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D.4.1.4 StructureDefinition: DAF-MedicationOrder - Detailed Descriptions

Definitions for the daf-core-medicationorder Profile.

MedicationOrder(DAFCoreMedicationOrder)
Definition

An order for both supply of the medication and the instructions for administration of the medication to a patient. The resource is called "MedicationOrder" rather than "MedicationPrescription" to generalize the use across inpatient and outpatient settings as well as for care plans, etc.

Control0..*
Alternate NamesPrescription
Comments

The WG will be updating the MedicationOrder resource to adjust each affected resource to align with the workflow pattern (see workflow.html). MedicationOrder will be renamed to MedicationRequest as part of these changes.

InvariantsDefined on this element
dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (xpath: not(parent::f:contained and f:text))
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (xpath: not(parent::f:contained and f:contained))
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (xpath: not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat('#', $id))])))
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (xpath: not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated)))
MedicationOrder.id
Definition

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

Control0..1
Typeid
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.

MedicationOrder.meta
Definition

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

Control0..1
TypeMeta
MedicationOrder.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.

Control0..1
Typeuri
Is Modifiertrue
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 as much as possible.

MedicationOrder.language
Definition

The base language in which the resource is written.

Control0..1
BindingA human language.
The codes SHALL be taken from Common Languages; other codes may be used where these codes are not suitable
Typecode
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).

MedicationOrder.text
Definition

A human-readable narrative that contains a summary of the resource, and may 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.

Control0..1 This element is affected by the following invariants: dom-1
TypeNarrative
Alternate Namesnarrative, 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 in formation is added later.

MedicationOrder.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.

Control0..*
TypeResource
Alternate Namesinline 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.

MedicationOrder.extension
Definition

May be used to represent additional information that is not part of the basic definition of the resource. In order 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.

Control0..*
TypeExtension
Alternate Namesextensions, 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.

MedicationOrder.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. Usually modifier elements provide negation or qualification. In order 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.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, 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.

MedicationOrder.identifier
Definition

External identifier - one that would be used by another non-FHIR system - for example a re-imbursement system might issue its own id for each prescription that is created. This is particularly important where FHIR only provides part of an entire workflow process where records have to be tracked through an entire system.

NoteThis is a business identifer, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
MedicationOrder.definition
Definition

Protocol or definition followed by this request.

Control0..*
TypeReference(Resource)
MedicationOrder.basedOn
Definition

Plan/proposal/order fulfilled by this request.

Control0..*
TypeReference(Resource)
MedicationOrder.requisition
Definition

Composite request this is part of.

Control0..1
TypeIdentifier
MedicationOrder.status
Definition

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

Control1..1
BindingA code specifying the state of the prescribing event. Describes the lifecycle of the prescription.
The codes SHALL be taken from MedicationOrderStatus
Typecode
Is Modifiertrue
Must Supporttrue
MedicationOrder.stage
Definition

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

Control1..1
BindingThe kind of medication order
For example codes, see MedicationOrderStage
TypeCodeableConcept
Is Modifiertrue
MedicationOrder.medication[x]
Definition

Identifies the medication being administered. 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.

Control1..1
BindingPrescribable medications
The codes SHALL be taken from Medication Clinical Drug (RxNorm); other codes may be used where these codes are not suitable
TypeChoice of: CodeableConcept, Reference(Profile daf-core-medication)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
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. Note: do not use Medication.name to describe the prescribed medication. When the only available information is a text description of the medication, Medication.code.text should be used.

MedicationOrder.patient
Definition

A link to a resource representing the person to whom the medication will be given.

Control1..1
TypeReference(Profile daf-core-patient)
Must Supporttrue
Comments

SubstanceAdministration->subject->Patient.

MedicationOrder.encounter
Definition

A link to a resource that identifies the particular occurrence of contact between patient and health care provider.

Control0..1
TypeReference(Encounter)
Comments

SubstanceAdministration->component->EncounterEvent.

MedicationOrder.supportingInformation
Definition

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

Control0..*
TypeReference(Resource)
MedicationOrder.dateWritten
Definition

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

Control1..1
TypedateTime
Must Supporttrue
MedicationOrder.prescriber
Definition

The healthcare professional responsible for authorizing the initial prescription.

Control1..1
TypeReference(DAF Practitioner)
Must Supporttrue
MedicationOrder.reasonCode
Definition

Can be the reason or the indication for writing the prescription.

Control0..*
BindingA coded concept indicating why the medication was ordered.
For example codes, see Condition/Problem/Diagnosis Codes
TypeCodeableConcept
Comments

This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonReference.

MedicationOrder.reasonReference
Definition

Condition or observation that supports why the prescription is being written.

Control0..*
TypeChoice of: Reference(Condition), Reference(Observation)
Comments

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

MedicationOrder.note
Definition

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

Control0..*
TypeAnnotation
MedicationOrder.category
Definition

Indicates where type of medication order and where the medication is expected to be consumed or administered.

Control0..1
BindingA coded concept identifying where the medication ordered is expected to be consumed or administered
For example codes, see MedicationOrderCategory
Typecode
MedicationOrder.dosageInstruction
Definition

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

Control0..*
TypeDosageInstruction
MedicationOrder.dispenseRequest
Definition

Indicates the specific details for the dispense or medication supply part of a medication order (also known as a Medication Prescription). 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.

Control0..1
TypeBackboneElement
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (xpath: @value|f:*|h:div)
MedicationOrder.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.

Control0..1
Typestring
MedicationOrder.dispenseRequest.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

Control0..*
TypeExtension
Alternate Namesextensions, 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.

MedicationOrder.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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content, modifiers
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.

MedicationOrder.dispenseRequest.validityPeriod
Definition

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

Control0..1
TypePeriod
Requirements

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

Comments

It reflects the prescriber 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.

MedicationOrder.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.

Control0..1
TypepositiveInt
Comments

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

MedicationOrder.dispenseRequest.quantity
Definition

The amount that is to be dispensed for one fill.

Control0..1
TypeQuantity(SimpleQuantity)
MedicationOrder.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.

Control0..1
TypeDuration
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.

MedicationOrder.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, and in others it does not matter. This block explains the prescriber's intent. If nothing is specified substitution may be done.

Control0..1
TypeBackboneElement
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (xpath: @value|f:*|h:div)
MedicationOrder.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.

Control0..1
Typestring
MedicationOrder.substitution.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

Control0..*
TypeExtension
Alternate Namesextensions, 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.

MedicationOrder.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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content, modifiers
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.

MedicationOrder.substitution.allowed
Definition

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

Control1..1
Typeboolean
MedicationOrder.substitution.reason
Definition

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

Control0..1
BindingA coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
For example codes, see SubstanceAdminSubstitutionReason
TypeCodeableConcept
MedicationOrder.priorPrescription
Definition

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

Control0..1
TypeReference(MedicationOrder)
MedicationOrder.eventHistory
Definition

A summary of the events of interest that have occurred as the request is processed; e.g. when the order was verified or when it was completed.

Control0..*
TypeReference(Provenance)
Comments

See usage notes in Request pattern in request history.