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D.4.1.4 StructureDefinition: DAF-MedicationStatement - Detailed Descriptions

Definitions for the daf-core-medicationstatement Profile.

MedicationStatement(DAFCoreMedicationStatement)
Definition

Statement that a medication is/was actively taken by a patient.

Control0..*
Comments

The WG will be updating the MedicationStatement resource to adjust each affected resource to align with the workflow pattern (see workflow.html).

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)))
mst-1: Reason not taken is only permitted if notTaken is Yes (xpath: not(exists(f:reasonNotTaken) and (f:notTaken/@value='N' or f:notTaken/@value='UNK')))
mst-2: Reason for use code is only permitted if notTaken is No (xpath: not(exists(*[starts-with(local-name(.), 'reasonForUseCode')]) and (f:notTaken/@value='Y' or f:notTaken/@value='UNK')))
mst-3: Reason for use reference is only permitted if notTaken is No (xpath: not(exists(*[starts-with(local-name(.), 'reasonForUseReference')]) and (f:notTaken/@value='Y' or f:notTaken/@value='UNK')))
MedicationStatement.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.

MedicationStatement.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
MedicationStatement.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.

MedicationStatement.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).

MedicationStatement.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.

MedicationStatement.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.

MedicationStatement.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.

MedicationStatement.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.

MedicationStatement.identifier
Definition

External identifier - FHIR will generate its own internal identifiers (probably URLs) which do not need to be explicitly managed by the resource. The identifier here is one that would be used by another non-FHIR system - for example an automated medication pump would provide a record each time it operated; an administration while the patient was off the ward might be made with a different system and entered after the event. Particularly important if these records have to be updated.

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

A code representing the patient or other source's judgment about the state of the medication used that this statement is about. Generally this will be active or completed.

Control1..1
BindingA set of codes indicating the current status of a MedicationStatement.
The codes SHALL be taken from MedicationStatementStatus
Typecode
Is Modifiertrue
Must Supporttrue
Comments

MedicationStatement is a statement at a point in time. The status is only representative at the point when it was asserted.

MedicationStatement.medication[x]
Definition

Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple 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 medication this statement concerns. When the only available information is a text description of the medication, Medication.code.text should be used.

MedicationStatement.patient
Definition

The person or animal who is/was taking the medication.

Control1..1
TypeReference(Profile daf-core-patient)
Must Supporttrue
MedicationStatement.effective[x]
Definition

The interval of time during which it is being asserted that the patient was taking the medication (or was not taking, when the wasNotGiven element is true).

Control1..1
TypeChoice of: dateTime, Period
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
Comments

If the medication is still being taken at the time the statement is recorded, the "end" date will be omitted.

MedicationStatement.informationSource
Definition

The person or organization that provided the information about the taking of this medication. Note: Use derivedFrom when a MedicationStatement is derived from other resources, e.g Claim or MedicationOrder.

Control0..1
TypeChoice of: Reference(Patient), Reference(Practitioner), Reference(RelatedPerson), Reference(Organization)
MedicationStatement.derivedFrom
Definition

Allows linking the MedicationStatement to the underlying MedicationOrder, or to other information that supports or is used to derive the MedicationStatement.

Control0..*
TypeReference(Resource)
Comments

Likely references would be to MedicationOrder, MedicationDispense, Claim, Observation or QuestionnaireAnswers.

MedicationStatement.dateAsserted
Definition

The date when the medication statement was asserted by the information source.

Control0..1
TypedateTime
MedicationStatement.notTaken
Definition

Indicator of the certainty of whether the medication was taken by the patient.

Control0..1
BindingA coded concept identifying level of certainty if patient has taken or has not taken the medication
The codes SHALL be taken from MedicationStatementNotTaken
Typecode
Is Modifiertrue
MedicationStatement.reasonNotTaken
Definition

A code indicating why the medication was not taken.

Control0..* This element is affected by the following invariants: mst-1
BindingA coded concept indicating the reason why the MedicationStatement is negated.
TypeCodeableConcept
MedicationStatement.reasonForUseCode
Definition

A reason for why the medication is being/was taken.

Control0..*
BindingA coded concept identifying why the medication is being taken.
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 reasonForUseReference.

MedicationStatement.reasonForUseReference
Definition

Condition that supports why the medication is being/was taken.

Control0..*
TypeReference(Condition)
Comments

This is a reference to a condition that is the reason why the medication is being/was taken. If only a code exists, use reasonForUseCode.

MedicationStatement.note
Definition

Provides extra information about the medication statement that is not conveyed by the other attributes.

Control0..*
TypeAnnotation
MedicationStatement.category
Definition

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

Control0..1
BindingA coded concept identifying where the medication included in the is expected to be consumed or administered
For example codes, see MedicationStatementCategory
Typecode
MedicationStatement.dosage
Definition

Indicates how the medication is/was used by the patient.

Control0..*
TypeDosageInstruction