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This version of the UK Core is a development copy.
This contains BREAKING CHANGES as a result of the C&TA Sprint 7 Review, and STU2 Sequence ballot reconciliation.
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StructureDefinition UKCore-MedicationRequest

Canonical_URL	Status	Current_Version	Last_Updated	Description
https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest	active	2.5.0	2023-12-12	This profile defines the UK constraints and extensions on the International FHIR resource MedicationRequest.

Profile_Purpose
An order or request for both supply of the medication and the instructions for administration of the medication to an individual. This profile covers inpatient medication orders as well as community orders (whether filled by the prescriber or by a pharmacy). It also includes orders for over-the-counter medications (e.g. Aspirin), total parenteral nutrition and diet/ vitamin supplements, and may be used to support the order of medication-related devices. It is not intended for use in prescribing particular diets, or for ordering non-medication-related items (eyeglasses, supplies, etc).

Profile_Purpose

An order or request for both supply of the medication and the instructions for administration of the medication to an individual.

This profile covers inpatient medication orders as well as community orders (whether filled by the prescriber or by a pharmacy). It also includes orders for over-the-counter medications (e.g. Aspirin), total parenteral nutrition and diet/ vitamin supplements, and may be used to support the order of medication-related devices.

It is not intended for use in prescribing particular diets, or for ordering non-medication-related items (eyeglasses, supplies, etc).

MedicationRequest	I		MedicationRequest	There are no (further) constraints on this element Element id MedicationRequest Short description Ordering of medication for patient or group Alternate names Prescription, Order Definition An order or request for both supply of the medication and the instructions for administration of the medication to a patient. The resource is called "MedicationRequest" rather than "MedicationPrescription" or "MedicationOrder" to generalize the use across inpatient and outpatient settings, including care plans, etc., and to harmonize with workflow patterns. Data type MedicationRequest Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.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-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-6: A resource should have narrative for robust management text.`div`.exists() dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` Mappings rim: Entity. Role, or Act workflow: Request script10.6: Message/Body/NewRx rim: CombinedMedicationRequest
id	Σ	0..1	string	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 string
meta	Σ	0..1	Meta	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 Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
implicitRules	Σ ?!	0..1	uri	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 uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
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 code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
text		0..1	Narrative	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 Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A rim: Act.text?
contained		0..*	Resource	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 Resource Mappings rim: Entity. Role, or Act rim: N/A
extension	I	0..*	Extension	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 Extension Sliced: 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 rim: N/A
medicationRepeatInformation	I	0..1	Extension(Complex)	Element id MedicationRequest.extension:medicationRepeatInformation Short description Allows the resource to be referenced within / by other resources. Alternate names extensions, user content Definition Medication repeat information. 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 Extension(Complex) Extension URL https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation 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	?! I	0..*	Extension	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 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 Extension Sliced: 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 rim: N/A
identifier	S	0..*	Identifier	Element id MedicationRequest.identifier Short description Allows the resource to be referenced within / by other resources. Definition Identifiers associated with this medication request that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server. Comments This is a business identifier, not a resource identifier. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd: Identifier workflow: Request.identifier script10.6: Message/Header/PrescriberOrderNumber w5: FiveWs.identifier v2: ORC-2-Placer Order Number / ORC-3-Filler Order Number rim: .id
status	S Σ ?!	1..1	codeBinding	Element id MedicationRequest.status Short description A code specifying the current state of the order. Definition A code specifying the current state of the order. Generally, this will be active or completed state. Comments This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. Data type code Binding A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription. medicationrequest Status (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Request.status script10.6: no mapping w5: FiveWs.status rim: .statusCode
statusReason		0..1	CodeableConcept	There are no (further) constraints on this element Element id MedicationRequest.statusReason Short description Reason for current status Definition Captures the reason for the current state of the MedicationRequest. 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 CodeableConcept Binding Identifies the reasons for a given status. medicationRequest Status Reason Codes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD workflow: Request.statusReason rim: .inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde
intent	S Σ ?!	1..1	codeBinding	Element id MedicationRequest.intent Short description Whether the request is a proposal, plan, or an original order. Definition Whether the request is a proposal, plan, or an original order. Comments It is expected that the type of requester will be restricted for different stages of a MedicationRequest. For example, Proposals can be created by a patient, relatedPerson, Practitioner or Device. Plans can be created by Practitioners, Patients, RelatedPersons and Devices. Original orders can be created by a Practitioner only. An instance-order is an instantiation of a request or order and may be used to populate Medication Administration Record. This element is labeled as a modifier because the intent alters when and how the resource is actually applicable. Data type code Binding The kind of medication order. medicationRequest Intent (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Request.intent w5: FiveWs.class rim: .moodCode (nuances beyond PRP/PLAN/RQO would need to be elsewhere)
category	S	0..*	CodeableConceptBinding	Element id MedicationRequest.category Short description Provides the business context for the relevant dispensing processes. Definition Indicates the type of medication request (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)). Comments The category can be used to include where the medication is expected to be consumed or other types of requests. Data type CodeableConcept Binding 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. UKCoreMedicationRequestCategory (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD 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
priority	Σ	0..1	codeBinding	There are no (further) constraints on this element Element id MedicationRequest.priority Short description routine \| urgent \| asap \| stat Definition Indicates how quickly the Medication Request should be addressed with respect to other requests. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type code Binding Identifies the level of importance to be assigned to actioning the request. RequestPriority (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Request.priority w5: FiveWs.grade rim: .priorityCode
doNotPerform	Σ ?!	0..1	boolean	There are no (further) constraints on this element Element id MedicationRequest.doNotPerform Short description True if request is prohibiting action Definition If true indicates that the provider is asking for the medication request not to occur. Comments If do not perform is not specified, the request is a positive request e.g. "do perform". Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: SubstanceAdministration.actionNegationInd
reported[x]	Σ	0..1		There are no (further) constraints on this element Element id MedicationRequest.reported[x] Short description 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. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: .participation[typeCode=INF].role
reportedBoolean			boolean	There are no (further) constraints on this element Data type boolean
reportedReference			Reference(Patient \| Practitioner \| PractitionerRole \| RelatedPerson \| Organization)	There are no (further) constraints on this element Data type Reference(Patient \| Practitioner \| PractitionerRole \| RelatedPerson \| Organization)
medication[x]	S Σ	1..1	Binding	Element id MedicationRequest.medication[x] Short description Identifies the medication being requested. Definition Identifies the medication being requested. This is a link to a resource that represents the medication which may be the details of the medication or simply an attribute carrying a code that identifies the medication from a known list of medications. Comments If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the Medication resource is recommended. For example, if you require form or lot number or if the medication is compounded or extemporaneously prepared, then you must reference the Medication resource. Binding A coded concept identifying substance or product that can be ordered. UKCoreMedicationCode (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a 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
medicationCodeableConcept			CodeableConcept	There are no (further) constraints on this element Data type CodeableConcept
medicationReference			Reference(Medication)	There are no (further) constraints on this element Data type Reference(Medication)
subject	S Σ I	1..1	Reference(Patient \| Group)	Element id MedicationRequest.subject Short description Who the medication request is for. Definition A link to a resource representing the person or set of individuals to whom the medication will be given. 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. Data type Reference(Patient \| Group) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) 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
encounter	I	0..1	Reference(Encounter)	There are no (further) constraints on this element Element id MedicationRequest.encounter Short description Encounter created as part of encounter/admission/stay Definition The Encounter during which this [x] was created or to which the creation of this record is tightly associated. Comments This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter." If there is a need to link to episodes of care they will be handled with an extension. Data type Reference(Encounter) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) 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"]
supportingInformation	I	0..*	Reference(Resource)	There are no (further) constraints on this element Element id MedicationRequest.supportingInformation Short description Information to support ordering of the medication Definition Include additional information (for example, patient height and weight) that supports the ordering of the medication. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(Resource) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) 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)]
authoredOn	S Σ	0..1	dateTime	Element id MedicationRequest.authoredOn Short description The date / time that the medication request was initially authored. Definition The date (and perhaps time) when the prescription was initially written or authored on. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a 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
requester	S Σ I	0..1	Reference(Practitioner \| PractitionerRole \| Organization \| Patient \| RelatedPerson \| Device)	Element id MedicationRequest.requester Short description Who is requesting the medication. Definition The individual, organization, or device that initiated the request and has responsibility for its activation. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(Practitioner \| PractitionerRole \| Organization \| Patient \| RelatedPerson \| Device) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Request.requester w5: FiveWs.author rim: .participation[typeCode=AUT].role
performer	I	0..1	Reference(Practitioner \| PractitionerRole \| Organization \| Patient \| Device \| RelatedPerson \| CareTeam)	There are no (further) constraints on this element Element id MedicationRequest.performer Short description Intended performer of administration Definition The specified desired performer of the medication treatment (e.g. the performer of the medication administration). Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(Practitioner \| PractitionerRole \| Organization \| Patient \| Device \| RelatedPerson \| CareTeam) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Request.performer w5: FiveWs.actor rim: .participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]
performerType	Σ	0..1	CodeableConcept	There are no (further) constraints on this element Element id MedicationRequest.performerType Short description Desired kind of performer of the medication administration Definition Indicates the type of performer of the administration of the medication. Comments If specified without indicating a performer, this indicates that the performer must be of the specified type. If specified with a performer then it indicates the requirements of the performer if the designated performer is not available. Data type CodeableConcept Binding Identifies the type of individual that is desired to administer the medication. ProcedurePerformerRoleCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD workflow: Request.performerType rim: .participation[typeCode=PRF].role[scoper.determinerCode=KIND].code
recorder	I	0..1	Reference(Practitioner \| PractitionerRole)	There are no (further) constraints on this element Element id MedicationRequest.recorder Short description 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. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(Practitioner \| PractitionerRole) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.who rim: .participation[typeCode=TRANS].role[classCode=ASSIGNED].code (HealthcareProviderType)
reasonCode		0..*	CodeableConcept	There are no (further) constraints on this element Element id MedicationRequest.reasonCode Short description Reason or indication for ordering or not ordering the medication Definition The reason or the indication for ordering or not ordering the medication. Comments This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonReference. Data type CodeableConcept Binding A coded concept indicating why the medication was ordered. Condition/Problem/DiagnosisCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD 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
reasonReference	I	0..*	Reference(Condition \| Observation)	There are no (further) constraints on this element Element id MedicationRequest.reasonReference Short description Condition or observation that supports why the prescription is being written Definition Condition or observation that supports why the medication was ordered. 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. Data type Reference(Condition \| Observation) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Request.reasonReference script10.6: no mapping w5: FiveWs.why[x] rim: reason.observation[code=ASSERTION].value
instantiatesCanonical	Σ	0..*	canonical()	There are no (further) constraints on this element Element id MedicationRequest.instantiatesCanonical Short description 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. Comments see Canonical References Data type canonical() Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Request.instantiates rim: .outboundRelationship[typeCode=DEFN].target
instantiatesUri	Σ	0..*	uri	There are no (further) constraints on this element Element id MedicationRequest.instantiatesUri Short description 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. Comments see http://en.wikipedia.org/wiki/Uniform_resource_identifier Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: .outboundRelationship[typeCode=DEFN].target
basedOn	Σ I	0..*	Reference(CarePlan \| MedicationRequest \| ServiceRequest \| ImmunizationRecommendation)	There are no (further) constraints on this element Element id MedicationRequest.basedOn Short description What request fulfills Definition A plan or request that is fulfilled in whole or in part by this medication request. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(CarePlan \| MedicationRequest \| ServiceRequest \| ImmunizationRecommendation) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Request.basedOn rim: .outboundRelationship[typeCode=FLFS].target[classCode=SBADM or PROC or PCPR or OBS, moodCode=RQO orPLAN or PRP]
groupIdentifier	Σ	0..1	Identifier	There are no (further) constraints on this element Element id MedicationRequest.groupIdentifier Short description Composite request this is part of Definition A shared identifier common to all requests that were authorized more or less simultaneously by a single author, representing the identifier of the requisition or prescription. Requirements Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd: Identifier workflow: Request.groupIdentifier rim: .outboundRelationship(typeCode=COMP].target[classCode=SBADM, moodCode=INT].id
courseOfTherapyType		0..1	CodeableConceptBinding	Element id MedicationRequest.courseOfTherapyType Short description A course of therapy for a medication request Definition The description of the course of therapy for a medication request. Comments This attribute should not be confused with the protocol of the medication. Data type CodeableConcept Binding Identifies the overall pattern of medication administratio. UKCoreMedicationRequestCourseOfTherapy (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD rim: Act.code where classCode = LIST and moodCode = EVN
insurance	I	0..*	Reference(Coverage \| ClaimResponse)	There are no (further) constraints on this element Element id MedicationRequest.insurance Short description Associated insurance coverage Definition Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be required for delivering the requested service. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(Coverage \| ClaimResponse) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Request.insurance rim: .outboundRelationship[typeCode=COVBY].target
note		0..*	Annotation	There are no (further) constraints on this element Element id MedicationRequest.note Short description Information about the prescription Definition Extra information about the prescription that could not be conveyed by the other attributes. Comments For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible). Data type Annotation Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: N/A rim: Act workflow: Request.note script10.6: Message/Body/NewRx/MedicationPrescribed/Note rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=OBS,moodCode=EVN,code="annotation"].value
dosageInstruction	S	0..*	Dosage	Element id MedicationRequest.dosageInstruction Short description Dosage instructions for the medication. Definition Indicates how the medication is to be used by the patient. Comments There are examples where a medication request may include the option of an oral dose or an Intravenous or Intramuscular dose. For example, "Ondansetron 8mg orally or IV twice a day as needed for nausea" or "Compazine® (prochlorperazine) 5-10mg PO or 25mg PR bid prn nausea or vomiting". In these cases, two medication requests would be created that could be grouped together. The decision on which dose and route of administration to use is based on the patient's condition at the time the dose is needed. Data type Dosage Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: .outboundRelationship[typeCode=COMP].target[classCode=SBADM, moodCode=INT] workflow: Request.occurrence[x] rim: see dosageInstruction mapping
id		0..1	string	There are no (further) constraints on this element Element id MedicationRequest.dosageInstruction.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 string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id MedicationRequest.dosageInstruction.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 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 Extension Sliced: 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 rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id MedicationRequest.dosageInstruction.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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 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 Extension 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
sequence	Σ	0..1	integer	There are no (further) constraints on this element Element id MedicationRequest.dosageInstruction.sequence Short description The order of the dosage instructions Definition Indicates the order in which the dosage instructions should be applied or interpreted. 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. Comments 32 bit number; for values larger than this, use decimal Data type integer Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: TQ1-1 rim: .text
text	S Σ	0..1	string	Element id MedicationRequest.dosageInstruction.text Short description Free text dosage instructions. Definition Free text dosage instructions e.g. SIG. 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. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: RXO-6; RXE-21 rim: .text
additionalInstruction	Σ	0..*	CodeableConcept	There are no (further) constraints on this element Element id MedicationRequest.dosageInstruction.additionalInstruction Short description Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness" Definition Supplemental instructions to the patient on how to take the medication (e.g. "with meals" or"take half to one hour before food") or warnings for the patient about the medication (e.g. "may cause drowsiness" or "avoid exposure of skin to direct sunlight or sunlamps"). 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 CodeableConcept Binding A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery". SNOMEDCTAdditionalDosageInstructions (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD v2: RXO-7 rim: .text
patientInstruction	Σ	0..1	string	There are no (further) constraints on this element Element id MedicationRequest.dosageInstruction.patientInstruction Short description Patient or consumer oriented instructions Definition Instructions in terms that are understood by the patient or consumer. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: RXO-7 rim: .text
timing	S Σ	0..1	Timing	Element id MedicationRequest.dosageInstruction.timing Short description When the medication should be administered. Definition When medication should be administered. 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 Timing Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: N/A rim: QSET<TS> (GTS) rim: .effectiveTime
asNeeded[x]	Σ	0..1	Binding	Element id MedicationRequest.dosageInstruction.asNeeded[x] Short description Take "as needed" (for x) Definition Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept). 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 (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: TQ1-9 rim: .outboundRelationship[typeCode=PRCN].target[classCode=OBS, moodCode=EVN, code="as needed"].value=boolean or codable concept
asNeededBoolean			boolean	There are no (further) constraints on this element Data type boolean
asNeededCodeableConcept			CodeableConcept	There are no (further) constraints on this element Data type CodeableConcept
site	Σ	0..1	CodeableConceptBinding	Element id MedicationRequest.dosageInstruction.site Short description Body site to administer to Definition Body site to administer to. 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 CodeableConcept Binding A coded concept describing the site location the medicine enters into or onto the body. UKCoreBodySite (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD v2: RXR-2 rim: .approachSiteCode
route	Σ	0..1	CodeableConceptBinding	Element id MedicationRequest.dosageInstruction.route Short description How drug should enter body Definition How drug should enter body. Requirements A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject. UKCoreSubstanceOrProductAdministrationRoute (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD v2: RXR-1 rim: .routeCode
method	Σ	0..1	CodeableConceptBinding	Element id MedicationRequest.dosageInstruction.method Short description Technique for administering medication Definition Technique for administering medication. 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 CodeableConcept Binding A coded concept describing the technique by which the medicine is administered. UKCoreMedicationDosageMethod (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD v2: RXR-4 rim: .doseQuantity
doseAndRate	S Σ	0..*	Element	Element id MedicationRequest.dosageInstruction.doseAndRate Short description Dosage instructions for the requested medication. Definition The amount of medication administered. Data type Element Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: TQ1-2
id		0..1	string	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 string Mappings rim: n/a
extension	I	0..*	Extension	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 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 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 Extension Sliced: 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 rim: N/A
type	Σ	0..1	CodeableConcept	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". Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept 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 rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD v2: RXO-21; RXE-23
dose[x]	S Σ	0..1		Element id MedicationRequest.dosageInstruction.doseAndRate.dose[x] Short description Quantity of requested medication to be administered. 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 rim: n/a v2: RXO-2, RXE-3 rim: .doseQuantity
doseRange			Range	There are no (further) constraints on this element Data type Range
doseQuantity			SimpleQuantity	There are no (further) constraints on this element Data type SimpleQuantity
rate[x]	S Σ	0..1		Element id MedicationRequest.dosageInstruction.doseAndRate.rate[x] Short description Rate at which the requested medication is to be administered. 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 rim: n/a v2: RXE22, RXE23, RXE-24 rim: .rateQuantity
rateRatio			Ratio	There are no (further) constraints on this element Data type Ratio
rateRange			Range	There are no (further) constraints on this element Data type Range
rateQuantity			SimpleQuantity	There are no (further) constraints on this element Data type SimpleQuantity
maxDosePerPeriod	Σ I	0..1	Ratio	There are no (further) constraints on this element Element id MedicationRequest.dosageInstruction.maxDosePerPeriod Short description Upper limit on medication per unit of time Definition Upper limit on medication per unit of time. 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 Ratio Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` rat-1: Numerator and denominator SHALL both be present, or both are absent. If both are absent, there SHALL be some extension present `(numerator.empty() xor denominator.exists()) and (numerator.exists() or extension.exists())` Mappings rim: n/a v2: N/A rim: RTO v2: RXO-23, RXE-19 rim: .maxDoseQuantity
maxDosePerAdministration	Σ I	0..1	SimpleQuantity	There are no (further) constraints on this element Element id MedicationRequest.dosageInstruction.maxDosePerAdministration Short description Upper limit on medication per administration Definition Upper limit on medication per administration. 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 SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` qty-3: If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()` sqty-1: The comparator is not used on a SimpleQuantity `comparator.empty()` Mappings rim: n/a v2: SN (see also Range) or CQ rim: PQ, IVL<PQ>, MO, CO, depending on the values rim: not supported
maxDosePerLifetime	Σ I	0..1	SimpleQuantity	There are no (further) constraints on this element Element id MedicationRequest.dosageInstruction.maxDosePerLifetime Short description Upper limit on medication per lifetime of the patient Definition Upper limit on medication per lifetime of the patient. Requirements The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject. Comments The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` qty-3: If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()` sqty-1: The comparator is not used on a SimpleQuantity `comparator.empty()` Mappings rim: n/a v2: SN (see also Range) or CQ rim: PQ, IVL<PQ>, MO, CO, depending on the values rim: not supported
dispenseRequest	S	0..1	BackboneElement	Element id MedicationRequest.dispenseRequest Short description Specific dispensing quantity instructions. 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 BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a script10.6: Message/Body/NewRx/MedicationPrescribed/ExpirationDate rim: component.supplyEvent
id		0..1	string	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 string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id MedicationRequest.dispenseRequest.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 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 Extension Sliced: 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 rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	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 May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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 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 Extension 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
initialFill		0..1	BackboneElement	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 BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: SubstanceAdministration -> ActRelationship[sequenceNumber = '1'] -> Supply
id		0..1	string	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 string Mappings rim: n/a
extension	I	0..*	Extension	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 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 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 Extension Sliced: 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 rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	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 May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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 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 Extension 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
quantity	I	0..1	SimpleQuantity	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. Comments The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` qty-3: If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()` sqty-1: The comparator is not used on a SimpleQuantity `comparator.empty()` Mappings rim: n/a v2: SN (see also Range) or CQ rim: PQ, IVL<PQ>, MO, CO, depending on the values rim: Supply.quantity[moodCode=RQO]
duration	I	0..1	Duration	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. Comments The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator. Data type Duration Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` qty-3: If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()` drt-1: There SHALL be a code if there is a value and it SHALL be an expression of time. If system is present, it SHALL be UCUM. `code.exists() implies ((system = %ucum) and value.exists())` Mappings rim: n/a v2: SN (see also Range) or CQ rim: PQ, IVL<PQ>, MO, CO, depending on the values rim: PQ, IVL<PQ> depending on the values rim: Supply.effectivetime[moodCode=RQO]
dispenseInterval	I	0..1	Duration	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. Comments The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator. Data type Duration Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` qty-3: If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()` drt-1: There SHALL be a code if there is a value and it SHALL be an expression of time. If system is present, it SHALL be UCUM. `code.exists() implies ((system = %ucum) and value.exists())` Mappings rim: n/a v2: SN (see also Range) or CQ rim: PQ, IVL<PQ>, MO, CO, depending on the values rim: PQ, IVL<PQ> depending on the values rim: Supply.effectivetime[moodCode=RQO]
validityPeriod	I	0..1	Period	There are no (further) constraints on this element Element id MedicationRequest.dispenseRequest.validityPeriod Short description Time period supply is authorized for Definition This indicates the validity period of a prescription (stale dating the Prescription). 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 Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1: If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim: n/a v2: DR rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] script10.6: Message/Body/NewRx/MedicationPrescribed/Refills rim: effectiveTime
numberOfRepeatsAllowed		0..1	unsignedInt	There are no (further) constraints on this element Element id MedicationRequest.dispenseRequest.numberOfRepeatsAllowed Short description Number of refills authorized Definition An integer indicating the number of times, in addition to the original dispense, (aka refills or repeats) that the patient can receive the prescribed medication. Usage Notes: This integer does not include the original order dispense. This means that if an order indicates dispense 30 tablets plus "3 repeats", then the order can be dispensed a total of 4 times and the patient can receive a total of 120 tablets. A prescriber may explicitly say that zero refills are permitted after the initial dispense. Comments If displaying "number of authorized fills", add 1 to this number. Data type unsignedInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a script10.6: Message/Body/NewRx/MedicationPrescribed/Quantity v2: RXE-12-Number of Refills rim: repeatNumber
quantity	S I	0..1	SimpleQuantity	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. Comments The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` qty-3: If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()` sqty-1: The comparator is not used on a SimpleQuantity `comparator.empty()` Mappings rim: n/a v2: SN (see also Range) or CQ rim: PQ, IVL<PQ>, MO, CO, depending on the values 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
expectedSupplyDuration	I	0..1	Duration	There are no (further) constraints on this element Element id MedicationRequest.dispenseRequest.expectedSupplyDuration Short description Number of days supply per dispense Definition Identifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last. 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 Duration Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` qty-3: If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()` drt-1: There SHALL be a code if there is a value and it SHALL be an expression of time. If system is present, it SHALL be UCUM. `code.exists() implies ((system = %ucum) and value.exists())` Mappings rim: n/a v2: SN (see also Range) or CQ rim: PQ, IVL<PQ>, MO, CO, depending on the values rim: PQ, IVL<PQ> depending on the values script10.6: Message/Body/NewRx/MedicationPrescribed/Substitutions rim: expectedUseTime
performer	I	0..1	Reference(Organization)	There are no (further) constraints on this element Element id MedicationRequest.dispenseRequest.performer Short description Intended dispenser Definition Indicates the intended dispensing Organization specified by the prescriber. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.who rim: .outboundRelationship[typeCode=COMP].target[classCode=SPLY, moodCode=RQO] .participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]
substitution	S	1..1	BackboneElement	Element id MedicationRequest.substitution Short description Any restrictions on medication substitution. Definition Indicates whether or not substitution can or should be part of the dispense. In some cases, substitution must happen, in other cases substitution must not happen. This block explains the prescriber's intent. If nothing is specified substitution may be done. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a script10.6: specific values within Message/Body/NewRx/MedicationPrescribed/Substitutions rim: subjectOf.substitutionPersmission
id		0..1	string	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 string Mappings rim: n/a
extension	I	0..*	Extension	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 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 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 Extension Sliced: 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 rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	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 May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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 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 Extension 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
allowed[x]		1..1		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. Binding Identifies the type of substitution allowed. v3.ActSubstanceAdminSubstitutionCode (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a script10.6: specific values within Message/Body/NewRx/MedicationPrescribed/Substitutions v2: RXO-9-Allow Substitutions / RXE-9-Substitution Status rim: code
allowedBoolean			boolean	There are no (further) constraints on this element Data type boolean
allowedCodeableConcept			CodeableConcept	There are no (further) constraints on this element Data type CodeableConcept
reason		0..1	CodeableConcept	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. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed. v3.SubstanceAdminSubstitutionReason (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD script10.6: not mapped v2: RXE-9 Substition status rim: reasonCode
priorPrescription	I	0..1	Reference(MedicationRequest)	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. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(MedicationRequest) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Request.replaces script10.6: not mapped rim: .outboundRelationship[typeCode=?RPLC or ?SUCC]/target[classCode=SBADM,moodCode=RQO]
detectedIssue	I	0..*	Reference(DetectedIssue)	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 Reference(DetectedIssue) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=ALRT,moodCode=EVN].value
eventHistory	I	0..*	Reference(Provenance)	There are no (further) constraints on this element 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 Reference(Provenance) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Request.relevantHistory rim: .inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]

Detailed Descriptions

MedicationRequest
Definition	An order or request for both supply of the medication and the instructions for administration of the medication to a patient. The resource is called "MedicationRequest" rather than "MedicationPrescription" or "MedicationOrder" to generalize the use across inpatient and outpatient settings, including care plans, etc., and to harmonize with workflow patterns.
Cardinality	0...*
Alias	Prescription, Order
Invariants	dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.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-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-6: A resource should have narrative for robust management text.`div`.exists() dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()`
Mappings	rim: Entity. Role, or Act workflow: Request script10.6: Message/Body/NewRx rim: CombinedMedicationRequest
MedicationRequest.id
Definition	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality	0...1
Type	string
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
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
Type	Meta
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: N/A
MedicationRequest.implicitRules
Definition	A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Cardinality	0...1
Type	uri
Modifier	True
Summary	True
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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
MedicationRequest.language
Definition	The base language in which the resource is written.
Cardinality	0...1
Type	code
Binding	A human language. CommonLanguages (preferred)
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).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
MedicationRequest.text
Definition	A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Cardinality	0...1
Type	Narrative
Alias	narrative, html, xhtml, display
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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: N/A rim: Act.text?
MedicationRequest.contained
Definition	These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality	0...*
Type	Resource
Alias	inline resources, anonymous resources, contained resources
Comments	This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Mappings	rim: Entity. Role, or Act rim: N/A
MedicationRequest.extension
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.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationRequest.extension:medicationRepeatInformation
Definition	Medication repeat information.
Cardinality	0...1
Type	Extension(Complex)
Alias	extensions, user content
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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationRequest.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Alias	extensions, user content
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	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationRequest.identifier
Definition	Identifiers associated with this medication request that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server.
Cardinality	0...*
Type	Identifier
Must Support	True
Comments	This is a business identifier, not a resource identifier.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd: Identifier 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.status
Definition	A code specifying the current state of the order. Generally, this will be active or completed state.
Cardinality	1...1
Type	code
Binding	A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription. medicationrequest Status (required)
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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a workflow: Request.status script10.6: no mapping w5: FiveWs.status rim: .statusCode
MedicationRequest.statusReason
Definition	Captures the reason for the current state of the MedicationRequest.
Cardinality	0...1
Type	CodeableConcept
Binding	Identifies the reasons for a given status. medicationRequest Status Reason Codes (example)
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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD workflow: Request.statusReason rim: .inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde
MedicationRequest.intent
Definition	Whether the request is a proposal, plan, or an original order.
Cardinality	1...1
Type	code
Binding	The kind of medication order. medicationRequest Intent (required)
Must Support	True
Modifier	True
Summary	True
Comments	It is expected that the type of requester will be restricted for different stages of a MedicationRequest. For example, Proposals can be created by a patient, relatedPerson, Practitioner or Device. Plans can be created by Practitioners, Patients, RelatedPersons and Devices. Original orders can be created by a Practitioner only. An instance-order is an instantiation of a request or order and may be used to populate Medication Administration Record. This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a workflow: Request.intent w5: FiveWs.class rim: .moodCode (nuances beyond PRP/PLAN/RQO would need to be elsewhere)
MedicationRequest.category
Definition	Indicates the type of medication request (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)).
Cardinality	0...*
Type	CodeableConcept
Binding	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. UKCoreMedicationRequestCategory (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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD 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.priority
Definition	Indicates how quickly the Medication Request should be addressed with respect to other requests.
Cardinality	0...1
Type	code
Binding	Identifies the level of importance to be assigned to actioning the request. RequestPriority (required)
Summary	True
Comments	Note that FHIR strings SHALL NOT exceed 1MB in size
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a workflow: Request.priority w5: FiveWs.grade rim: .priorityCode
MedicationRequest.doNotPerform
Definition	If true indicates that the provider is asking for the medication request not to occur.
Cardinality	0...1
Type	boolean
Modifier	True
Summary	True
Comments	If do not perform is not specified, the request is a positive request e.g. "do perform".
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: SubstanceAdministration.actionNegationInd
MedicationRequest.reported[x]
Definition	Indicates if this record was captured as a secondary 'reported' record rather than as an original primary source-of-truth record. It may also indicate the source of the report.
Cardinality	0...1
Type	boolean
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: .participation[typeCode=INF].role
MedicationRequest.medication[x]
Definition	Identifies the medication being requested. This is a link to a resource that represents the medication which may be the details of the medication or simply an attribute carrying a code that identifies the medication from a known list of medications.
Cardinality	1...1
Type	CodeableConcept
Binding	A coded concept identifying substance or product that can be ordered. UKCoreMedicationCode (preferred)
Must Support	True
Summary	True
Comments	If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the Medication resource is recommended. For example, if you require form or lot number or if the medication is compounded or extemporaneously prepared, then you must reference the Medication resource.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a 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
Definition	A link to a resource representing the person or set of individuals to whom the medication will be given.
Cardinality	1...1
Type	Reference(Patient \| Group)
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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) 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.encounter
Definition	The Encounter during which this [x] was created or to which the creation of this record is tightly associated.
Cardinality	0...1
Type	Reference(Encounter)
Comments	This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter." If there is a need to link to episodes of care they will be handled with an extension.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) 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.supportingInformation
Definition	Include additional information (for example, patient height and weight) that supports the ordering of the medication.
Cardinality	0...*
Type	Reference(Resource)
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) 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.authoredOn
Definition	The date (and perhaps time) when the prescription was initially written or authored on.
Cardinality	0...1
Type	dateTime
Must Support	True
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a 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
Definition	The individual, organization, or device that initiated the request and has responsibility for its activation.
Cardinality	0...1
Type	Reference(Practitioner \| PractitionerRole \| Organization \| Patient \| RelatedPerson \| Device)
Must Support	True
Summary	True
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Request.requester w5: FiveWs.author rim: .participation[typeCode=AUT].role
MedicationRequest.performer
Definition	The specified desired performer of the medication treatment (e.g. the performer of the medication administration).
Cardinality	0...1
Type	Reference(Practitioner \| PractitionerRole \| Organization \| Patient \| Device \| RelatedPerson \| CareTeam)
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Request.performer w5: FiveWs.actor rim: .participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]
MedicationRequest.performerType
Definition	Indicates the type of performer of the administration of the medication.
Cardinality	0...1
Type	CodeableConcept
Binding	Identifies the type of individual that is desired to administer the medication. ProcedurePerformerRoleCodes (example)
Summary	True
Comments	If specified without indicating a performer, this indicates that the performer must be of the specified type. If specified with a performer then it indicates the requirements of the performer if the designated performer is not available.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD workflow: Request.performerType rim: .participation[typeCode=PRF].role[scoper.determinerCode=KIND].code
MedicationRequest.recorder
Definition	The person who entered the order on behalf of another individual for example in the case of a verbal or a telephone order.
Cardinality	0...1
Type	Reference(Practitioner \| PractitionerRole)
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.who rim: .participation[typeCode=TRANS].role[classCode=ASSIGNED].code (HealthcareProviderType)
MedicationRequest.reasonCode
Definition	The reason or the indication for ordering or not ordering the medication.
Cardinality	0...*
Type	CodeableConcept
Binding	A coded concept indicating why the medication was ordered. Condition/Problem/DiagnosisCodes (example)
Comments	This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonReference.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD 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
Definition	Condition or observation that supports why the medication was ordered.
Cardinality	0...*
Type	Reference(Condition \| Observation)
Comments	This is a reference to a condition or observation that is the reason for the medication order. If only a code exists, use reasonCode.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Request.reasonReference script10.6: no mapping w5: FiveWs.why[x] rim: reason.observation[code=ASSERTION].value
MedicationRequest.instantiatesCanonical
Definition	The URL pointing to a protocol, guideline, orderset, or other definition that is adhered to in whole or in part by this MedicationRequest.
Cardinality	0...*
Type	canonical()
Summary	True
Comments	see Canonical References
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a workflow: Request.instantiates rim: .outboundRelationship[typeCode=DEFN].target
MedicationRequest.instantiatesUri
Definition	The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this MedicationRequest.
Cardinality	0...*
Type	uri
Summary	True
Comments	see http://en.wikipedia.org/wiki/Uniform_resource_identifier
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: .outboundRelationship[typeCode=DEFN].target
MedicationRequest.basedOn
Definition	A plan or request that is fulfilled in whole or in part by this medication request.
Cardinality	0...*
Type	Reference(CarePlan \| MedicationRequest \| ServiceRequest \| ImmunizationRecommendation)
Summary	True
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Request.basedOn rim: .outboundRelationship[typeCode=FLFS].target[classCode=SBADM or PROC or PCPR or OBS, moodCode=RQO orPLAN or PRP]
MedicationRequest.groupIdentifier
Definition	A shared identifier common to all requests that were authorized more or less simultaneously by a single author, representing the identifier of the requisition or prescription.
Cardinality	0...1
Type	Identifier
Summary	True
Requirements	Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd: Identifier workflow: Request.groupIdentifier rim: .outboundRelationship(typeCode=COMP].target[classCode=SBADM, moodCode=INT].id
MedicationRequest.courseOfTherapyType
Definition	The description of the course of therapy for a medication request.
Cardinality	0...1
Type	CodeableConcept
Binding	Identifies the overall pattern of medication administratio. UKCoreMedicationRequestCourseOfTherapy (extensible)
Comments	This attribute should not be confused with the protocol of the medication.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD rim: Act.code where classCode = LIST and moodCode = EVN
MedicationRequest.insurance
Definition	Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be required for delivering the requested service.
Cardinality	0...*
Type	Reference(Coverage \| ClaimResponse)
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Request.insurance rim: .outboundRelationship[typeCode=COVBY].target
MedicationRequest.note
Definition	Extra information about the prescription that could not be conveyed by the other attributes.
Cardinality	0...*
Type	Annotation
Comments	For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: N/A rim: Act workflow: Request.note script10.6: Message/Body/NewRx/MedicationPrescribed/Note rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=OBS,moodCode=EVN,code="annotation"].value
MedicationRequest.dosageInstruction
Definition	Indicates how the medication is to be used by the patient.
Cardinality	0...*
Type	Dosage
Must Support	True
Comments	There are examples where a medication request may include the option of an oral dose or an Intravenous or Intramuscular dose. For example, "Ondansetron 8mg orally or IV twice a day as needed for nausea" or "Compazine® (prochlorperazine) 5-10mg PO or 25mg PR bid prn nausea or vomiting". In these cases, two medication requests would be created that could be grouped together. The decision on which dose and route of administration to use is based on the patient's condition at the time the dose is needed.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: .outboundRelationship[typeCode=COMP].target[classCode=SBADM, moodCode=INT] workflow: Request.occurrence[x] rim: see dosageInstruction mapping
MedicationRequest.dosageInstruction.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
MedicationRequest.dosageInstruction.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationRequest.dosageInstruction.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
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	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationRequest.dosageInstruction.sequence
Definition	Indicates the order in which the dosage instructions should be applied or interpreted.
Cardinality	0...1
Type	integer
Summary	True
Requirements	If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. If the sequence number is different, then the Dosages are intended to be sequential.
Comments	32 bit number; for values larger than this, use decimal
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: TQ1-1 rim: .text
MedicationRequest.dosageInstruction.text
Definition	Free text dosage instructions e.g. SIG.
Cardinality	0...1
Type	string
Must Support	True
Summary	True
Requirements	Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing. Additional information about administration or preparation of the medication should be included as text.
Comments	Note that FHIR strings SHALL NOT exceed 1MB in size
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: RXO-6; RXE-21 rim: .text
MedicationRequest.dosageInstruction.additionalInstruction
Definition	Supplemental instructions to the patient on how to take the medication (e.g. "with meals" or"take half to one hour before food") or warnings for the patient about the medication (e.g. "may cause drowsiness" or "avoid exposure of skin to direct sunlight or sunlamps").
Cardinality	0...*
Type	CodeableConcept
Binding	A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery". SNOMEDCTAdditionalDosageInstructions (example)
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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD v2: RXO-7 rim: .text
MedicationRequest.dosageInstruction.patientInstruction
Definition	Instructions in terms that are understood by the patient or consumer.
Cardinality	0...1
Type	string
Summary	True
Comments	Note that FHIR strings SHALL NOT exceed 1MB in size
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: RXO-7 rim: .text
MedicationRequest.dosageInstruction.timing
Definition	When medication should be administered.
Cardinality	0...1
Type	Timing
Must Support	True
Summary	True
Requirements	The timing schedule for giving the medication to the patient. This data type allows many different expressions. For example: "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.
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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: N/A rim: QSET<TS> (GTS) rim: .effectiveTime
MedicationRequest.dosageInstruction.asNeeded[x]
Definition	Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept).
Cardinality	0...1
Type	boolean
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 (preferred)
Summary	True
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".
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: TQ1-9 rim: .outboundRelationship[typeCode=PRCN].target[classCode=OBS, moodCode=EVN, code="as needed"].value=boolean or codable concept
MedicationRequest.dosageInstruction.site
Definition	Body site to administer to.
Cardinality	0...1
Type	CodeableConcept
Binding	A coded concept describing the site location the medicine enters into or onto the body. UKCoreBodySite (preferred)
Summary	True
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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD v2: RXR-2 rim: .approachSiteCode
MedicationRequest.dosageInstruction.route
Definition	How drug should enter body.
Cardinality	0...1
Type	CodeableConcept
Binding	A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject. UKCoreSubstanceOrProductAdministrationRoute (preferred)
Summary	True
Requirements	A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD v2: RXR-1 rim: .routeCode
MedicationRequest.dosageInstruction.method
Definition	Technique for administering medication.
Cardinality	0...1
Type	CodeableConcept
Binding	A coded concept describing the technique by which the medicine is administered. UKCoreMedicationDosageMethod (preferred)
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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD v2: RXR-4 rim: .doseQuantity
MedicationRequest.dosageInstruction.doseAndRate
Definition	The amount of medication administered.
Cardinality	0...*
Type	Element
Must Support	True
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: TQ1-2
MedicationRequest.dosageInstruction.doseAndRate.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
MedicationRequest.dosageInstruction.doseAndRate.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationRequest.dosageInstruction.doseAndRate.type
Definition	The kind of dose or rate specified, for example, ordered or calculated.
Cardinality	0...1
Type	CodeableConcept
Binding	The kind of dose or rate specified. DoseAndRateType (example)
Summary	True
Requirements	If the type is not populated, assume to be "ordered".
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD v2: RXO-21; RXE-23
MedicationRequest.dosageInstruction.doseAndRate.dose[x]
Definition	Amount of medication per dose.
Cardinality	0...1
Type	Range
Must Support	True
Summary	True
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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: RXO-2, RXE-3 rim: .doseQuantity
MedicationRequest.dosageInstruction.doseAndRate.rate[x]
Definition	Amount of medication per unit of time.
Cardinality	0...1
Type	Ratio
Must Support	True
Summary	True
Requirements	Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.
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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: RXE22, RXE23, RXE-24 rim: .rateQuantity
MedicationRequest.dosageInstruction.maxDosePerPeriod
Definition	Upper limit on medication per unit of time.
Cardinality	0...1
Type	Ratio
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".
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` rat-1: Numerator and denominator SHALL both be present, or both are absent. If both are absent, there SHALL be some extension present `(numerator.empty() xor denominator.exists()) and (numerator.exists() or extension.exists())`
Mappings	rim: n/a v2: N/A rim: RTO v2: RXO-23, RXE-19 rim: .maxDoseQuantity
MedicationRequest.dosageInstruction.maxDosePerAdministration
Definition	Upper limit on medication per administration.
Cardinality	0...1
Type	SimpleQuantity
Summary	True
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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` qty-3: If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()` sqty-1: The comparator is not used on a SimpleQuantity `comparator.empty()`
Mappings	rim: n/a v2: SN (see also Range) or CQ rim: PQ, IVL<PQ>, MO, CO, depending on the values rim: not supported
MedicationRequest.dosageInstruction.maxDosePerLifetime
Definition	Upper limit on medication per lifetime of the patient.
Cardinality	0...1
Type	SimpleQuantity
Summary	True
Requirements	The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.
Comments	The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` qty-3: If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()` sqty-1: The comparator is not used on a SimpleQuantity `comparator.empty()`
Mappings	rim: n/a v2: SN (see also Range) or CQ rim: PQ, IVL<PQ>, MO, CO, depending on the values rim: not supported
MedicationRequest.dispenseRequest
Definition	Indicates the specific details for the dispense or medication supply part of a medication request (also known as a Medication Prescription or Medication Order). Note that this information is not always sent with the order. There may be in some settings (e.g. hospitals) institutional or system support for completing the dispense details in the pharmacy department.
Cardinality	0...1
Type	BackboneElement
Must Support	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a script10.6: Message/Body/NewRx/MedicationPrescribed/ExpirationDate rim: component.supplyEvent
MedicationRequest.dispenseRequest.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
MedicationRequest.dispenseRequest.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationRequest.dispenseRequest.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
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	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationRequest.dispenseRequest.initialFill
Definition	Indicates the quantity or duration for the first dispense of the medication.
Cardinality	0...1
Type	BackboneElement
Comments	If populating this element, either the quantity or the duration must be included.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: SubstanceAdministration -> ActRelationship[sequenceNumber = '1'] -> Supply
MedicationRequest.dispenseRequest.initialFill.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
MedicationRequest.dispenseRequest.initialFill.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationRequest.dispenseRequest.initialFill.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
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	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationRequest.dispenseRequest.initialFill.quantity
Definition	The amount or quantity to provide as part of the first dispense.
Cardinality	0...1
Type	SimpleQuantity
Comments	The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` qty-3: If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()` sqty-1: The comparator is not used on a SimpleQuantity `comparator.empty()`
Mappings	rim: n/a v2: SN (see also Range) or CQ rim: PQ, IVL<PQ>, MO, CO, depending on the values rim: Supply.quantity[moodCode=RQO]
MedicationRequest.dispenseRequest.initialFill.duration
Definition	The length of time that the first dispense is expected to last.
Cardinality	0...1
Type	Duration
Comments	The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` qty-3: If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()` drt-1: There SHALL be a code if there is a value and it SHALL be an expression of time. If system is present, it SHALL be UCUM. `code.exists() implies ((system = %ucum) and value.exists())`
Mappings	rim: n/a v2: SN (see also Range) or CQ rim: PQ, IVL<PQ>, MO, CO, depending on the values rim: PQ, IVL<PQ> depending on the values rim: Supply.effectivetime[moodCode=RQO]
MedicationRequest.dispenseRequest.dispenseInterval
Definition	The minimum period of time that must occur between dispenses of the medication.
Cardinality	0...1
Type	Duration
Comments	The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` qty-3: If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()` drt-1: There SHALL be a code if there is a value and it SHALL be an expression of time. If system is present, it SHALL be UCUM. `code.exists() implies ((system = %ucum) and value.exists())`
Mappings	rim: n/a v2: SN (see also Range) or CQ rim: PQ, IVL<PQ>, MO, CO, depending on the values rim: PQ, IVL<PQ> depending on the values rim: Supply.effectivetime[moodCode=RQO]
MedicationRequest.dispenseRequest.validityPeriod
Definition	This indicates the validity period of a prescription (stale dating the Prescription).
Cardinality	0...1
Type	Period
Requirements	Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription.
Comments	It reflects the prescribers' perspective for the validity of the prescription. Dispenses must not be made against the prescription outside of this period. The lower-bound of the Dispensing Window signifies the earliest date that the prescription can be filled for the first time. If an upper-bound is not specified then the Prescription is open-ended or will default to a stale-date based on regulations.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1: If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)`
Mappings	rim: n/a v2: DR rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] script10.6: Message/Body/NewRx/MedicationPrescribed/Refills rim: effectiveTime
MedicationRequest.dispenseRequest.numberOfRepeatsAllowed
Definition	An integer indicating the number of times, in addition to the original dispense, (aka refills or repeats) that the patient can receive the prescribed medication. Usage Notes: This integer does not include the original order dispense. This means that if an order indicates dispense 30 tablets plus "3 repeats", then the order can be dispensed a total of 4 times and the patient can receive a total of 120 tablets. A prescriber may explicitly say that zero refills are permitted after the initial dispense.
Cardinality	0...1
Type	unsignedInt
Comments	If displaying "number of authorized fills", add 1 to this number.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a script10.6: Message/Body/NewRx/MedicationPrescribed/Quantity v2: RXE-12-Number of Refills rim: repeatNumber
MedicationRequest.dispenseRequest.quantity
Definition	The amount that is to be dispensed for one fill.
Cardinality	0...1
Type	SimpleQuantity
Must Support	True
Comments	The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` qty-3: If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()` sqty-1: The comparator is not used on a SimpleQuantity `comparator.empty()`
Mappings	rim: n/a v2: SN (see also Range) or CQ rim: PQ, IVL<PQ>, MO, CO, depending on the values 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.expectedSupplyDuration
Definition	Identifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last.
Cardinality	0...1
Type	Duration
Comments	In some situations, this attribute may be used instead of quantity to identify the amount supplied by how long it is expected to last, rather than the physical quantity issued, e.g. 90 days supply of medication (based on an ordered dosage). When possible, it is always better to specify quantity, as this tends to be more precise. expectedSupplyDuration will always be an estimate that can be influenced by external factors.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` qty-3: If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()` drt-1: There SHALL be a code if there is a value and it SHALL be an expression of time. If system is present, it SHALL be UCUM. `code.exists() implies ((system = %ucum) and value.exists())`
Mappings	rim: n/a v2: SN (see also Range) or CQ rim: PQ, IVL<PQ>, MO, CO, depending on the values rim: PQ, IVL<PQ> depending on the values script10.6: Message/Body/NewRx/MedicationPrescribed/Substitutions rim: expectedUseTime
MedicationRequest.dispenseRequest.performer
Definition	Indicates the intended dispensing Organization specified by the prescriber.
Cardinality	0...1
Type	Reference(Organization)
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.who rim: .outboundRelationship[typeCode=COMP].target[classCode=SPLY, moodCode=RQO] .participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]
MedicationRequest.substitution
Definition	Indicates whether or not substitution can or should be part of the dispense. In some cases, substitution must happen, in other cases substitution must not happen. This block explains the prescriber's intent. If nothing is specified substitution may be done.
Cardinality	1...1
Type	BackboneElement
Must Support	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a script10.6: specific values within Message/Body/NewRx/MedicationPrescribed/Substitutions rim: subjectOf.substitutionPersmission
MedicationRequest.substitution.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
MedicationRequest.substitution.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationRequest.substitution.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
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	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationRequest.substitution.allowed[x]
Definition	The purpose of this element is to allow the prescriber to dispense a different drug from what was prescribed.
Cardinality	1...1
Type	boolean
Binding	Identifies the type of substitution allowed. v3.ActSubstanceAdminSubstitutionCode (example)
Comments	This element is labeled as a modifier because whether substitution is allow or not, it cannot be ignored.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a script10.6: specific values within Message/Body/NewRx/MedicationPrescribed/Substitutions v2: RXO-9-Allow Substitutions / RXE-9-Substitution Status rim: code
MedicationRequest.substitution.reason
Definition	Indicates the reason for the substitution, or why substitution must or must not be performed.
Cardinality	0...1
Type	CodeableConcept
Binding	A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed. v3.SubstanceAdminSubstitutionReason (example)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD script10.6: not mapped v2: RXE-9 Substition status rim: reasonCode
MedicationRequest.priorPrescription
Definition	A link to a resource representing an earlier order related order or prescription.
Cardinality	0...1
Type	Reference(MedicationRequest)
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Request.replaces script10.6: not mapped rim: .outboundRelationship[typeCode=?RPLC or ?SUCC]/target[classCode=SBADM,moodCode=RQO]
MedicationRequest.detectedIssue
Definition	Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. Drug-drug interaction, duplicate therapy, dosage alert etc.
Cardinality	0...*
Type	Reference(DetectedIssue)
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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=ALRT,moodCode=EVN].value
MedicationRequest.eventHistory
Definition	Links to Provenance records for past versions of this resource or fulfilling request or event resources that identify key state transitions or updates that are likely to be relevant to a user looking at the current version of the resource.
Cardinality	0...*
Type	Reference(Provenance)
Comments	This might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Request.relevantHistory rim: .inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]

Table View

XML View

<StructureDefinition xmlns="http://hl7.org/fhir">
    <id value="UKCore-MedicationRequest" />
    <url value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
    <version value="2.5.0" />
    <name value="UKCoreMedicationRequest" />
    <title value="UK Core MedicationRequest" />
    <status value="active" />
    <date value="2023-12-12" />
    <publisher value="HL7 UK" />
    <contact>
        <name value="HL7 UK" />
        <telecom>
            <system value="email" />
            <value value="ukcore@hl7.org.uk" />
            <use value="work" />
            <rank value="1" />
        </telecom>
    </contact>
    <description value="This profile defines the UK constraints and extensions on the International FHIR resource [MedicationRequest](https://hl7.org/fhir/R4/MedicationRequest.html)." />
    <purpose value="An order or request for both supply of the medication and the instructions for administration of the medication to an individual. \n\nThis profile covers inpatient medication orders as well as community orders (whether filled by the prescriber or by a pharmacy). It also includes orders for over-the-counter medications (e.g. Aspirin), total parenteral nutrition and diet/ vitamin supplements, and may be used to support the order of medication-related devices. \n\nIt is not intended for use in prescribing particular diets, or for ordering non-medication-related items (eyeglasses, supplies, etc)." />
    <copyright value="Copyright &#169; 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the &quot;License&quot;); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an &quot;AS IS&quot; BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7&#174; FHIR&#174; standard Copyright &#169; 2011+ HL7 The HL7&#174; FHIR&#174; standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html." />
    <fhirVersion value="4.0.1" />
    <kind value="resource" />
    <abstract value="false" />
    <type value="MedicationRequest" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/MedicationRequest" />
    <derivation value="constraint" />
    <differential>
        <element id="MedicationRequest.extension:medicationRepeatInformation">
            <path value="MedicationRequest.extension" />
            <sliceName value="medicationRepeatInformation" />
            <short value="Allows the resource to be referenced within / by other resources." />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation" />
            </type>
        </element>
        <element id="MedicationRequest.identifier">
            <path value="MedicationRequest.identifier" />
            <short value="Allows the resource to be referenced within / by other resources." />
            <mustSupport value="true" />
        </element>
        <element id="MedicationRequest.status">
            <path value="MedicationRequest.status" />
            <short value="A code specifying the current state of the order." />
            <mustSupport value="true" />
        </element>
        <element id="MedicationRequest.intent">
            <path value="MedicationRequest.intent" />
            <short value="Whether the request is a proposal, plan, or an original order." />
            <mustSupport value="true" />
        </element>
        <element id="MedicationRequest.category">
            <path value="MedicationRequest.category" />
            <short value="Provides the business context for the relevant dispensing processes." />
            <mustSupport value="true" />
            <binding>
                <strength value="extensible" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationRequestCategory" />
            </binding>
        </element>
        <element id="MedicationRequest.medication[x]">
            <path value="MedicationRequest.medication[x]" />
            <short value="Identifies the medication being requested." />
            <mustSupport value="true" />
            <binding>
                <strength value="preferred" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationCode" />
            </binding>
        </element>
        <element id="MedicationRequest.subject">
            <path value="MedicationRequest.subject" />
            <short value="Who the medication request is for." />
            <mustSupport value="true" />
        </element>
        <element id="MedicationRequest.authoredOn">
            <path value="MedicationRequest.authoredOn" />
            <short value="The date / time that the medication request was initially authored." />
            <mustSupport value="true" />
        </element>
        <element id="MedicationRequest.requester">
            <path value="MedicationRequest.requester" />
            <short value="Who is requesting the medication." />
            <mustSupport value="true" />
        </element>
        <element id="MedicationRequest.courseOfTherapyType">
            <path value="MedicationRequest.courseOfTherapyType" />
            <short value="A course of therapy for a medication request" />
            <definition value="The description of the course of therapy for a medication request." />
            <binding>
                <strength value="extensible" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationRequestCourseOfTherapy" />
            </binding>
        </element>
        <element id="MedicationRequest.dosageInstruction">
            <path value="MedicationRequest.dosageInstruction" />
            <short value="Dosage instructions for the medication." />
            <mustSupport value="true" />
        </element>
        <element id="MedicationRequest.dosageInstruction.text">
            <path value="MedicationRequest.dosageInstruction.text" />
            <short value="Free text dosage instructions." />
            <mustSupport value="true" />
        </element>
        <element id="MedicationRequest.dosageInstruction.timing">
            <path value="MedicationRequest.dosageInstruction.timing" />
            <short value="When the medication should be administered." />
            <mustSupport value="true" />
        </element>
        <element id="MedicationRequest.dosageInstruction.asNeeded[x]">
            <path value="MedicationRequest.dosageInstruction.asNeeded[x]" />
            <binding>
                <strength value="preferred" />
            </binding>
        </element>
        <element id="MedicationRequest.dosageInstruction.site">
            <path value="MedicationRequest.dosageInstruction.site" />
            <binding>
                <strength value="preferred" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-BodySite" />
            </binding>
        </element>
        <element id="MedicationRequest.dosageInstruction.route">
            <path value="MedicationRequest.dosageInstruction.route" />
            <binding>
                <strength value="preferred" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-SubstanceOrProductAdministrationRoute" />
            </binding>
        </element>
        <element id="MedicationRequest.dosageInstruction.method">
            <path value="MedicationRequest.dosageInstruction.method" />
            <binding>
                <strength value="preferred" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationDosageMethod" />
            </binding>
        </element>
        <element id="MedicationRequest.dosageInstruction.doseAndRate">
            <path value="MedicationRequest.dosageInstruction.doseAndRate" />
            <short value="Dosage instructions for the requested medication." />
            <mustSupport value="true" />
        </element>
        <element id="MedicationRequest.dosageInstruction.doseAndRate.dose[x]">
            <path value="MedicationRequest.dosageInstruction.doseAndRate.dose[x]" />
            <short value="Quantity of requested medication to be administered." />
            <mustSupport value="true" />
        </element>
        <element id="MedicationRequest.dosageInstruction.doseAndRate.rate[x]">
            <path value="MedicationRequest.dosageInstruction.doseAndRate.rate[x]" />
            <short value="Rate at which the requested medication is to be administered." />
            <mustSupport value="true" />
        </element>
        <element id="MedicationRequest.dispenseRequest">
            <path value="MedicationRequest.dispenseRequest" />
            <short value="Specific dispensing quantity instructions." />
            <mustSupport value="true" />
        </element>
        <element id="MedicationRequest.dispenseRequest.quantity">
            <path value="MedicationRequest.dispenseRequest.quantity" />
            <short value="&gt;Amount of medication to supply per dispense." />
            <mustSupport value="true" />
        </element>
        <element id="MedicationRequest.substitution">
            <path value="MedicationRequest.substitution" />
            <short value="Any restrictions on medication substitution." />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="MedicationRequest.substitution.allowed[x]">
            <path value="MedicationRequest.substitution.allowed[x]" />
            <definition value="The purpose of this element is to allow the prescriber to dispense a different drug from what was prescribed." />
        </element>
    </differential>
</StructureDefinition>

JSON View

{
    "resourceType": "StructureDefinition",
    "id": "UKCore-MedicationRequest",
    "url": "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest",
    "version": "2.5.0",
    "name": "UKCoreMedicationRequest",
    "title": "UK Core MedicationRequest",
    "status": "active",
    "date": "2023-12-12",
    "publisher": "HL7 UK",
    "contact":  [
        {
            "name": "HL7 UK",
            "telecom":  [
                {
                    "system": "email",
                    "value": "ukcore@hl7.org.uk",
                    "use": "work",
                    "rank": 1
                }
            ]
        }
    ],
    "description": "This profile defines the UK constraints and extensions on the International FHIR resource [MedicationRequest](https://hl7.org/fhir/R4/MedicationRequest.html).",
    "purpose": "An order or request for both supply of the medication and the instructions for administration of the medication to an individual. \n\nThis profile covers inpatient medication orders as well as community orders (whether filled by the prescriber or by a pharmacy). It also includes orders for over-the-counter medications (e.g. Aspirin), total parenteral nutrition and diet/ vitamin supplements, and may be used to support the order of medication-related devices. \n\nIt is not intended for use in prescribing particular diets, or for ordering non-medication-related items (eyeglasses, supplies, etc).",
    "copyright": "Copyright © 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the \"License\"); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an \"AS IS\" BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7® FHIR® standard Copyright © 2011+ HL7 The HL7® FHIR® standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html.",
    "fhirVersion": "4.0.1",
    "kind": "resource",
    "abstract": false,
    "type": "MedicationRequest",
    "baseDefinition": "http://hl7.org/fhir/StructureDefinition/MedicationRequest",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "MedicationRequest.extension:medicationRepeatInformation",
                "path": "MedicationRequest.extension",
                "sliceName": "medicationRepeatInformation",
                "short": "Allows the resource to be referenced within / by other resources.",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation"
                        ]
                    }
                ]
            },
            {
                "id": "MedicationRequest.identifier",
                "path": "MedicationRequest.identifier",
                "short": "Allows the resource to be referenced within / by other resources.",
                "mustSupport": true
            },
            {
                "id": "MedicationRequest.status",
                "path": "MedicationRequest.status",
                "short": "A code specifying the current state of the order.",
                "mustSupport": true
            },
            {
                "id": "MedicationRequest.intent",
                "path": "MedicationRequest.intent",
                "short": "Whether the request is a proposal, plan, or an original order.",
                "mustSupport": true
            },
            {
                "id": "MedicationRequest.category",
                "path": "MedicationRequest.category",
                "short": "Provides the business context for the relevant dispensing processes.",
                "mustSupport": true,
                "binding": {
                    "strength": "extensible",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationRequestCategory"
                }
            },
            {
                "id": "MedicationRequest.medication[x]",
                "path": "MedicationRequest.medication[x]",
                "short": "Identifies the medication being requested.",
                "mustSupport": true,
                "binding": {
                    "strength": "preferred",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationCode"
                }
            },
            {
                "id": "MedicationRequest.subject",
                "path": "MedicationRequest.subject",
                "short": "Who the medication request is for.",
                "mustSupport": true
            },
            {
                "id": "MedicationRequest.authoredOn",
                "path": "MedicationRequest.authoredOn",
                "short": "The date / time that the medication request was initially authored.",
                "mustSupport": true
            },
            {
                "id": "MedicationRequest.requester",
                "path": "MedicationRequest.requester",
                "short": "Who is requesting the medication.",
                "mustSupport": true
            },
            {
                "id": "MedicationRequest.courseOfTherapyType",
                "path": "MedicationRequest.courseOfTherapyType",
                "short": "A course of therapy for a medication request",
                "definition": "The description of the course of therapy for a medication request.",
                "binding": {
                    "strength": "extensible",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationRequestCourseOfTherapy"
                }
            },
            {
                "id": "MedicationRequest.dosageInstruction",
                "path": "MedicationRequest.dosageInstruction",
                "short": "Dosage instructions for the medication.",
                "mustSupport": true
            },
            {
                "id": "MedicationRequest.dosageInstruction.text",
                "path": "MedicationRequest.dosageInstruction.text",
                "short": "Free text dosage instructions.",
                "mustSupport": true
            },
            {
                "id": "MedicationRequest.dosageInstruction.timing",
                "path": "MedicationRequest.dosageInstruction.timing",
                "short": "When the medication should be administered.",
                "mustSupport": true
            },
            {
                "id": "MedicationRequest.dosageInstruction.asNeeded[x]",
                "path": "MedicationRequest.dosageInstruction.asNeeded[x]",
                "binding": {
                    "strength": "preferred"
                }
            },
            {
                "id": "MedicationRequest.dosageInstruction.site",
                "path": "MedicationRequest.dosageInstruction.site",
                "binding": {
                    "strength": "preferred",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-BodySite"
                }
            },
            {
                "id": "MedicationRequest.dosageInstruction.route",
                "path": "MedicationRequest.dosageInstruction.route",
                "binding": {
                    "strength": "preferred",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-SubstanceOrProductAdministrationRoute"
                }
            },
            {
                "id": "MedicationRequest.dosageInstruction.method",
                "path": "MedicationRequest.dosageInstruction.method",
                "binding": {
                    "strength": "preferred",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationDosageMethod"
                }
            },
            {
                "id": "MedicationRequest.dosageInstruction.doseAndRate",
                "path": "MedicationRequest.dosageInstruction.doseAndRate",
                "short": "Dosage instructions for the requested medication.",
                "mustSupport": true
            },
            {
                "id": "MedicationRequest.dosageInstruction.doseAndRate.dose[x]",
                "path": "MedicationRequest.dosageInstruction.doseAndRate.dose[x]",
                "short": "Quantity of requested medication to be administered.",
                "mustSupport": true
            },
            {
                "id": "MedicationRequest.dosageInstruction.doseAndRate.rate[x]",
                "path": "MedicationRequest.dosageInstruction.doseAndRate.rate[x]",
                "short": "Rate at which the requested medication is to be administered.",
                "mustSupport": true
            },
            {
                "id": "MedicationRequest.dispenseRequest",
                "path": "MedicationRequest.dispenseRequest",
                "short": "Specific dispensing quantity instructions.",
                "mustSupport": true
            },
            {
                "id": "MedicationRequest.dispenseRequest.quantity",
                "path": "MedicationRequest.dispenseRequest.quantity",
                "short": ">Amount of medication to supply per dispense.",
                "mustSupport": true
            },
            {
                "id": "MedicationRequest.substitution",
                "path": "MedicationRequest.substitution",
                "short": "Any restrictions on medication substitution.",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "MedicationRequest.substitution.allowed[x]",
                "path": "MedicationRequest.substitution.allowed[x]",
                "definition": "The purpose of this element is to allow the prescriber to dispense a different drug from what was prescribed."
            }
        ]
    }
}

Feedback

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Report issue for UKCore-MedicationRequest

Examples

Eye drops - An example to illustrate a request for eye drops.
Example UKCore-MedicationRequest-EyeDrops

Repeat Information - An example to illustrate the RepeatInformation extension.
Example UKCore-Extension-RepeatInformation

Example Usage Scenarios

The following are example usage scenarios for the UK Core MedicationRequest profile:

Query for a patient's specific requested medication
Record or update a requested medication.

Profile Specific Implementation Guidance:

Mandatory and Must Support Data Elements

The following elements are identified as MustSupport, and it is expected that consumers and suppliers SHALL support these as per the MustSupport Guidance.

Element	Reason
`MedicationRequest.identifier`	Allows the resource to be referenced within / by other resources.
`MedicationRequest.status`	A code specifying the current state of the order.
`MedicationRequest.intent`	Whether the request is a proposal, plan, or an original order.
`MedicationRequest.category`	Provides the business context for the relevant dispensing processes.
`MedicationRequest.medication[x]`	Identifies the medication being requested.
`MedicationRequest.subject`	Who the medication request is for.
`MedicationRequest.authoredOn`	The date / time that the medication request was initially authored.
`MedicationRequest.requester`	Who is requesting the medication.
`MedicationRequest.dosageInstruction`	Dosage instructions for the medication.
`MedicationRequest.dosageInstruction.text`	Free text dosage instructions.
`MedicationRequest.dosageInstruction.timing`	When the medication should be administered.
`MedicationRequest.dosageInstruction.doseAndRate`	Dosage instructions for the requested medication.
`MedicationRequest.dosageInstruction.doseAndRate.dose[x]`	Quantity of requested medication to be administered.
`MedicationRequest.dosageInstruction.doseAndRate.rate[x]`	Rate at which the requested medication is to be administered.
`MedicationRequest.dispenseRequest`	Specific dispensing quantity instructions.
`MedicationRequest.dispenseRequest.quantity`	>Amount of medication to supply per dispense.
`MedicationRequest.substitution`	Any restrictions on medication substitution.

Extensions

More information about the extensions on the UKCore-MedicationRequest profile can be found using the links below.

Extension	Context	Link	Comment
medicationRepeatInformation	MedicationRequest.extension	https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-MedicationRepeatInformation	Allows the resource to be referenced within / by other resources.

Bindings (differential)

More information about the bindings to UK Core ValueSets can be found below.

Context	Strength	Link
MedicationRequest.category	extensible	https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationRequestCategory
MedicationRequest.medication[x]	preferred	https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationCode
MedicationRequest.courseOfTherapyType	extensible	https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationRequestCourseOfTherapy
MedicationRequest.dosageInstruction.site	preferred	https://fhir.hl7.org.uk/ValueSet/UKCore-BodySite
MedicationRequest.dosageInstruction.route	preferred	https://fhir.hl7.org.uk/ValueSet/UKCore-SubstanceOrProductAdministrationRoute
MedicationRequest.dosageInstruction.method	preferred	https://fhir.hl7.org.uk/ValueSet/UKCore-MedicationDosageMethod

`status`

Important

It is expected that most implementations will require the use of status to support workflow.

The scope of MedicationRequest.status MAY vary depending on the nature of the implementation. The FHIR standard defines the MedicationRequest.status of completed as “All actions that are implied by the prescription have occurred”.

This allows for different design decisions for tracking a medication request status.

An implementation MAY track the MedicationRequest.status through to the receipt of the medication request at the pharmacy, after which the MedicationRequest.status is completed
An implementation MAY track the MedicationRequest.status through to completion of dispensing events, after which the MedicationRequest.status is completed
An implementation MAY track the MedicationRequest.status through to completion of administration events for the medication that has been dispensed, after which the MedicationRequest.status is completed.

The following guidance is based on an implementation tracking the status through to completion of dispensing events.

Status	FHIR Definition	Implementation Guidance
`draft`	The prescription is not yet "actionable", e.g. it is a work in progress, requires sign-off, verification or needs to be run through decision support process.	The order is work in progress within the ePMA system and has not yet sent to the pharmacy.
`active`	The prescription is "actionable", but not all actions that are implied by it have occurred yet.	The order has been sent and accepted by the pharmacy. Dispensing and administration activities may have been started but are not yet `Complete`.
`completed`	All actions that are implied by the prescription have occurred.	Dispensing activities have been completed for the medication defined within the order.
`on-hold`	Actions implied by the prescription are to be temporarily halted but are expected to continue later. May also be called `Suspended`.	Will prevent the order being sent to the pharmacy. If already sent, an update needs to be sent to the pharmacy to temporarily halt further dispensing.
`cancelled`	The prescription has been withdrawn before any administrations have occurred.	Will prevent the order being sent to the pharmacy. If already sent, an update needs to be sent to the pharmacy so that no further medication is dispensed.
`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.	The order needs to be stopped on clinical grounds. An update needs to be sent to the pharmacy so that no further medication is dispensed.
`entered-in-error`	Some of the actions that are implied by the medication request may have occurred. For example, the medication may have been dispensed and the patient may have taken some of the medication. Clinical decision support systems SHOULD take this status into account.	The order needs to be stopped due to human data entry error. An update needs to be sent to the pharmacy so that no further medication is dispensed.
`unknown`	The authoring/source system does not know which of the status values currently applies for this observation. Note: This concept is not to be used for ‘other’ - one of the listed statuses is presumed to apply, but the authoring/source system does not know which.	Recommended not to be supported as the use case for this status value is unclear.

Logical `MedicationRequest` status transitions

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

Status transitions explained

Previous	Future	Interoperability Recommendation
`draft`	`active`	This transition will trigger the sending / sharing of the MedicationRequest from the prescribing system to the pharmacy system to start dispensing activities.
`draft`	`cancelled`	Contained within the prescribing system.
`draft`	`on-hold`	Contained within the prescribing system.
`draft`	`entered-in-error`	Contained within the prescribing system.
`on-hold`	`draft`	Contained within the prescribing system.
`on-hold`	`active`	This transition will trigger an update to the `MedicationRequest` from the prescribing system to the pharmacy system to restart dispensing activities.
`on-hold`	`cancelled`	Contained within the prescribing system.
`on-hold`	`stopped`	Contained within the prescribing system.
`on-hold`	`entered-in-error`	Contained within the prescribing system.
`active`	`active`	Not a MedicationRequest status transition but the pharmacy system could send / share dispensing activities with the prescribing system, typically using a FHIR profile based on `MedicationDispense`.
`active`	`on-hold`	This transition will trigger an update to the `MedicationRequest` from the prescribing system to the pharmacy system to suspend dispensing activities. If dispensing has already occurred but meds have not been delivered to the ward then they can stay within the pharmacy until the request is re-activated. If meds have been delivered to the ward then there is no action required by the pharmacy system.
`active`	`entered-in-error`	This transition will trigger an update to the `MedicationRequest` from the prescribing system to the pharmacy system to stop dispensing activities.
`active`	`stopped`	This transition will trigger an update to the `MedicationRequest` from the prescribing system to the pharmacy system to stop dispensing activities.
`active`	`completed`	Contained within the prescribing system. All requested medication has been received from pharmacy and has been recorded / confirmed within the ePMA system.

`statusReason`

A coded reason for the current state of the medication request.

SHOULD only be populated when the MedicationRequest.status is on-hold, cancelled or stopped.

`intent`

The value order SHOULD be used to denote this is a medication request order.

`category`

It is expected that any implementation will need to distinguish between medication orders for processes for dispensing and / or administration so this element is business required.

Category values mapped to target use-cases

Example use cases for each category:

Category	Use-case	Scenario
`inpatient`	Inpatient medication requests, for a named patient, to be dispensed by the hospital pharmacy and intended for administration on a hospital ward.	Patient Anne Teak is admitted as an inpatient is prescribed Amoxicillin 500mg orally three times daily for a suspected chest infection.
`leave`	Medication requests, for a named patient who is on short-term leave from an inpatient stay (but is not discharged), to be dispensed by the hospital pharmacy and intended for administration at home.	Current inpatient Jackie Taitor is going home for weekend leave and is prescribed 3 days supply of Citalopram 20mg tablets one to be taken in the morning.
`discharge`	Discharge medications requests, for a named patient, to be dispensed by the hospital pharmacy and issued on discharge for administration at home.	Patient Bill Ding is discharged from hospital following an admission where they were diagnosed as being diabetic. They were prescribed 4 weeks quantity of Metformin 500mg tablets to take twice daily on an on-going basis. Their GP will be instructed to continue this course of medication within a discharge note.
`outpatient`	Outpatient medication requests, for a named patient, to be dispensed by the hospital pharmacy and intended for administration in the Outpatients department, Accident and Emergency department, or Day unit.	Patient Moe DeGrasse is prescribed a Goserelin 3.6mg implant to be administered by IM injection in the Outpatients department on 1st May 2020.
`community`	Outpatient medication requests, for a named patient, to be dispensed by the hospital pharmacy for administration at home.	Patient Lorna Mower has attended the dermatology outpatients clinic and is prescribed Betamethasone 0.1% cream to be applied sparingly twice daily for 2 weeks.

Note: A community medication request would trigger the printing and signing of a paper FP10HNC prescription, or (when implemented by the Trust) an electronic prescription sent to the NHS Electronic Prescription Service.

`priority`

Recommendation: not to be used within an implementation - or used with caution.

The stating of a priority, in any business context including healthcare, is often de-valued as given the choice, every clinician wants medication urgently for their patients.

If MedicationRequest.priority is used, consider only initially supporting the routine and urgent request priorities, and set clear criteria for when a MedicationRequest should be marked and handled as urgent.

Usage of the value "stat"

The stat request priority is potentially confusing as it has two meanings:

to indicate a "here and now" order going to pharmacy
used within a MedicationRequest.dosageInstruction can also mean "give once immediately".

Avoid using stat and asap where possible.

`doNotPerform`

At this time it is advised that providers to not support this element within an implementation.

Consumers SHALL check the value of this element prior to processing and, if MedicationRequest.doNotPerform is true, either appropriately process doNotPerform MedicationRequests (e.g. notify the user) or reject the resource.

`medication[x]`

Medication WITH dm+d code

Where a dm+d code exists it SHALL be used either as MedicationRequest.medicationCodeableConcept.coding or as MedicationRequest.medicationReference.Medication.code

Where CodeableConcept is used, MedicationRequest.medicationCodeableConcept.coding is the dm+d code and MedicationRequest.medicationCodeableConcept.text is dm+d concept name/description.

Can be either a dm+d code as a CodeableConcept or reference to UK Core Profile UKCore-Medication resource. Using a CodeableConcept is preferred unless additional data if required that would be contained within a UK Core Profile UKCore-Medication resource.

The elements MedicationRequest.medicationCodeableConcept.coding and MedicationRequest.medicationReference.Medication.code are both bound to ValueSet UKCore-MedicationCode

Examples where a reference to a UK Core Profile UKCore-Medication would be applicable include:

Record a VTM with a specific form
Record manufacturer with a concept as described in ValueSet UKCore-MedicationCode
Record batch number
Record ingredients (for example with a magisterial prescription or an excipient).

Medication WITHOUT dm+d code

Medication not published within the dm+d may be requested in the Acute care setting.

In this scenario it is recommended to use the MedicationRequest.medicationCodeableConcept variant for this element.

If the prescribing system has both a locally assigned code and description for the medication then;

The MedicationRequest.medicationCodeableConcept.text SHOULD be the description for the medication.
The MedicationRequest.medicationCodeableConcept.coding.code SHOULD be the code for the medication.
The MedicationRequest.medicationCodeableConcept.coding.display SHOULD be the description for the medication, i.e. the same value as MedicationRequest.medicationCodeableConcept.text.

If the prescribing system only has a description for the medication then;

The MedicationRequest.medicationCodeableConcept.text SHOULD be the locally assigned description for the medication.

`subject`

Where possible, it is expected that the resource being referenced SHOULD conform to one of the following UK Core profiles:

`encounter`

Encounter created as part of encounter/admission/stay by reference to the encounter. Where possible, it is expected that the resource being referenced SHOULD conform to Profile UKCore-Encounter

`supportingInformation`

Where a UK Core profile exists, the resource being referenced SHOULD conform to the profile.

Some examples of use include:

Reference an Observation resource to share data like the patient’s height and weight.
Reference a Condition resource to share a patient’s condition if this influences the pharmacy dispensing process. For example; 105502003 Dependence on renal dialysis (finding) or 46177005 End stage renal disease (disorder) would justify an unusual dosage on a prescription.
Reference an AllergyIntolerance resource to share a patient’s allergy to make it clear why certain medication is being requested. For example, a Penicillin allergy.
Reference a CarePlan resource where medication dispensing is considered as part of a specific treatment regimen. For example, care plans for stroke patients.

`authoredOn`

SHOULD be populated with the date and time that the medication request was authored.

`requester`

A business required element identifying the clinically qualified human prescriber referenced by a Practitioner or PractitionerRole resource. They may be other possible references depending on the use case the full list is below.

Where possible, it is expected that the resource being referenced SHOULD conform to one of the following UK Core profiles:

`performer`

Intended performer of administration by reference.

Where possible, it is expected that the resource being referenced SHOULD conform to one of the following UK Core profiles:

`recorder`

The identification of the MedicationRequest.recorder where this is a different person to the MedicationRequest.requester provides an additional point of contact for any queries related to the medication request and is done by a reference.

Where possible, it is expected that the resource being referenced SHOULD conform to one of the following UK Core profiles:

`reasonCode`

Useful to the wider clinical team as an additional safety check, especially if the requested medication is normally prescribed for different reasons, to avoid confusion between clinical teams. Recording an indication against a medication request also gives valuable insight when data is collated for secondary uses, especially if linked with outcome data.

Where possible this SHOULD be a coded term from the SNOMED CT hierarchy as a descendant of the concept 404684003 (Clinical finding); however, free-text reasons are also acceptable.

`reasonReference`

Reference to Condition or Observation that supports why the prescription is being written by reference.

Where possible, it is expected that the resource being referenced SHOULD conform to one of the following UK Core profiles:

If the clinical system has recorded the reason for medication (often known as the indication) as either a Condition or Observation resource then a logical link to that resource has business benefit.

`basedOn`

Where possible, it is expected that the resource being referenced SHOULD conform to one of the following UK Core profiles:

Recommendation: To reference a previous medication request use MedicationRequest.priorPrescription instead of this element.

If the clinical system has implemented the CarePlan resource, a logical link to the care plan for which the medication request is based has business benefit.

`groupIdentifier`

Gives the ability to logically link/group medication requests.

For example, the FHIR interface for the NHS England Electronic Prescription Service uses the MedicationRequest.groupIdentifier to group medication requests for the same patient and prescribed at the same time.

`courseOfTherapyType`

An element defining the course of therapy, such as 'continuous' or 'acute'.

`note`

Use when the prescriber wishes to provide supporting textual information to the dispenser.

Important

This element SHALL NOT be used for dosing instructions.

`dosageInstruction`

Consider aligning to the Implementation Guide for Digital Medicines, but as a minimum, MedicationRequest.dosageInstruction.text.

Where a structured dosage is provided, populate MedicationRequest.dosageInstruction.text with a human readable dosage string that is clinically equivalent to the coded dosage instruction. This is for interoperability with consuming systems that do not yet support fully structured dosing instructions.

`dispenseRequest`

Used to convey specific dispensing requests to the pharmacy that are not otherwise detailed within the MedicationRequest.dosageInstruction.

For most medication requests the hospital pharmacy will typically dispense a quantity of medication appropriate for the medication and dosage, as per their local agreed best practice, to balance the quantity of medication held in pharmacy to that held on the ward.

The inclusion of a MedicationRequest.dispenseRequest MAY be useful when requesting discharge medication requests.

Use Case	Original Medication	Discharge Medication	dispense Request
Instruction to the pharmacy to dispense a specific quantity of medication, either expressed as a number of days or as a dose form quantity.	Paracetamol - 1g - four times a day	Paracetamol - 1g - four times a day One week supplied on discharge.	7 days or 28 tablets
Any inpatient scenario where the pharmacy is instructed to dispense a specific quantity of medication. For example, if the patient is known to be discharged soon.	Atenolol - 50mg - daily	Atenolol - 50mg - daily Two weeks supplied on discharge, GP to continue.	14 days or 14 tablets

`dispenseRequest.validityPeriod`

In electronic repeat dispensing, the MedicationRequest.dispenseRequest.validityPeriod.end is used to record when an eRD prescription cycle ends. This is different to the extension medicationRepeatInformation.authorisationExpiryDate which is the date the prescriber must review the prescription with the patient.

`substitution`

Important

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.

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.

Within UK Core this element is mandatory and SHOULD have a boolean value of false to denote that substitution is not allowed, unless substitution can occur in a specific case.

Allowing substitution

Where substitution to be be allowed, set to true. The inclusion of the coded reason is optional as the ValueSet defined in FHIR is of limited benefit to UK healthcare.

`priorPrescription`

A reference to previous request.

Where possible, it is expected that the resource being referenced SHOULD conform to Profile UKCore-MedicationRequest.

Useful when the clinical system would benefit from being able to link re-supply requests with a previous request.

`eventHistory`

A list of events of interest in the lifecycle and SHOULD conform to UKCore-Provenance (draft).

StructureDefinition UKCore-MedicationRequest

Detailed Descriptions

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Feedback

Examples

Example Usage Scenarios

Profile Specific Implementation Guidance:

Mandatory and Must Support Data Elements

Extensions

Bindings (differential)

status

Important

Logical MedicationRequest status transitions

Status transitions explained

statusReason

intent

category

Category values mapped to target use-cases

priority

Usage of the value "stat"

doNotPerform

medication[x]

Medication WITH dm+d code

Medication WITHOUT dm+d code

subject

encounter

supportingInformation

authoredOn

requester

performer

recorder

reasonCode

reasonReference

basedOn

groupIdentifier

courseOfTherapyType

note

Important

dosageInstruction

dispenseRequest

dispenseRequest.validityPeriod

substitution

Important

Allowing substitution

priorPrescription

eventHistory

`status`

Logical `MedicationRequest` status transitions

`statusReason`

`intent`

`category`

`priority`

`doNotPerform`

`medication[x]`

`subject`

`encounter`

`supportingInformation`

`authoredOn`

`requester`

`performer`

`recorder`

`reasonCode`

`reasonReference`

`basedOn`

`groupIdentifier`

`courseOfTherapyType`

`note`

`dosageInstruction`

`dispenseRequest`

`dispenseRequest.validityPeriod`

`substitution`

`priorPrescription`

`eventHistory`