dispenseInterval

Short Minimum period of time between dispenses

Definition

The minimum period of time that must occur between dispenses of the medication.

Cardinality 0..1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: Supply.effectivetime[moodCode=RQO]

MedicationRequest.dispenseRequest.validityPeriod

Short Time period supply is authorized for

Definition

"dispenseRequest": {
          "validityPeriod": {
            "start": "2020-06-10",
            "end": "2020-12-07"
          },
          ...
      }

Cardinality 0..1

Must Support True

Requirements

Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

script10.6: Message/Body/NewRx/MedicationPrescribed/Refills
rim: effectiveTime

MedicationRequest.dispenseRequest.validityPeriod.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.dispenseRequest.validityPeriod.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.dispenseRequest.validityPeriod.start

Short Starting time with inclusive boundary

Definition

The start of the period. The boundary is inclusive.

Cardinality 1..1

Summary True

Comments

If the low element is missing, the meaning is that the low boundary is not known.

Conditions The cardinality or value of this element may be affected by these constraints: per-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: DR.1
rim: ./low

MedicationRequest.dispenseRequest.validityPeriod.end

Short End time with inclusive boundary, if not ongoing

Definition

Cardinality 0..1

Summary True

Comments

The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.

Meaning when missing

If the end of the period is missing, it means that the period is ongoing

Conditions The cardinality or value of this element may be affected by these constraints: per-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: DR.2
rim: ./high

MedicationRequest.dispenseRequest.numberOfRepeatsAllowed

Short Number of refills authorized

Definition

Example for a continuous issue:


"dispenseRequest": {
        "numberOfRepeatsAllowed": 0
    }

Example for a continuous-repeat-dispensing issue with intent of original-order:


"dispenseRequest": {
        "numberOfRepeatsAllowed": 2
    }

This will result in a total of three issues of the medication.

Cardinality 0..1

Must Support True

Comments

If displaying "number of authorized fills", add 1 to this number.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

script10.6: Message/Body/NewRx/MedicationPrescribed/Quantity
v2: RXE-12-Number of Refills
rim: repeatNumber

MedicationRequest.dispenseRequest.quantity

Short Amount of medication to supply per dispense

Definition

The amount that is to be dispensed for one fill.

Cardinality 1..1

Must Support True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

script10.6: Message/Body/NewRx/MedicationPrescribed/DaysSupply
v2: RXD-4-Actual Dispense Amount / RXD-5.1-Actual Dispense Units.code / RXD-5.3-Actual Dispense Units.name of coding system
rim: quantity

MedicationRequest.dispenseRequest.quantity.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.dispenseRequest.quantity.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.dispenseRequest.quantity.value

Short Numerical value (with implicit precision)

Definition

The value of the measured amount. The value includes an implicit precision in the presentation of the value.

Cardinality 1..1

Summary True

Requirements

Precision is handled implicitly in almost all cases of measurement.

Comments

The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: SN.2 / CQ - N/A
rim: PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value

MedicationRequest.dispenseRequest.quantity.comparator

Short < | <= | >= | > - how to understand the value

Definition

Not allowed to be used in this context

Cardinality 0..0

How the Quantity should be understood and represented.

Modifier True

Summary True

Requirements

Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

Meaning when missing

If there is no comparator, then there is no modification of the value

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: SN.1 / CQ.1
rim: IVL properties

MedicationRequest.dispenseRequest.quantity.unit

Short Unit representation

Definition

A human-readable form of the unit.

Cardinality 1..1

Summary True

Requirements

There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: (see OBX.6 etc.) / CQ.2
rim: PQ.unit

MedicationRequest.dispenseRequest.quantity.system

Short System that defines coded unit form

Definition

The identification of the system that provides the coded form of the unit.

Cardinality 0..1

Summary True

Requirements

Need to know the system that defines the coded form of the unit.

Conditions The cardinality or value of this element may be affected by these constraints: qty-3

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: (see OBX.6 etc.) / CQ.2
rim: CO.codeSystem, PQ.translation.codeSystem

MedicationRequest.dispenseRequest.quantity.code

Short Coded form of the unit

Definition

A computer processable form of the unit in some unit representation system.

Cardinality 1..1

Summary True

Requirements

Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

Comments

The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: (see OBX.6 etc.) / CQ.2
rim: PQ.code, MO.currency, PQ.translation.code

MedicationRequest.dispenseRequest.expectedSupplyDuration

Short Days Supply

Definition

The expectedSupplyDuration entity is required for repeat dispensing (repeatable) prescriptions only.

"dispenseRequest": {
          ...
          "expectedSupplyDuration": {
            "value": 28,
            "unit": "days",
            "system": "http://unitsofmeasure.org",
            "code": "d"
          }
      }

Cardinality 0..1

Must Support True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

script10.6: Message/Body/NewRx/MedicationPrescribed/Substitutions
rim: expectedUseTime

MedicationRequest.dispenseRequest.expectedSupplyDuration.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.dispenseRequest.expectedSupplyDuration.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.dispenseRequest.expectedSupplyDuration.value

Short Numerical value (with implicit precision)

Definition

The value of the measured amount. The value includes an implicit precision in the presentation of the value.

Cardinality 1..1

Summary True

Requirements

Precision is handled implicitly in almost all cases of measurement.

Comments

The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: SN.2 / CQ - N/A
rim: PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value

MedicationRequest.dispenseRequest.expectedSupplyDuration.comparator

Short < | <= | >= | > - how to understand the value

Definition

Cardinality 0..1

How the Quantity should be understood and represented.

Modifier True

Summary True

Requirements

Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

Meaning when missing

If there is no comparator, then there is no modification of the value

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: SN.1 / CQ.1
rim: IVL properties

MedicationRequest.dispenseRequest.expectedSupplyDuration.unit

Short Unit representation

Definition

A human-readable form of the unit.

Cardinality 0..1

Summary True

Requirements

There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: (see OBX.6 etc.) / CQ.2
rim: PQ.unit

MedicationRequest.dispenseRequest.expectedSupplyDuration.system

Short System that defines coded unit form

Definition

The identification of the system that provides the coded form of the unit.

Cardinality 0..1

Summary True

Requirements

Need to know the system that defines the coded form of the unit.

Conditions The cardinality or value of this element may be affected by these constraints: qty-3

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: (see OBX.6 etc.) / CQ.2
rim: CO.codeSystem, PQ.translation.codeSystem

MedicationRequest.dispenseRequest.expectedSupplyDuration.code

Short Coded form of the unit

Definition

A computer processable form of the unit in some unit representation system.

Cardinality 1..1

Summary True

Requirements

Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

Comments

The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Auto Value

Mappings

v2: (see OBX.6 etc.) / CQ.2
rim: PQ.code, MO.currency, PQ.translation.code

MedicationRequest.dispenseRequest.performer

Short Intended dispenser

Definition

The extension https://fhir.nhs.uk/StructureDefinition/Extension-DM-PerformerSiteType MUST be present.

Patients pharmacy preferences may be sourced from PDS.

Patients pharmacy preferences may be overriden by an 'one-off pharmacy nomination' by populating the dispenseRequest.performer.identifier with the ODS/ANANA code of the destination pharmacy.

"dispenseRequest": {
        "extension":  [
            {
                "url": "https://fhir.nhs.uk/StructureDefinition/Extension-DM-PerformerSiteType",
                "valueCoding": {
                    "system": "https://fhir.nhs.uk/CodeSystem/dispensing-site-preference",
                    "code": "0004"
                }
            },
        ],
        "performer": {
            "identifier": {
                "system": "https://fhir.nhs.uk/Id/ods-organization-code",
                "value": "FX748"
            }
        },

Cardinality 0..1

Type Reference(NHSDigitalOrganization)

Must Support True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

w5: FiveWs.who
rim: .outboundRelationship[typeCode=COMP].target[classCode=SPLY, moodCode=RQO] .participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]

MedicationRequest.dispenseRequest.performer.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.dispenseRequest.performer.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.dispenseRequest.performer.extension:dispensingPractitioner

Short practitioner who released(/downloaded) the prescription

Definition

Details of the dispenser who is actioning the MedicationRequest

       "dispenseRequest": { 
                    "performer": {
                        "extension":  [
                            {
                                "url": "https://fhir.nhs.uk/StructureDefinition/Extension-DM-DispensingPerformer",
                                "valueReference": {
                                    "reference": "urn:uuid:25f3dd9f-5838-44a7-930e-c78ae3ecadd6",
                                    "display": "LOTTIE POTTS"
                                }
                            }
                        ],
                        "identifier": {
                            "system": "https://fhir.nhs.uk/Id/ods-organization-code",
                            "value": "VNE51"
                        },
                        "display": "The Simple Pharmacy"
                    }
                },

Cardinality 0..1

Type Extension(Reference(NHSDigitalPractitionerRole))

Must Support True

Alias extensions, user content

Comments

Conditions The cardinality or value of this element may be affected by these constraints: ele-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a
rim: N/A

MedicationRequest.dispenseRequest.performer.reference

Short Literal reference, Relative, internal or absolute URL

Definition

Cardinality 0..1

Summary True

Comments

Conditions The cardinality or value of this element may be affected by these constraints: ref-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.dispenseRequest.performer.type

Short Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Cardinality 0..1

Aa resource (or, for logical models, the URI of the logical model).

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.dispenseRequest.performer.identifier

Short Logical reference, when literal reference is not known

Definition

Cardinality 0..1

Summary True

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: .identifier

MedicationRequest.dispenseRequest.performer.identifier.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.dispenseRequest.performer.identifier.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.dispenseRequest.performer.identifier.use

Short usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Cardinality 0..1

Identifies the purpose for this identifier, if known .

Modifier True

Summary True

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: N/A
rim: Role.code or implied by context

MedicationRequest.dispenseRequest.performer.identifier.type

Short Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Cardinality 0..1

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Summary True

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.5
rim: Role.code or implied by context

MedicationRequest.dispenseRequest.performer.identifier.system

Short The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Cardinality 1..1

Summary True

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Auto Value

https://fhir.nhs.uk/Id/ods-organization-code

Examples

General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

MedicationRequest.dispenseRequest.performer.identifier.value

Short The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Cardinality 1..1

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

MedicationRequest.dispenseRequest.performer.identifier.period

Short Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Cardinality 0..1

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

MedicationRequest.dispenseRequest.performer.identifier.assigner

Short Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Cardinality 0..1

Type Reference()

Summary True

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

MedicationRequest.dispenseRequest.performer.display

Short Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Cardinality 0..1

Summary True

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.substitution

Short Any restrictions on medication substitution

Definition

Within UK healthcare, substitution is not the norm and so this element will normally be set to a default of false.

Substitution being set to false is a mandatory requirement for EPS..

Substituition is a mandatory requirement for EPS.


"substitution": {
        "allowedBoolean": false
    }

Cardinality 1..1

Must Support True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

script10.6: specific values within Message/Body/NewRx/MedicationPrescribed/Substitutions
rim: subjectOf.substitutionPersmission

MedicationRequest.substitution.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.substitution.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.substitution.modifierExtension

Short Extensions that cannot be ignored even if unrecognized

Definition

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Cardinality 0..*

Modifier True

Summary True

Alias extensions, user content, modifiers

Requirements

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: N/A

MedicationRequest.substitution.allowed[x]

Short Whether substitution is allowed or not

Definition

The purpose of this element is to allow the prescriber to dispense a different drug from what was prescribed.

Cardinality 1..1

Comments

This element is labeled as a modifier because whether substitution is allow or not, it cannot be ignored.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

script10.6: specific values within Message/Body/NewRx/MedicationPrescribed/Substitutions
v2: RXO-9-Allow Substitutions / RXE-9-Substitution Status
rim: code

MedicationRequest.substitution.reason

Short Why should (not) substitution be made

Definition

Indicates the reason for the substitution, or why substitution must or must not be performed.

Cardinality 0..1

v3.SubstanceAdminSubstitutionReason (example)

A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

script10.6: not mapped
v2: RXE-9 Substition status
rim: reasonCode

MedicationRequest.priorPrescription

Short An order/prescription that is being replaced

Definition

A link to a resource representing an earlier order related order or prescription.

Cardinality 0..1

Type Reference()

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

workflow: Request.replaces
script10.6: not mapped
rim: .outboundRelationship[typeCode=?RPLC or ?SUCC]/target[classCode=SBADM,moodCode=RQO]

MedicationRequest.priorPrescription.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.priorPrescription.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.priorPrescription.reference

Short Literal reference, Relative, internal or absolute URL

Definition

Cardinality 0..1

Summary True

Comments

Conditions The cardinality or value of this element may be affected by these constraints: ref-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.priorPrescription.type

Short Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Cardinality 0..1

Aa resource (or, for logical models, the URI of the logical model).

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.priorPrescription.identifier

Short Logical reference, when literal reference is not known

Definition

Cardinality 0..1

Summary True

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: .identifier

MedicationRequest.priorPrescription.identifier.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.priorPrescription.identifier.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.priorPrescription.identifier.use

Short usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Cardinality 0..1

Identifies the purpose for this identifier, if known .

Modifier True

Summary True

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: N/A
rim: Role.code or implied by context

MedicationRequest.priorPrescription.identifier.type

Short Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Cardinality 0..1

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Summary True

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.5
rim: Role.code or implied by context

MedicationRequest.priorPrescription.identifier.system

Short The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Cardinality 0..1

Summary True

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

MedicationRequest.priorPrescription.identifier.value

Short The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Cardinality 0..1

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

MedicationRequest.priorPrescription.identifier.period

Short Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Cardinality 0..1

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

MedicationRequest.priorPrescription.identifier.assigner

Short Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Cardinality 0..1

Type Reference()

Summary True

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

MedicationRequest.priorPrescription.display

Short Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Cardinality 0..1

Summary True

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.detectedIssue

Short Clinical Issue with action

Definition

Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. Drug-drug interaction, duplicate therapy, dosage alert etc.

Cardinality 0..*

Type Reference(DetectedIssue)

Alias Contraindication, Drug Utilization Review (DUR), Alert

Comments

This element can include a detected issue that has been identified either by a decision support system or by a clinician and may include information on the steps that were taken to address the issue.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=ALRT,moodCode=EVN].value

MedicationRequest.detectedIssue.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.detectedIssue.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.detectedIssue.reference

Short Literal reference, Relative, internal or absolute URL

Definition

Cardinality 0..1

Summary True

Comments

Conditions The cardinality or value of this element may be affected by these constraints: ref-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.detectedIssue.type

Short Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Cardinality 0..1

Aa resource (or, for logical models, the URI of the logical model).

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.detectedIssue.identifier

Short Logical reference, when literal reference is not known

Definition

Cardinality 0..1

Summary True

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: .identifier

MedicationRequest.detectedIssue.identifier.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.detectedIssue.identifier.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.detectedIssue.identifier.use

Short usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Cardinality 0..1

Identifies the purpose for this identifier, if known .

Modifier True

Summary True

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: N/A
rim: Role.code or implied by context

MedicationRequest.detectedIssue.identifier.type

Short Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Cardinality 0..1

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Summary True

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.5
rim: Role.code or implied by context

MedicationRequest.detectedIssue.identifier.system

Short The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Cardinality 0..1

Summary True

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

MedicationRequest.detectedIssue.identifier.value

Short The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Cardinality 0..1

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

MedicationRequest.detectedIssue.identifier.period

Short Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Cardinality 0..1

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

MedicationRequest.detectedIssue.identifier.assigner

Short Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Cardinality 0..1

Type Reference()

Summary True

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

MedicationRequest.detectedIssue.display

Short Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Cardinality 0..1

Summary True

Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.eventHistory

Short A list of events of interest in the lifecycle

Definition

Cardinality 0..*

Type Reference(NHSDigitalProvenance)

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

workflow: Request.relevantHistory
rim: .inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]

MedicationRequest.eventHistory.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.eventHistory.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.eventHistory.reference

Short Literal reference, Relative, internal or absolute URL

Definition

Cardinality 0..1

Summary True

Comments

Conditions The cardinality or value of this element may be affected by these constraints: ref-1

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.eventHistory.type

Short Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

Cardinality 0..1

Aa resource (or, for logical models, the URI of the logical model).

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: N/A

MedicationRequest.eventHistory.identifier

Short Logical reference, when literal reference is not known

Definition

Cardinality 0..1

Summary True

Comments

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

rim: .identifier

MedicationRequest.eventHistory.identifier.id

Short Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Cardinality 0..1

Mappings

rim: n/a

MedicationRequest.eventHistory.identifier.extension

Short Additional content defined by implementations

Definition

Cardinality 0..*

Alias extensions, user content

Comments

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()

Mappings

rim: n/a

MedicationRequest.eventHistory.identifier.use

Short usual | official | temp | secondary | old (If known)

Definition

The purpose of this identifier.

Cardinality 0..1

Identifies the purpose for this identifier, if known .

Modifier True

Summary True

Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: N/A
rim: Role.code or implied by context

MedicationRequest.eventHistory.identifier.type

Short Description of identifier

Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Cardinality 0..1

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Summary True

Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.5
rim: Role.code or implied by context

MedicationRequest.eventHistory.identifier.system

Short The namespace for the identifier value

Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Cardinality 0..1

Summary True

Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

http://www.acme.com/identifiers/patient

Mappings

v2: CX.4 / EI-2-4
rim: II.root or Role.id.root
servd: ./IdentifierType

MedicationRequest.eventHistory.identifier.value

Short The value that is unique

Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Cardinality 0..1

Summary True

Comments

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Examples

General

Mappings

v2: CX.1 / EI.1
rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
servd: ./Value

MedicationRequest.eventHistory.identifier.period

Short Time period when id is/was valid for use

Definition

Time period during which identifier is/was valid for use.

Cardinality 0..1

Summary True

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.7 + CX.8
rim: Role.effectiveTime or implied by context
servd: ./StartDate and ./EndDate

MedicationRequest.eventHistory.identifier.assigner

Short Organization that issued id (may be just text)

Definition

Organization that issued/manages the identifier.

Cardinality 0..1

Type Reference()

Summary True

Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Constraints

ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())

Mappings

v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
servd: ./IdentifierIssuingAuthority

MedicationRequest.eventHistory.display

Short Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Cardinality 0..1