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        CDC National Healthcare Safety Network (NHSN) Digital Quality Measures (dQM) Content Package IG
        2.0.0 - Release 2 US

        This page is part of the NHSN Digital Quality Measures (dQM) Content Package Implementation Guide (v2.0.0: Release) based on FHIR (HL7? FHIR? Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

        Resource Profile: AcuteCareHospitalDailyEventMedicationRequest - Detailed Descriptions

        Page standards status: Trial-use Maturity Level: 2

        Definitions for the ach-daily-medicationrequest resource profile.

        Guidance on how to interpret the contents of this table can be foundhere

        0. 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.

        Short Ordering of medication for patient or group
        Comments

        -

        Control 0..*
        Is Modifier false
        Must Support false
        Summary false
        Alternate Names Prescription, Order
        Invariants dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
        dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
        dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
        dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
        dom-6: A resource should have narrative for robust management (text.`div`.exists())
        us-core-21: requester SHALL be present if intent is "order" ((intent='order' or intent='original-order' or intent='reflex-order'or intent='filler-order' or intent='instance-order') implies requester.exists())
        2. MedicationRequest.id
        Definition

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

        Short icon Changed:(NHSN-MS) Logical id of this artifactLogical id of this artifact
        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.

        Control 10..1
        Type idstring
        Is Modifier false
        Must Support icon Added:true
        Summary true
        4. 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.

        Short A set of rules under which this content was created
        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.

        Control 0..1
        Type uri
        Is Modifier true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
        Primitive Value This primitive element may be present, or absent, or replaced by an extension
        Summary true
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        6. 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).

        Short Extensions that cannot be ignored
        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.

        Control 0..*
        Type Extension
        Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
        Summary false
        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.

        Alternate Names extensions, user content
        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())
        8. MedicationRequest.status
        Definition

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

        Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknownactive | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
        Comments

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

        Control 1..1
        Binding The codes SHALL be taken from medicationrequest Statushttp://hl7.org/fhir/ValueSet/medicationrequest-status|4.0.1
        (required to http://hl7.org/fhir/ValueSet/medicationrequest-status)

        A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.


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

        Type code
        Is Modifier true because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
        Primitive Value This primitive element may be present, or absent, or replaced by an extension
        Must Support true
        Summary true
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        10. MedicationRequest.intent
        Definition

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

        Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) proposal | plan | order | original-order | reflex-order | filler-order | instance-order | optionproposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
        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.

        Control 1..1
        This element is affected by the following invariants: us-core-21
        Binding The codes SHALL be taken from medicationRequest Intenthttp://hl7.org/fhir/ValueSet/medicationrequest-intent|4.0.1
        (required to http://hl7.org/fhir/ValueSet/medicationrequest-intent)

        The kind of medication order.

        Type code
        Is Modifier true because This element changes the interpretation of all descriptive attributes. For example "the time the request is recommended to occur" vs. "the time the request is authorized to occur" or "who is recommended to perform the request" vs. "who is authorized to perform the request
        Primitive Value This primitive element may be present, or absent, or replaced by an extension
        Must Support true
        Summary true
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        12. 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)).

        Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Type of medication usageType of medication usage
        Comments

        The category can be used to include where the medication is expected to be consumed or other types of requests.

        Control 0..*
        Binding Unless not suitable, these codes SHALL be taken from For example codes, see medicationRequest Category Codeshttp://hl7.org/fhir/ValueSet/medicationrequest-category|4.0.1
        (extensible to http://hl7.org/fhir/ValueSet/medicationrequest-category)
        Type CodeableConcept
        Is Modifier false
        Must Support true
        Summary false
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        Slicing This element introduces a set of slices on MedicationRequest.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • pattern @ $this
        • 14. MedicationRequest.category:us-core
          Slice Name us-core
          Definition

          Indicates the type of medication request (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)).

          Short (NHSN-MS)(USCDI) Type of medication usageType of medication usage
          Comments

          The category can be used to include where the medication is expected to be consumed or other types of requests.

          Control 0..*
          Binding The codes SHALL be taken from For example codes, see medicationRequest Category Codeshttp://hl7.org/fhir/ValueSet/medicationrequest-category|4.0.1
          (required to http://hl7.org/fhir/ValueSet/medicationrequest-category)

          The type of medication order. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets


          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.

          Type CodeableConcept
          Is Modifier false
          Must Support true
          Summary false
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          16. MedicationRequest.priority
          Definition

          Indicates how quickly the Medication Request should be addressed with respect to other requests.

          Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) routine | urgent | asap | statroutine | urgent | asap | stat
          Control 0..1
          Binding The codes SHALL be taken from RequestPriorityhttp://hl7.org/fhir/ValueSet/request-priority|4.0.1
          (required to http://hl7.org/fhir/ValueSet/request-priority|4.0.1)

          Identifies the level of importance to be assigned to actioning the request.

          Type code
          Is Modifier false
          Primitive Value This primitive element may be present, or absent, or replaced by an extension
          Must Support true
          Summary true
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          18. MedicationRequest.doNotPerform
          Definition

          If true indicates that the provider is asking for the medication request not to occur.

          Short icon Changed:(NHSN-MS)(QI-Core) True if medication was not requestedTrue if request is prohibiting action
          Comments

          If do not perform is not specified, the request is a positive request e.g. "do perform".

          Control 0..1
          Type boolean
          Is Modifier true because This element is labeled as a modifier because this element negates the request to occur (ie, this is a request for the medication not to be ordered or prescribed, etc)
          Primitive Value This primitive element may be present, or absent, or replaced by an extension
          Must Support true
          Summary true
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          20. 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.

          Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Reported rather than primary recordReported rather than primary record
          Control 0..1
          Type Choice of: boolean, Reference(QICore Practitioner, QICore PractitionerRole, QICore Patient, QICore RelatedPerson, Patient, Practitioner, PractitionerRole, RelatedPerson, Organization)
          [x] Note SeeChoice of Data Typesfor further information about how to use [x]
          Is Modifier false
          Primitive Value This primitive element may be present, or absent, or replaced by an extension
          Must Support true
          Must Support Types Choice of: boolean, Reference
          Summary true
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          22. 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.

          Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Medication to be takenMedication to be taken
          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.

          Control 1..1
          Binding Unless not suitable, these codes SHALL be taken from For example codes, see MedicationClinicalDrug (20240606) .http://hl7.org/fhir/ValueSet/medication-codes|4.0.1
          (extensible to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4|20240606)
          Type Choice of: CodeableConcept, Reference(US Core Medication Profile, Medication)bundled
          [x] Note SeeChoice of Data Typesfor further information about how to use [x]
          Is Modifier false
          Must Support true
          Must Support Types No must-support rules about the choice of types/profiles
          Summary true
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          not-done-extension-present: qicore-notDoneValueSet extension does not exist (extension.where(url='http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet').exists().not())
          Slicing This element introduces a set of slices on MedicationRequest.medication[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
          • type @ $this
          • 24. MedicationRequest.medication[x]:medicationCodeableConcept
            Slice Name medicationCodeableConcept
            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.

            Short (NHSN-MS)(USCDI) Medication to be takenMedication to be taken
            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.

            Control 01..1
            Binding Unless not suitable, these codes SHALL be taken from For example codes, see MedicationClinicalDrug (20240606) .http://hl7.org/fhir/ValueSet/medication-codes|4.0.1
            (extensible to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4|20240606)
            Type CodeableConcept, Reference(Medication)
            [x] Note SeeChoice of Data Typesfor further information about how to use [x]
            Is Modifier false
            Must Support true
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            26. MedicationRequest.medication[x]:medicationCodeableConcept.extension:notDoneValueSet
            Slice Name notDoneValueSet
            Definition

            A logical reference (e.g. a reference to ValueSet.url) to a value set/version that identifies a set of possible coded values representing activities that were not requested, ordered, or performed.

            Short (QI-Core) If not requested, Url of a value set of medications not requested
            Control 0..1
            Type Extension(QICore Not Done ValueSet) (Extension Type: canonical(ValueSet))
            Is Modifier false
            Summary false
            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())
            28. MedicationRequest.medication[x]:medicationReference
            Slice Name medicationReference
            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.

            Short (NHSN-MS)(QI-Core) Medication to be takenMedication to be taken
            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.

            Control 01..1
            Type Reference(ACH Daily Event Medication, Medication)bundled, CodeableConcept
            [x] Note SeeChoice of Data Typesfor further information about how to use [x]
            Is Modifier false
            Must Support true
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            30. MedicationRequest.medication[x]:medicationReference.reference
            Definition

            A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

            Short (NHSN-MS) Literal reference, Relative, internal or absolute URLLiteral reference, Relative, internal or absolute URL
            Comments

            Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

            Control 10..1
            This element is affected by the following invariants: ref-1
            Type string
            Is Modifier false
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Must Support true
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            32. MedicationRequest.subject
            Definition

            A link to a resource representing the person or set of individuals to whom the medication will be given.

            Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Who or group medication request is forWho or group medication request is for
            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.

            Control 1..1
            Type Reference(Cross-Measure Patient Profile, Patient, Group)bundled
            Is Modifier false
            Must Support true
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            34. MedicationRequest.subject.reference
            Definition

            A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

            Short icon Changed:(NHSN-MS) Literal reference, Relative, internal or absolute URLLiteral reference, Relative, internal or absolute URL
            Comments

            Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

            Control 10..1
            This element is affected by the following invariants: ref-1
            Type string
            Is Modifier false
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Must Support true
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            36. MedicationRequest.encounter
            Definition

            The Encounter during which this [x] was created or to which the creation of this record is tightly associated.

            Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Encounter created as part of encounter/admission/stayEncounter created as part of encounter/admission/stay
            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.

            Control 0..1
            Type Reference(QICore Encounter, Encounter)bundled
            Is Modifier false
            Must Support true
            Summary false
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            38. MedicationRequest.encounter.reference
            Definition

            A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

            Short icon Changed:(NHSN-MS) Literal reference, Relative, internal or absolute URLLiteral reference, Relative, internal or absolute URL
            Comments

            Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

            Control 10..1
            This element is affected by the following invariants: ref-1
            Type string
            Is Modifier false
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Must Support true
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            40. MedicationRequest.authoredOn
            Definition

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

            Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) When request was initially authoredWhen request was initially authored
            Control 10..1
            Type dateTime
            Is Modifier false
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Must Support true
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            42. MedicationRequest.requester
            Definition

            The individual, organization, or device that initiated the request and has responsibility for its activation.

            Short icon Changed:(QI-Core)(USCDI) Who/What requested the RequestWho/What requested the Request
            Comments

            Should include QICoreDevice but the base profile does excludes device references.

            Control 0..1
            This element is affected by the following invariants: us-core-21
            Type Reference(QICore Practitioner, QICore PractitionerRole, QICore Patient, Practitioner, PractitionerRole, Organization, Patient, RelatedPerson, Device)
            Is Modifier false
            Must Support true
            Must Support Types No must-support rules about the choice of types/profiles
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            44. MedicationRequest.reasonCode
            Definition

            The reason or the indication for ordering or not ordering the medication.

            Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Reason or indication for ordering or not ordering the medicationReason or 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.

            Control 0..*
            Binding Unless not suitable, these codes SHALL be taken from For example codes, see USCoreConditionCodes (6.1.0)http://hl7.org/fhir/ValueSet/condition-code|4.0.1
            (extensible to http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code|6.1.0)
            Type CodeableConcept
            Is Modifier false
            Must Support true
            Summary false
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            46. MedicationRequest.reasonReference
            Definition

            Condition or observation that supports why the medication was ordered.

            Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) QI-Core Condition or Observation that supports the prescriptionCondition or observation that supports why the prescription is being written
            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.

            Control 0..*
            Type Reference(QICore Condition Encounter Diagnosis, QICore Condition Problems Health Concerns, QICore Simple Observation (Substitute), Condition, Observation)bundled
            Is Modifier false
            Must Support true
            Must Support Types No must-support rules about the choice of types/profiles
            Summary false
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            48. MedicationRequest.reasonReference.reference
            Definition

            A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

            Short icon Changed:(NHSN-MS) Literal reference, Relative, internal or absolute URLLiteral reference, Relative, internal or absolute URL
            Comments

            Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

            Control 10..1
            This element is affected by the following invariants: ref-1
            Type string
            Is Modifier false
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Must Support true
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            50. 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.

            Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Protocol or guideline the order is based onInstantiates FHIR protocol or definition
            Control 0..*
            Type canonical
            Is Modifier false
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Must Support true
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            52. 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.

            Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) External protocol or guideline the order is based onInstantiates external protocol or definition
            Control 0..*
            Type uri
            Is Modifier false
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Must Support true
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            54. MedicationRequest.dosageInstruction
            Definition

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

            Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) How medication should be takenHow the medication should be taken
            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.

            Control 0..*
            Type Dosage
            Is Modifier false
            Must Support true
            Summary false
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            56. 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).

            Short Extensions that cannot be ignored even if unrecognized
            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.

            Control 0..*
            Type Extension
            Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summary true
            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.

            Alternate Names extensions, user content, modifiers
            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())
            58. MedicationRequest.dosageInstruction.text
            Definition

            Free text dosage instructions e.g. SIG.

            Short icon Changed:(USCDI) Free text dosage instructions e.g. SIGFree text dosage instructions e.g. SIG
            Control 0..1
            Type string
            Is Modifier false
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            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.

            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            60. MedicationRequest.dosageInstruction.timing
            Definition

            When medication should be administered.

            Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) When medication should be administeredWhen medication should be administered
            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.

            Control 0..1
            Type Timing
            Is Modifier false
            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.

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

            Short Extensions that cannot be ignored even if unrecognized
            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.

            Control 0..*
            Type Extension
            Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summary true
            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.

            Alternate Names extensions, user content, modifiers
            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())
            64. MedicationRequest.dosageInstruction.timing.event
            Definition

            Identifies specific times when the event occurs.

            Short (NHSN-MS) When the event occursWhen the event occurs
            Control 0..*
            Type dateTime
            Is Modifier false
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Must Support true
            Summary true
            Requirements

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

            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            66. MedicationRequest.dosageInstruction.timing.repeat
            Definition

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

            Short (NHSN-MS)(QI-Core) When the event is to occurWhen the event is to occur
            Control 0..1
            Type Element
            Is Modifier false
            Must Support true
            Summary true
            Requirements

            Many timing schedules are determined by regular repetitions.

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

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

            Short (NHSN-MS)(QI-Core) Length/Range of lengths, or (Start and/or end) limitsLength/Range of lengths, or (Start and/or end) limits
            Control 0..1
            Type Choice of: Duration, Range, Period
            [x] Note SeeChoice of Data Typesfor further information about how to use [x]
            Is Modifier false
            Must Support true
            Must Support Types No must-support rules about the choice of types/profiles
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            70. MedicationRequest.dosageInstruction.timing.repeat.count
            Definition

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

            Short (NHSN-MS) Number of times to repeatNumber of times to repeat
            Comments

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

            Control 0..1
            Type positiveInt
            Is Modifier false
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Must Support true
            Summary true
            Requirements

            Repetitions may be limited by end time or total occurrences.

            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            72. MedicationRequest.dosageInstruction.timing.repeat.countMax
            Definition

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

            Short (NHSN-MS) Maximum number of times to repeatMaximum number of times to repeat
            Control 0..1
            Type positiveInt
            Is Modifier false
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Must Support true
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            74. MedicationRequest.dosageInstruction.timing.repeat.duration
            Definition

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

            Short (NHSN-MS) How long when it happensHow long when it happens
            Comments

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

            Control 0..1
            Type decimal
            Is Modifier false
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Must Support true
            Summary true
            Requirements

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

            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            76. MedicationRequest.dosageInstruction.timing.repeat.durationMax
            Definition

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

            Short (NHSN-MS) How long when it happens (Max)How long when it happens (Max)
            Comments

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

            Control 0..1
            Type decimal
            Is Modifier false
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Must Support true
            Summary true
            Requirements

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

            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            78. MedicationRequest.dosageInstruction.timing.repeat.durationUnit
            Definition

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

            Short (NHSN-MS) s | min | h | d | wk | mo | a - unit of time (UCUM)s | min | h | d | wk | mo | a - unit of time (UCUM)
            Control 0..1
            Binding The codes SHALL be taken from UnitsOfTimehttp://hl7.org/fhir/ValueSet/units-of-time|4.0.1
            (required to http://hl7.org/fhir/ValueSet/units-of-time|4.0.1)

            A unit of time (units from UCUM).

            Type code
            Is Modifier false
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Must Support true
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            80. MedicationRequest.dosageInstruction.timing.repeat.frequency
            Definition

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

            Short (NHSN-MS)(QI-Core) Event occurs frequency times per periodEvent occurs frequency times per period
            Control 0..1
            Type positiveInt
            Is Modifier false
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Must Support true
            Summary true
            Meaning if Missing If no frequency is stated, the assumption is that the event occurs once per period, but systems SHOULD always be specific about this
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            82. MedicationRequest.dosageInstruction.timing.repeat.frequencyMax
            Definition

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

            Short (NHSN-MS)(QI-Core) Event occurs frequencyMax times per periodEvent occurs up to frequencyMax times per period
            Control 0..1
            Type positiveInt
            Is Modifier false
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Must Support true
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            84. MedicationRequest.dosageInstruction.timing.repeat.period
            Definition

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

            Short (NHSN-MS)(QI-Core) Event occurs frequency times per periodEvent occurs frequency times per period
            Control 0..1
            Type decimal
            Is Modifier false
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Must Support true
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            86. MedicationRequest.dosageInstruction.timing.repeat.periodMax
            Definition

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

            Short (NHSN-MS)(QI-Core) Upper limit of period (3-4 hours)Upper limit of period (3-4 hours)
            Control 0..1
            Type decimal
            Is Modifier false
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Must Support true
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            88. MedicationRequest.dosageInstruction.timing.repeat.periodUnit
            Definition

            The units of time for the period in UCUM units.

            Short (NHSN-MS)(QI-Core) s | min | h | d | wk | mo | a - unit of time (UCUM)s | min | h | d | wk | mo | a - unit of time (UCUM)
            Control 0..1
            Binding The codes SHALL be taken from UnitsOfTimehttp://hl7.org/fhir/ValueSet/units-of-time|4.0.1
            (required to http://hl7.org/fhir/ValueSet/units-of-time|4.0.1)

            A unit of time (units from UCUM).

            Type code
            Is Modifier false
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Must Support true
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            90. MedicationRequest.dosageInstruction.timing.repeat.dayOfWeek
            Definition

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

            Short (NHSN-MS) mon | tue | wed | thu | fri | sat | sunmon | tue | wed | thu | fri | sat | sun
            Comments

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

            Control 0..*
            Binding The codes SHALL be taken from DaysOfWeekhttp://hl7.org/fhir/ValueSet/days-of-week|4.0.1
            (required to http://hl7.org/fhir/ValueSet/days-of-week|4.0.1)
            Type code
            Is Modifier false
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Must Support true
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            92. MedicationRequest.dosageInstruction.timing.repeat.timeOfDay
            Definition

            Specified time of day for action to take place.

            Short (NHSN-MS) Time of day for actionTime of day for action
            Comments

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

            Control 0..*
            Type time
            Is Modifier false
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Must Support true
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            94. MedicationRequest.dosageInstruction.timing.repeat.when
            Definition

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

            Short (NHSN-MS) Code for time period of occurrenceCode for time period of occurrence
            Comments

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

            Control 0..*
            Binding The codes SHALL be taken from EventTiminghttp://hl7.org/fhir/ValueSet/event-timing|4.0.1
            (required to http://hl7.org/fhir/ValueSet/event-timing|4.0.1)

            Real world event relating to the schedule.

            Type code
            Is Modifier false
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Must Support true
            Summary true
            Requirements

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

            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            96. MedicationRequest.dosageInstruction.timing.repeat.offset
            Definition

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

            Short (NHSN-MS) Minutes from event (before or after)Minutes from event (before or after)
            Control 0..1
            Type unsignedInt
            Is Modifier false
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Must Support true
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            98. MedicationRequest.dosageInstruction.timing.code
            Definition

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

            Short (NHSN-MS) BID | TID | QID | AM | PM | QD | QOD | +BID | TID | QID | AM | PM | QD | QOD | +
            Comments

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

            Control 0..1
            Binding The codes SHOULD be taken from TimingAbbreviationhttp://hl7.org/fhir/ValueSet/timing-abbreviation|4.0.1
            (preferred to http://hl7.org/fhir/ValueSet/timing-abbreviation|4.0.1)

            Code for a known / defined timing pattern.

            Type CodeableConcept
            Is Modifier false
            Must Support true
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            100. 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).

            Short icon Changed:(NHSN-MS)(QI-Core) Take "as needed" (for x)Take "as needed" (for x)
            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".

            Control 0..1
            Binding For example codes, see SNOMEDCTMedicationAsNeededReasonCodeshttp://hl7.org/fhir/ValueSet/medication-as-needed-reason|4.0.1
            (example to http://hl7.org/fhir/ValueSet/medication-as-needed-reason)

            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.

            Type Choice of: boolean, CodeableConcept
            [x] Note SeeChoice of Data Typesfor further information about how to use [x]
            Is Modifier false
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Must Support true
            Must Support Types No must-support rules about the choice of types/profiles
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            102. MedicationRequest.dosageInstruction.site
            Definition

            Body site to administer to.

            Short icon Changed:(NHSN-MS) Body site to administer toBody site to administer to
            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.

            Control 0..1
            Binding For example codes, see SNOMEDCTAnatomicalStructureForAdministrationSiteCodeshttp://hl7.org/fhir/ValueSet/approach-site-codes|4.0.1
            (example to http://hl7.org/fhir/ValueSet/approach-site-codes)

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

            Type CodeableConcept
            Is Modifier false
            Must Support true
            Summary true
            Requirements

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

            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            104. MedicationRequest.dosageInstruction.route
            Definition

            How drug should enter body.

            Short icon Changed:(NHSN-MS) How drug should enter bodyHow drug should enter body
            Control icon Changed:10..1
            Binding Unless not suitable, these codes SHALL be taken from For example codes, see SNOMEDCTRouteCodeshttp://hl7.org/fhir/ValueSet/route-codes|4.0.1
            (extensible to http://hl7.org/fhir/ValueSet/route-codes)
            Type CodeableConcept
            Is Modifier false
            Must Support true
            Summary true
            Requirements

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

            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            106. MedicationRequest.dosageInstruction.method
            Definition

            Technique for administering medication.

            Short icon Changed:(NHSN-MS) Technique for administering medicationTechnique for administering medication
            Comments

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

            Control 0..1
            Binding For example codes, see SNOMEDCTAdministrationMethodCodeshttp://hl7.org/fhir/ValueSet/administration-method-codes|4.0.1
            (example to http://hl7.org/fhir/ValueSet/administration-method-codes)

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

            Type CodeableConcept
            Is Modifier false
            Must Support true
            Summary true
            Requirements

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

            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            108. MedicationRequest.dosageInstruction.doseAndRate
            Definition

            The amount of medication administered.

            Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Amount of medication administeredAmount of medication administered
            Control 0..*
            Type Element
            Is Modifier false
            Must Support true
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            110. MedicationRequest.dosageInstruction.doseAndRate.type
            Definition

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

            Short icon Changed:(NHSN-MS) The kind of dose or rate specifiedThe kind of dose or rate specified
            Control 0..1
            Binding For example codes, see DoseAndRateTypehttp://hl7.org/fhir/ValueSet/dose-rate-type|4.0.1
            (example to http://hl7.org/fhir/ValueSet/dose-rate-type)

            The kind of dose or rate specified.

            Type CodeableConcept
            Is Modifier false
            Must Support true
            Summary true
            Requirements

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

            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            112. MedicationRequest.dosageInstruction.doseAndRate.dose[x]
            Definition

            Amount of medication per dose.

            Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Amount of medication per doseAmount of medication per dose
            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.

            Control 0..1
            Binding The codes SHOULD be taken from For codes, see Common UCUM units
            (preferred to http://hl7.org/fhir/ValueSet/ucum-common)
            Additional Bindings Purpose
            UCUMCodes Max Binding
            Type Choice of: Quantity(SimpleQuantity), Range
            [x] Note SeeChoice of Data Typesfor further information about how to use [x]
            Is Modifier false
            Must Support true
            Must Support Types QuantityRange
            Summary true
            Requirements

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

            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            114. MedicationRequest.dosageInstruction.doseAndRate.rate[x]
            Definition

            Amount of medication per unit of time.

            Short icon Changed:(NHSN-MS) Amount of medication per unit of timeAmount of medication per unit of time
            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.

            Control 0..1
            Type Choice of: Ratio, Range, Quantity(SimpleQuantity, SimpleQuantity)
            [x] Note SeeChoice of Data Typesfor further information about how to use [x]
            Is Modifier false
            Must Support true
            Must Support Types No must-support rules about the choice of types/profiles
            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.

            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            116. 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.

            Short icon Changed:(QI-Core)(USCDI) Medication supply authorizationMedication supply authorization
            Control 0..1
            Type BackboneElement
            Is Modifier false
            Must Support icon Added:true
            Summary false
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            118. 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).

            Short Extensions that cannot be ignored even if unrecognized
            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.

            Control 0..*
            Type Extension
            Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summary true
            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.

            Alternate Names extensions, user content, modifiers
            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())
            120. MedicationRequest.dispenseRequest.dispenseInterval
            Definition

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

            Short icon Changed:(QI-Core) Minimum period of time between dispensesMinimum period of time between dispenses
            Control 0..1
            Type Duration
            Is Modifier false
            Summary false
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            122. 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.

            Short icon Changed:(QI-Core)(USCDI) Number of refills authorizedNumber of refills authorized
            Comments

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

            Control 0..1
            Type unsignedInt
            Is Modifier false
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Must Support icon Added:true
            Summary false
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            124. MedicationRequest.dispenseRequest.quantity
            Definition

            The amount that is to be dispensed for one fill.

            Short icon Changed:(QI-Core)(USCDI) Amount of medication to supply per dispenseAmount of medication to supply per dispense
            Control 0..1
            Type Quantity(SimpleQuantity, SimpleQuantity)
            Is Modifier false
            Must Support icon Added:true
            Summary false
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            126. 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.

            Short icon Changed:(QI-Core) Number of days supply per dispenseNumber of days supply per dispense
            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.

            Control 0..1
            Type Duration
            Is Modifier false
            Summary false
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

            Guidance on how to interpret the contents of this table can be foundhere

            0. MedicationRequest
            2. MedicationRequest.id
            Short icon Added:(NHSN-MS) Logical id of this artifact
            Control 1..?
            Must Support icon Added:true
            4. MedicationRequest.meta
            6. MedicationRequest.meta.extension:link-received-date-extension
            Slice Name link-received-date-extension
            Control 0..1
            Type Extension(Received Date) (Extension Type: dateTime)
            icon Added: 8. MedicationRequest.status
            Short (NHSN-MS)(QI-Core)(USCDI) active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
            icon Added: 10. MedicationRequest.intent
            Short (NHSN-MS)(QI-Core)(USCDI) proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
            12. MedicationRequest.category
            Short icon Added:(NHSN-MS)(QI-Core)(USCDI) Type of medication usage
            Binding Unless not suitable, these codes SHALL be taken from medicationRequest Category Codes
            (extensible to http://hl7.org/fhir/ValueSet/medicationrequest-category)
            Must Support icon Removed:true
            14. MedicationRequest.category:us-core
            Slice Name us-core
            Short (NHSN-MS)(USCDI) Type of medication usage
            16. MedicationRequest.priority
            Short icon Added:(NHSN-MS)(QI-Core)(USCDI) routine | urgent | asap | stat
            Must Support true
            18. MedicationRequest.doNotPerform
            Short icon Added:(NHSN-MS)(QI-Core) True if medication was not requested
            Must Support true
            20. MedicationRequest.reported[x]
            Short icon Added:(NHSN-MS)(QI-Core)(USCDI) Reported rather than primary record
            Type Choice of: icon Added:boolean, icon Added:Reference(QICore Practitioner, QICore PractitionerRole, QICore Patient, QICore RelatedPerson)
            [x] Note SeeChoice of Data Typesfor further information about how to use [x]
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            22. MedicationRequest.medication[x]
            icon Removed:--. MedicationRequest.reported[x]:reportedReference
            Slice Name reportedReference
            Control 0..1
            Type Reference(US Core Patient Profile, US Core Practitioner Profile, US Core Organization Profile)
            [x] Note SeeChoice of Data Typesfor further information about how to use [x]
            Short icon Added:(NHSN-MS)(QI-Core)(USCDI) Medication to be taken
            Type Choice of: icon Added:CodeableConcept, icon Added:Reference(US Core Medication Profile)bundled
            [x] Note SeeChoice of Data Typesfor further information about how to use [x]
            Invariants icon Added:not-done-extension-present: qicore-notDoneValueSet extension does not exist (extension.where(url='http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet').exists().not())
            Slicing This element introduces a set of slices on MedicationRequest.medication[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • type @ $this
            • icon Added: 24. MedicationRequest.medication[x]:medicationCodeableConcept
              Slice Name medicationCodeableConcept
              Short (NHSN-MS)(USCDI) Medication to be taken
              Control 0..1
              Type CodeableConcept
              [x] Note SeeChoice of Data Typesfor further information about how to use [x]
              Must Support true
              26. MedicationRequest.medication[x]:medicationCodeableConcept.extension:notDoneValueSet
              Slice Name notDoneValueSet
              Short (QI-Core) If not requested, Url of a value set of medications not requested
              Control 0..1
              Type Extension(QICore Not Done ValueSet) (Extension Type: canonical(ValueSet))
              28. MedicationRequest.medication[x]:medicationReference
              Slice Name medicationReference
              Short icon Added:(NHSN-MS)(QI-Core) Medication to be taken
              Control 0..1
              Type Reference(ACH Daily Event Medication)bundled
              [x] Note SeeChoice of Data Typesfor further information about how to use [x]
              Must Support icon Added:true
              30. MedicationRequest.medication[x]:medicationReference.reference
              Short icon Added:(NHSN-MS) Literal reference, Relative, internal or absolute URL
              Control 1..?
              Must Support true
              icon Added: 32. MedicationRequest.subject
              Short (NHSN-MS)(QI-Core)(USCDI) Who or group medication request is for
              Type Reference(Cross-Measure Patient Profile)bundled
              34. MedicationRequest.subject.reference
              Short (NHSN-MS) Literal reference, Relative, internal or absolute URL
              Control 1..?
              Must Support true
              icon Added: 36. MedicationRequest.encounter
              Short (NHSN-MS)(QI-Core)(USCDI) Encounter created as part of encounter/admission/stay
              Type Reference(QICore Encounter)bundled
              38. MedicationRequest.encounter.reference
              Short (NHSN-MS) Literal reference, Relative, internal or absolute URL
              Control 1..?
              Must Support true
              icon Added: 40. MedicationRequest.authoredOn
              Short (NHSN-MS)(QI-Core)(USCDI) When request was initially authored
              Control 1..?
              icon Added: 42. MedicationRequest.requester
              Short (QI-Core)(USCDI) Who/What requested the Request
              Comments

              Should include QICoreDevice but the base profile does excludes device references.

              Type Reference(QICore Practitioner, QICore PractitionerRole, QICore Patient)
              44. MedicationRequest.reasonCode
              Short icon Added:(NHSN-MS)(QI-Core)(USCDI) Reason or indication for ordering or not ordering the medication
              Must Support true
              46. MedicationRequest.reasonReference
              Short icon Added:(NHSN-MS)(QI-Core)(USCDI) QI-Core Condition or Observation that supports the prescription
              Type icon Added:Reference(QICore Condition Encounter Diagnosis, QICore Condition Problems Health Concerns, QICore Simple Observation (Substitute))bundled
              Must Support true
              Must Support Types No must-support rules about the choice of types/profiles
              48. MedicationRequest.reasonReference.reference
              Short icon Added:(NHSN-MS) Literal reference, Relative, internal or absolute URL
              Control 1..?
              Must Support true
              50. MedicationRequest.instantiatesCanonical
              Short icon Added:(NHSN-MS)(QI-Core)(USCDI) Protocol or guideline the order is based on
              Must Support true
              52. MedicationRequest.instantiatesUri
              Short icon Added:(NHSN-MS)(QI-Core)(USCDI) External protocol or guideline the order is based on
              Must Support true
              icon Added: 54. MedicationRequest.dosageInstruction
              Short (NHSN-MS)(QI-Core)(USCDI) How medication should be taken
              56. MedicationRequest.dosageInstruction.timing
              Short (NHSN-MS)(QI-Core)(USCDI) When medication should be administered
              58. MedicationRequest.dosageInstruction.timing.event
              Short (NHSN-MS) When the event occurs
              Must Support true
              60. MedicationRequest.dosageInstruction.timing.repeat
              Short (NHSN-MS)(QI-Core) When the event is to occur
              Must Support true
              62. MedicationRequest.dosageInstruction.timing.repeat.bounds[x]
              Short (NHSN-MS)(QI-Core) Length/Range of lengths, or (Start and/or end) limits
              [x] Note SeeChoice of Data Typesfor further information about how to use [x]
              Must Support true
              64. MedicationRequest.dosageInstruction.timing.repeat.count
              Short (NHSN-MS) Number of times to repeat
              Must Support true
              66. MedicationRequest.dosageInstruction.timing.repeat.countMax
              Short (NHSN-MS) Maximum number of times to repeat
              Must Support true
              68. MedicationRequest.dosageInstruction.timing.repeat.duration
              Short (NHSN-MS) How long when it happens
              Must Support true
              70. MedicationRequest.dosageInstruction.timing.repeat.durationMax
              Short (NHSN-MS) How long when it happens (Max)
              Must Support true
              72. MedicationRequest.dosageInstruction.timing.repeat.durationUnit
              Short (NHSN-MS) s | min | h | d | wk | mo | a - unit of time (UCUM)
              Must Support true
              74. MedicationRequest.dosageInstruction.timing.repeat.frequency
              Short (NHSN-MS)(QI-Core) Event occurs frequency times per period
              Must Support true
              76. MedicationRequest.dosageInstruction.timing.repeat.frequencyMax
              Short (NHSN-MS)(QI-Core) Event occurs frequencyMax times per period
              Must Support true
              78. MedicationRequest.dosageInstruction.timing.repeat.period
              Short (NHSN-MS)(QI-Core) Event occurs frequency times per period
              Must Support true
              80. MedicationRequest.dosageInstruction.timing.repeat.periodMax
              Short (NHSN-MS)(QI-Core) Upper limit of period (3-4 hours)
              Must Support true
              82. MedicationRequest.dosageInstruction.timing.repeat.periodUnit
              Short (NHSN-MS)(QI-Core) s | min | h | d | wk | mo | a - unit of time (UCUM)
              Must Support true
              84. MedicationRequest.dosageInstruction.timing.repeat.dayOfWeek
              Short (NHSN-MS) mon | tue | wed | thu | fri | sat | sun
              Must Support true
              86. MedicationRequest.dosageInstruction.timing.repeat.timeOfDay
              Short (NHSN-MS) Time of day for action
              Must Support true
              88. MedicationRequest.dosageInstruction.timing.repeat.when
              Short (NHSN-MS) Code for time period of occurrence
              Must Support true
              90. MedicationRequest.dosageInstruction.timing.repeat.offset
              Short (NHSN-MS) Minutes from event (before or after)
              Must Support true
              92. MedicationRequest.dosageInstruction.timing.code
              Short (NHSN-MS) BID | TID | QID | AM | PM | QD | QOD | +
              Must Support true
              94. MedicationRequest.dosageInstruction.asNeeded[x]
              Short (NHSN-MS)(QI-Core) Take "as needed" (for x)
              [x] Note SeeChoice of Data Typesfor further information about how to use [x]
              Must Support true
              96. MedicationRequest.dosageInstruction.site
              Short (NHSN-MS) Body site to administer to
              Must Support true
              98. MedicationRequest.dosageInstruction.route
              Short (NHSN-MS) How drug should enter body
              Control 1..?
              Binding Unless not suitable, these codes SHALL be taken from SNOMEDCTRouteCodes
              (extensible to http://hl7.org/fhir/ValueSet/route-codes)
              Must Support true
              100. MedicationRequest.dosageInstruction.method
              Short (NHSN-MS) Technique for administering medication
              Must Support true
              102. MedicationRequest.dosageInstruction.doseAndRate
              Short (NHSN-MS)(QI-Core)(USCDI) Amount of medication administered
              104. MedicationRequest.dosageInstruction.doseAndRate.type
              Short (NHSN-MS) The kind of dose or rate specified
              Must Support true
              106. MedicationRequest.dosageInstruction.doseAndRate.dose[x]
              Short (NHSN-MS)(QI-Core)(USCDI) Amount of medication per dose
              [x] Note SeeChoice of Data Typesfor further information about how to use [x]
              108. MedicationRequest.dosageInstruction.doseAndRate.rate[x]
              Short (NHSN-MS) Amount of medication per unit of time
              [x] Note SeeChoice of Data Typesfor further information about how to use [x]
              Must Support true
              icon Added: 110. MedicationRequest.dispenseRequest
              Short (QI-Core)(USCDI) Medication supply authorization
              112. MedicationRequest.dispenseRequest.dispenseInterval
              Short (QI-Core) Minimum period of time between dispenses
              114. MedicationRequest.dispenseRequest.numberOfRepeatsAllowed
              Short (QI-Core)(USCDI) Number of refills authorized
              116. MedicationRequest.dispenseRequest.quantity
              Short (QI-Core)(USCDI) Amount of medication to supply per dispense
              118. MedicationRequest.dispenseRequest.expectedSupplyDuration
              Short (QI-Core) Number of days supply per dispense
              icon Removed:--. MedicationRequest.subject.reference
              Control 1..?
              Must Support true
              icon Removed:--. MedicationRequest.encounter.reference
              Control 1..?
              Must Support true
              icon Removed:--. MedicationRequest.dosageInstruction.timing
              Must Support true
              icon Removed:--. MedicationRequest.dosageInstruction.asNeeded[x]
              [x] Note SeeChoice of Data Typesfor further information about how to use [x]
              Must Support true
              icon Removed:--. MedicationRequest.dosageInstruction.site
              Must Support true
              icon Removed:--. MedicationRequest.dosageInstruction.route
              Binding Unless not suitable, these codes SHALL be taken from SNOMEDCTRouteCodes
              (extensible to http://hl7.org/fhir/ValueSet/route-codes)
              Must Support true
              icon Removed:--. MedicationRequest.dosageInstruction.method
              Must Support true
              icon Removed:--. MedicationRequest.dosageInstruction.doseAndRate
              Must Support true
              icon Removed:--. MedicationRequest.dosageInstruction.doseAndRate.type
              Must Support true
              icon Removed:--. MedicationRequest.dosageInstruction.doseAndRate.dose[x]
              [x] Note SeeChoice of Data Typesfor further information about how to use [x]
              Must Support true
              icon Removed:--. MedicationRequest.dosageInstruction.doseAndRate.rate[x]
              [x] Note SeeChoice of Data Typesfor further information about how to use [x]
              Must Support true

              Guidance on how to interpret the contents of this table can be foundhere

              0. MedicationRequest
              Definition

              icon Changed:

              -

              Short Ordering of medication for patient or group
              Comments

              icon Added:

              -

              Control 0..*
              Is Modifier false
              Must Support false
              Summary false
              Alternate Names Prescription, Order
              Invariants dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
              dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
              dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
              dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
              dom-6: A resource should have narrative for robust management (text.`div`.exists())
              us-core-21: requester SHALL be present if intent is "order" ((intent='order' or intent='original-order' or intent='reflex-order'or intent='filler-order' or intent='instance-order') implies requester.exists())
              2. MedicationRequest.id
              Definition

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

              Short icon Changed:(NHSN-MS) Logical id of this artifact
              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.

              Control 1..1
              Type id
              Is Modifier false
              Must Support icon Added:true
              Summary true
              4. 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.

              Short Metadata about the resource
              Control 0..1
              Type Meta
              Is Modifier false
              Summary true
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              6. MedicationRequest.meta.id
              Definition

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

              Short Unique id for inter-element referencing
              Control 0..1
              Type string
              Is Modifier false
              XML Format In the XML format, this property is represented as an attribute.
              Summary false
              8. MedicationRequest.meta.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.

              Short Additional content defined by implementations
              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.

              Control 0..*
              Type Extension
              Is Modifier false
              Summary false
              Alternate Names extensions, user content
              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())
              Slicing This element introduces a set of slices on MedicationRequest.meta.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 10. MedicationRequest.meta.extension:link-received-date-extension
                Slice Name link-received-date-extension
                Definition

                This extension stores the date and time a Resource was received by the processing system (e.g., NHSNLink).

                Short Received Date
                Control 0..1
                Type Extension(Received Date) (Extension Type: dateTime)
                Is Modifier false
                Summary false
                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())
                12. MedicationRequest.meta.versionId
                Definition

                The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

                Short Version specific identifier
                Comments

                The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

                Control 0..1
                Type id
                Is Modifier false
                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                Summary true
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                14. MedicationRequest.meta.lastUpdated
                Definition

                When the resource last changed - e.g. when the version changed.

                Short When the resource version last changed
                Comments

                This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

                Control 0..1
                Type instant
                Is Modifier false
                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                Summary true
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                16. MedicationRequest.meta.source
                Definition

                A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

                Short Identifies where the resource comes from
                Comments

                In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.

                This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

                Control 0..1
                Type uri
                Is Modifier false
                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                Summary true
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                18. MedicationRequest.meta.profile
                Definition

                A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

                Short Profiles this resource claims to conform to
                Comments

                It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

                Control 0..*
                Type canonical(StructureDefinition)
                Is Modifier false
                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                Summary true
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                20. MedicationRequest.meta.security
                Definition

                Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

                Short Security Labels applied to this resource
                Comments

                The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

                Control 0..*
                Binding Unless not suitable, these codes SHALL be taken from All Security Labels
                (extensible to http://hl7.org/fhir/ValueSet/security-labels|4.0.1)

                Security Labels from the Healthcare Privacy and Security Classification System.

                Type Coding
                Is Modifier false
                Summary true
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                22. MedicationRequest.meta.tag
                Definition

                Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

                Short Tags applied to this resource
                Comments

                The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

                Control 0..*
                Binding For example codes, see CommonTags
                (example to http://hl7.org/fhir/ValueSet/common-tags|4.0.1)

                Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

                Type Coding
                Is Modifier false
                Summary true
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                24. 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.

                Short A set of rules under which this content was created
                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.

                Control 0..1
                Type uri
                Is Modifier true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                Summary true
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                26. MedicationRequest.language
                Definition

                The base language in which the resource is written.

                Short Language of the resource content
                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).

                Control 0..1
                Binding The codes SHOULD be taken from CommonLanguages
                (preferred to http://hl7.org/fhir/ValueSet/languages)

                A human language.

                Additional Bindings Purpose
                AllLanguages Max Binding
                Type code
                Is Modifier false
                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                Summary false
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                28. 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.

                Short Text summary of the resource, for human interpretation
                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.

                Control 0..1
                Type Narrative
                Is Modifier false
                Summary false
                Alternate Names narrative, html, xhtml, display
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                30. 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.

                Short Contained, inline 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.

                Control 0..*
                Type Resource
                Is Modifier false
                Summary false
                Alternate Names inline resources, anonymous resources, contained resources
                32. 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.

                Short Additional content defined by implementations
                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.

                Control 0..*
                Type Extension
                Is Modifier false
                Summary false
                Alternate Names extensions, user content
                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())
                34. 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).

                Short Extensions that cannot be ignored
                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.

                Control 0..*
                Type Extension
                Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                Summary false
                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.

                Alternate Names extensions, user content
                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())
                36. 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.

                Short External ids for this request
                Comments

                This is a business identifier, not a resource identifier.

                Note This is a business identifier, not a resource identifier (see discussion)
                Control 0..*
                Type Identifier
                Is Modifier false
                Summary false
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                38. MedicationRequest.status
                Definition

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

                Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
                Comments

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

                Control 1..1
                Binding The codes SHALL be taken from medicationrequest Status
                (required to http://hl7.org/fhir/ValueSet/medicationrequest-status)

                A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.

                Type code
                Is Modifier true because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                Must Support true
                Summary true
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                40. MedicationRequest.statusReason
                Definition

                Captures the reason for the current state of the MedicationRequest.

                Short Reason for current status
                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.

                Control 0..1
                Binding For example codes, see medicationRequest Status Reason Codes
                (example to http://hl7.org/fhir/ValueSet/medicationrequest-status-reason)

                Identifies the reasons for a given status.

                Type CodeableConcept
                Is Modifier false
                Summary false
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                42. MedicationRequest.intent
                Definition

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

                Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
                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.

                Control 1..1
                This element is affected by the following invariants: us-core-21
                Binding The codes SHALL be taken from medicationRequest Intent
                (required to http://hl7.org/fhir/ValueSet/medicationrequest-intent)

                The kind of medication order.

                Type code
                Is Modifier true because This element changes the interpretation of all descriptive attributes. For example "the time the request is recommended to occur" vs. "the time the request is authorized to occur" or "who is recommended to perform the request" vs. "who is authorized to perform the request
                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                Must Support true
                Summary true
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                44. 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)).

                Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Type of medication usage
                Comments

                The category can be used to include where the medication is expected to be consumed or other types of requests.

                Control 0..*
                Binding Unless not suitable, these codes SHALL be taken from medicationRequest Category Codes
                (extensible to http://hl7.org/fhir/ValueSet/medicationrequest-category)
                Type CodeableConcept
                Is Modifier false
                Must Support true
                Summary false
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                Slicing This element introduces a set of slices on MedicationRequest.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • pattern @ $this
                • 46. MedicationRequest.category:us-core
                  Slice Name us-core
                  Definition

                  Indicates the type of medication request (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)).

                  Short (NHSN-MS)(USCDI) Type of medication usage
                  Comments

                  The category can be used to include where the medication is expected to be consumed or other types of requests.

                  Control 0..*
                  Binding The codes SHALL be taken from medicationRequest Category Codes
                  (required to http://hl7.org/fhir/ValueSet/medicationrequest-category)

                  The type of medication order. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets

                  Type CodeableConcept
                  Is Modifier false
                  Must Support true
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  48. MedicationRequest.priority
                  Definition

                  Indicates how quickly the Medication Request should be addressed with respect to other requests.

                  Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) routine | urgent | asap | stat
                  Control 0..1
                  Binding The codes SHALL be taken from RequestPriority
                  (required to http://hl7.org/fhir/ValueSet/request-priority|4.0.1)

                  Identifies the level of importance to be assigned to actioning the request.

                  Type code
                  Is Modifier false
                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                  Must Support true
                  Summary true
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  50. MedicationRequest.doNotPerform
                  Definition

                  If true indicates that the provider is asking for the medication request not to occur.

                  Short icon Changed:(NHSN-MS)(QI-Core) True if medication was not requested
                  Comments

                  If do not perform is not specified, the request is a positive request e.g. "do perform".

                  Control 0..1
                  Type boolean
                  Is Modifier true because This element is labeled as a modifier because this element negates the request to occur (ie, this is a request for the medication not to be ordered or prescribed, etc)
                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                  Must Support true
                  Summary true
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  52. 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.

                  Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Reported rather than primary record
                  Control 0..1
                  Type Choice of: boolean, Reference(QICore Practitioner, QICore PractitionerRole, QICore Patient, QICore RelatedPerson)
                  [x] Note SeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifier false
                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                  Must Support true
                  Must Support Types Choice of: boolean, Reference
                  Summary true
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  54. 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.

                  Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Medication to be taken
                  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.

                  Control 1..1
                  Binding Unless not suitable, these codes SHALL be taken from MedicationClinicalDrug (20240606) .
                  (extensible to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4|20240606)
                  Type Choice of: CodeableConcept, Reference(US Core Medication Profile)bundled
                  [x] Note SeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifier false
                  Must Support true
                  Must Support Types No must-support rules about the choice of types/profiles
                  Summary true
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  not-done-extension-present: qicore-notDoneValueSet extension does not exist (extension.where(url='http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet').exists().not())
                  Slicing This element introduces a set of slices on MedicationRequest.medication[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                  • type @ $this
                  • 56. MedicationRequest.medication[x]:medicationCodeableConcept
                    Slice Name medicationCodeableConcept
                    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.

                    Short (NHSN-MS)(USCDI) Medication to be taken
                    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.

                    Control 0..1
                    Binding Unless not suitable, these codes SHALL be taken from MedicationClinicalDrug (20240606) .
                    (extensible to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4|20240606)
                    Type CodeableConcept
                    [x] Note SeeChoice of Data Typesfor further information about how to use [x]
                    Is Modifier false
                    Must Support true
                    Summary true
                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    58. MedicationRequest.medication[x]:medicationCodeableConcept.id
                    Definition

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

                    Short Unique id for inter-element referencing
                    Control 0..1
                    Type string
                    Is Modifier false
                    XML Format In the XML format, this property is represented as an attribute.
                    Summary false
                    60. MedicationRequest.medication[x]:medicationCodeableConcept.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.

                    Short Additional content defined by implementations
                    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.

                    Control 0..*
                    Type Extension
                    Is Modifier false
                    Summary false
                    Alternate Names extensions, user content
                    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())
                    Slicing This element introduces a set of slices on MedicationRequest.medication[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ url
                    • 62. MedicationRequest.medication[x]:medicationCodeableConcept.extension:notDoneValueSet
                      Slice Name notDoneValueSet
                      Definition

                      A logical reference (e.g. a reference to ValueSet.url) to a value set/version that identifies a set of possible coded values representing activities that were not requested, ordered, or performed.

                      Short (QI-Core) If not requested, Url of a value set of medications not requested
                      Control 0..1
                      Type Extension(QICore Not Done ValueSet) (Extension Type: canonical(ValueSet))
                      Is Modifier false
                      Summary false
                      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())
                      64. MedicationRequest.medication[x]:medicationCodeableConcept.coding
                      Definition

                      A reference to a code defined by a terminology system.

                      Short Code defined by a terminology system
                      Comments

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

                      Control 0..*
                      Type Coding
                      Is Modifier false
                      Summary true
                      Requirements

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

                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      66. MedicationRequest.medication[x]:medicationCodeableConcept.text
                      Definition

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

                      Short Plain text representation of the concept
                      Comments

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

                      Control 0..1
                      Type string
                      Is Modifier false
                      Primitive Value This primitive element may be present, or absent, or replaced by an extension
                      Summary true
                      Requirements

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

                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      68. MedicationRequest.medication[x]:medicationReference
                      Slice Name medicationReference
                      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.

                      Short (NHSN-MS)(QI-Core) Medication to be taken
                      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.

                      Control 0..1
                      Type Reference(ACH Daily Event Medication)bundled
                      [x] Note SeeChoice of Data Typesfor further information about how to use [x]
                      Is Modifier false
                      Must Support true
                      Summary true
                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      70. MedicationRequest.medication[x]:medicationReference.id
                      Definition

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

                      Short Unique id for inter-element referencing
                      Control 0..1
                      Type string
                      Is Modifier false
                      XML Format In the XML format, this property is represented as an attribute.
                      Summary false
                      72. MedicationRequest.medication[x]:medicationReference.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.

                      Short Additional content defined by implementations
                      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.

                      Control 0..*
                      Type Extension
                      Is Modifier false
                      Summary false
                      Alternate Names extensions, user content
                      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())
                      Slicing This element introduces a set of slices on MedicationRequest.medication[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 74. MedicationRequest.medication[x]:medicationReference.reference
                        Definition

                        A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                        Short (NHSN-MS) Literal reference, Relative, internal or absolute URL
                        Comments

                        Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                        Control 1..1
                        This element is affected by the following invariants: ref-1
                        Type string
                        Is Modifier false
                        Primitive Value This primitive element may be present, or absent, or replaced by an extension
                        Must Support true
                        Summary true
                        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        76. MedicationRequest.medication[x]:medicationReference.type
                        Definition

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

                        The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

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

                        This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                        Control 0..1
                        Binding Unless not suitable, these codes SHALL be taken from ResourceType
                        (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

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

                        Type uri
                        Is Modifier false
                        Primitive Value This primitive element may be present, or absent, or replaced by an extension
                        Summary true
                        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        78. MedicationRequest.medication[x]:medicationReference.identifier
                        Definition

                        An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                        Short Logical reference, when literal reference is not known
                        Comments

                        When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                        When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

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

                        Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                        Note This is a business identifier, not a resource identifier (see discussion)
                        Control 0..1
                        Type Identifier
                        Is Modifier false
                        Summary true
                        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        80. MedicationRequest.medication[x]:medicationReference.display
                        Definition

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

                        Short Text alternative for the resource
                        Comments

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

                        Control 0..1
                        Type string
                        Is Modifier false
                        Primitive Value This primitive element may be present, or absent, or replaced by an extension
                        Summary true
                        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        82. MedicationRequest.subject
                        Definition

                        A link to a resource representing the person or set of individuals to whom the medication will be given.

                        Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Who or group medication request is for
                        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.

                        Control 1..1
                        Type Reference(Cross-Measure Patient Profile)bundled
                        Is Modifier false
                        Must Support true
                        Summary true
                        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        84. MedicationRequest.subject.id
                        Definition

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

                        Short Unique id for inter-element referencing
                        Control 0..1
                        Type string
                        Is Modifier false
                        XML Format In the XML format, this property is represented as an attribute.
                        Summary false
                        86. MedicationRequest.subject.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.

                        Short Additional content defined by implementations
                        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.

                        Control 0..*
                        Type Extension
                        Is Modifier false
                        Summary false
                        Alternate Names extensions, user content
                        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())
                        Slicing This element introduces a set of slices on MedicationRequest.subject.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 88. MedicationRequest.subject.reference
                          Definition

                          A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                          Short icon Changed:(NHSN-MS) Literal reference, Relative, internal or absolute URL
                          Comments

                          Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                          Control 1..1
                          This element is affected by the following invariants: ref-1
                          Type string
                          Is Modifier false
                          Primitive Value This primitive element may be present, or absent, or replaced by an extension
                          Must Support true
                          Summary true
                          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          90. MedicationRequest.subject.type
                          Definition

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

                          The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

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

                          This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                          Control 0..1
                          Binding Unless not suitable, these codes SHALL be taken from ResourceType
                          (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

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

                          Type uri
                          Is Modifier false
                          Primitive Value This primitive element may be present, or absent, or replaced by an extension
                          Summary true
                          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          92. MedicationRequest.subject.identifier
                          Definition

                          An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                          Short Logical reference, when literal reference is not known
                          Comments

                          When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                          When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

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

                          Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                          Note This is a business identifier, not a resource identifier (see discussion)
                          Control 0..1
                          Type Identifier
                          Is Modifier false
                          Summary true
                          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          94. MedicationRequest.subject.display
                          Definition

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

                          Short Text alternative for the resource
                          Comments

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

                          Control 0..1
                          Type string
                          Is Modifier false
                          Primitive Value This primitive element may be present, or absent, or replaced by an extension
                          Summary true
                          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          96. MedicationRequest.encounter
                          Definition

                          The Encounter during which this [x] was created or to which the creation of this record is tightly associated.

                          Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Encounter created as part of encounter/admission/stay
                          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.

                          Control 0..1
                          Type Reference(QICore Encounter)bundled
                          Is Modifier false
                          Must Support true
                          Summary false
                          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          98. MedicationRequest.encounter.id
                          Definition

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

                          Short Unique id for inter-element referencing
                          Control 0..1
                          Type string
                          Is Modifier false
                          XML Format In the XML format, this property is represented as an attribute.
                          Summary false
                          100. MedicationRequest.encounter.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.

                          Short Additional content defined by implementations
                          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.

                          Control 0..*
                          Type Extension
                          Is Modifier false
                          Summary false
                          Alternate Names extensions, user content
                          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())
                          Slicing This element introduces a set of slices on MedicationRequest.encounter.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 102. MedicationRequest.encounter.reference
                            Definition

                            A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                            Short icon Changed:(NHSN-MS) Literal reference, Relative, internal or absolute URL
                            Comments

                            Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                            Control 1..1
                            This element is affected by the following invariants: ref-1
                            Type string
                            Is Modifier false
                            Primitive Value This primitive element may be present, or absent, or replaced by an extension
                            Must Support true
                            Summary true
                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            104. MedicationRequest.encounter.type
                            Definition

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

                            The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

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

                            This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                            Control 0..1
                            Binding Unless not suitable, these codes SHALL be taken from ResourceType
                            (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

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

                            Type uri
                            Is Modifier false
                            Primitive Value This primitive element may be present, or absent, or replaced by an extension
                            Summary true
                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            106. MedicationRequest.encounter.identifier
                            Definition

                            An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                            Short Logical reference, when literal reference is not known
                            Comments

                            When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                            When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

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

                            Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                            Note This is a business identifier, not a resource identifier (see discussion)
                            Control 0..1
                            Type Identifier
                            Is Modifier false
                            Summary true
                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            108. MedicationRequest.encounter.display
                            Definition

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

                            Short Text alternative for the resource
                            Comments

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

                            Control 0..1
                            Type string
                            Is Modifier false
                            Primitive Value This primitive element may be present, or absent, or replaced by an extension
                            Summary true
                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            110. MedicationRequest.supportingInformation
                            Definition

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

                            Short Information to support ordering of the medication
                            Control 0..*
                            Type Reference(Resource)
                            Is Modifier false
                            Summary false
                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            112. MedicationRequest.authoredOn
                            Definition

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

                            Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) When request was initially authored
                            Control 1..1
                            Type dateTime
                            Is Modifier false
                            Primitive Value This primitive element may be present, or absent, or replaced by an extension
                            Must Support true
                            Summary true
                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            114. MedicationRequest.requester
                            Definition

                            The individual, organization, or device that initiated the request and has responsibility for its activation.

                            Short icon Changed:(QI-Core)(USCDI) Who/What requested the Request
                            Comments

                            icon Added:

                            Should include QICoreDevice but the base profile does excludes device references.

                            Control icon Changed:0..1
                            This element is affected by the following invariants: us-core-21
                            Type Reference(QICore Practitioner, QICore PractitionerRole, QICore Patient)
                            Is Modifier false
                            Must Support true
                            Must Support Types No must-support rules about the choice of types/profiles
                            Summary true
                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            116. MedicationRequest.performer
                            Definition

                            The specified desired performer of the medication treatment (e.g. the performer of the medication administration).

                            Short Intended performer of administration
                            Control 0..1
                            Type Reference(Practitioner, PractitionerRole, Organization, Patient, Device, RelatedPerson, CareTeam)
                            Is Modifier false
                            Summary false
                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            118. MedicationRequest.performerType
                            Definition

                            Indicates the type of performer of the administration of the medication.

                            Short Desired kind of performer of the medication administration
                            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.

                            Control 0..1
                            Binding For example codes, see ProcedurePerformerRoleCodes
                            (example to http://hl7.org/fhir/ValueSet/performer-role)

                            Identifies the type of individual that is desired to administer the medication.

                            Type CodeableConcept
                            Is Modifier false
                            Summary true
                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            120. 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.

                            Short Person who entered the request
                            Control 0..1
                            Type Reference(Practitioner, PractitionerRole)
                            Is Modifier false
                            Summary false
                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            122. MedicationRequest.reasonCode
                            Definition

                            The reason or the indication for ordering or not ordering the medication.

                            Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Reason or 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.

                            Control 0..*
                            Binding Unless not suitable, these codes SHALL be taken from USCoreConditionCodes (6.1.0)
                            (extensible to http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code|6.1.0)
                            Type CodeableConcept
                            Is Modifier false
                            Must Support true
                            Summary false
                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            124. MedicationRequest.reasonReference
                            Definition

                            Condition or observation that supports why the medication was ordered.

                            Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) QI-Core Condition or Observation that supports the prescription
                            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.

                            Control 0..*
                            Type Reference(QICore Condition Encounter Diagnosis, QICore Condition Problems Health Concerns, QICore Simple Observation (Substitute))bundled
                            Is Modifier false
                            Must Support true
                            Must Support Types No must-support rules about the choice of types/profiles
                            Summary false
                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            126. MedicationRequest.reasonReference.id
                            Definition

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

                            Short Unique id for inter-element referencing
                            Control 0..1
                            Type string
                            Is Modifier false
                            XML Format In the XML format, this property is represented as an attribute.
                            Summary false
                            128. MedicationRequest.reasonReference.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.

                            Short Additional content defined by implementations
                            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.

                            Control 0..*
                            Type Extension
                            Is Modifier false
                            Summary false
                            Alternate Names extensions, user content
                            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())
                            Slicing This element introduces a set of slices on MedicationRequest.reasonReference.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • value @ url
                            • 130. MedicationRequest.reasonReference.reference
                              Definition

                              A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                              Short icon Changed:(NHSN-MS) Literal reference, Relative, internal or absolute URL
                              Comments

                              Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                              Control 1..1
                              This element is affected by the following invariants: ref-1
                              Type string
                              Is Modifier false
                              Primitive Value This primitive element may be present, or absent, or replaced by an extension
                              Must Support true
                              Summary true
                              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              132. MedicationRequest.reasonReference.type
                              Definition

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

                              The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

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

                              This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                              Control 0..1
                              Binding Unless not suitable, these codes SHALL be taken from ResourceType
                              (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

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

                              Type uri
                              Is Modifier false
                              Primitive Value This primitive element may be present, or absent, or replaced by an extension
                              Summary true
                              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              134. MedicationRequest.reasonReference.identifier
                              Definition

                              An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                              Short Logical reference, when literal reference is not known
                              Comments

                              When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                              When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

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

                              Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                              Note This is a business identifier, not a resource identifier (see discussion)
                              Control 0..1
                              Type Identifier
                              Is Modifier false
                              Summary true
                              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              136. MedicationRequest.reasonReference.display
                              Definition

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

                              Short Text alternative for the resource
                              Comments

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

                              Control 0..1
                              Type string
                              Is Modifier false
                              Primitive Value This primitive element may be present, or absent, or replaced by an extension
                              Summary true
                              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              138. 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.

                              Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Protocol or guideline the order is based on
                              Control 0..*
                              Type canonical
                              Is Modifier false
                              Primitive Value This primitive element may be present, or absent, or replaced by an extension
                              Must Support true
                              Summary true
                              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              140. 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.

                              Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) External protocol or guideline the order is based on
                              Control 0..*
                              Type uri
                              Is Modifier false
                              Primitive Value This primitive element may be present, or absent, or replaced by an extension
                              Must Support true
                              Summary true
                              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              142. MedicationRequest.basedOn
                              Definition

                              A plan or request that is fulfilled in whole or in part by this medication request.

                              Short What request fulfills
                              Control 0..*
                              Type Reference(CarePlan, MedicationRequest, ServiceRequest, ImmunizationRecommendation)
                              Is Modifier false
                              Summary true
                              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              144. 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.

                              Short Composite request this is part of
                              Control 0..1
                              Type Identifier
                              Is Modifier false
                              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()))
                              146. MedicationRequest.courseOfTherapyType
                              Definition

                              The description of the overall patte3rn of the administration of the medication to the patient.

                              Short Overall pattern of medication administration
                              Comments

                              This attribute should not be confused with the protocol of the medication.

                              Control 0..1
                              Binding For example codes, see medicationRequest Course of Therapy Codes
                              (example to http://hl7.org/fhir/ValueSet/medicationrequest-course-of-therapy)

                              Identifies the overall pattern of medication administratio.

                              Type CodeableConcept
                              Is Modifier false
                              Summary false
                              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              148. MedicationRequest.insurance
                              Definition

                              Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be required for delivering the requested service.

                              Short Associated insurance coverage
                              Control 0..*
                              Type Reference(Coverage, ClaimResponse)
                              Is Modifier false
                              Summary false
                              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              150. MedicationRequest.note
                              Definition

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

                              Short Information about the prescription
                              Control 0..*
                              Type Annotation
                              Is Modifier false
                              Summary false
                              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              152. MedicationRequest.dosageInstruction
                              Definition

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

                              Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) How medication should be taken
                              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.

                              Control 0..*
                              Type Dosage
                              Is Modifier false
                              Must Support true
                              Summary false
                              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              154. 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.

                              Short Unique id for inter-element referencing
                              Control 0..1
                              Type string
                              Is Modifier false
                              XML Format In the XML format, this property is represented as an attribute.
                              Summary false
                              156. 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.

                              Short Additional content defined by implementations
                              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.

                              Control 0..*
                              Type Extension
                              Is Modifier false
                              Summary false
                              Alternate Names extensions, user content
                              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())
                              Slicing This element introduces a set of slices on MedicationRequest.dosageInstruction.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ url
                              • 158. 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).

                                Short Extensions that cannot be ignored even if unrecognized
                                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.

                                Control 0..*
                                Type Extension
                                Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                Summary true
                                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.

                                Alternate Names extensions, user content, modifiers
                                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())
                                160. MedicationRequest.dosageInstruction.sequence
                                Definition

                                Indicates the order in which the dosage instructions should be applied or interpreted.

                                Short The order of the dosage instructions
                                Control 0..1
                                Type integer
                                Is Modifier false
                                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                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.

                                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                162. MedicationRequest.dosageInstruction.text
                                Definition

                                Free text dosage instructions e.g. SIG.

                                Short icon Changed:(USCDI) Free text dosage instructions e.g. SIG
                                Control 0..1
                                Type string
                                Is Modifier false
                                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                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.

                                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                164. 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").

                                Short Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
                                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.

                                Control 0..*
                                Binding For example codes, see SNOMEDCTAdditionalDosageInstructions
                                (example to http://hl7.org/fhir/ValueSet/additional-instruction-codes)

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

                                Type CodeableConcept
                                Is Modifier false
                                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.

                                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                166. MedicationRequest.dosageInstruction.patientInstruction
                                Definition

                                Instructions in terms that are understood by the patient or consumer.

                                Short Patient or consumer oriented instructions
                                Control 0..1
                                Type string
                                Is Modifier false
                                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                Summary true
                                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                168. MedicationRequest.dosageInstruction.timing
                                Definition

                                When medication should be administered.

                                Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) When medication should be administered
                                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.

                                Control 0..1
                                Type Timing
                                Is Modifier false
                                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.

                                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                170. MedicationRequest.dosageInstruction.timing.id
                                Definition

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

                                Short Unique id for inter-element referencing
                                Control 0..1
                                Type string
                                Is Modifier false
                                XML Format In the XML format, this property is represented as an attribute.
                                Summary false
                                172. MedicationRequest.dosageInstruction.timing.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.

                                Short Additional content defined by implementations
                                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.

                                Control 0..*
                                Type Extension
                                Is Modifier false
                                Summary false
                                Alternate Names extensions, user content
                                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())
                                Slicing This element introduces a set of slices on MedicationRequest.dosageInstruction.timing.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • value @ url
                                • 174. MedicationRequest.dosageInstruction.timing.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).

                                  Short Extensions that cannot be ignored even if unrecognized
                                  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.

                                  Control 0..*
                                  Type Extension
                                  Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                  Summary true
                                  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.

                                  Alternate Names extensions, user content, modifiers
                                  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())
                                  176. MedicationRequest.dosageInstruction.timing.event
                                  Definition

                                  Identifies specific times when the event occurs.

                                  Short (NHSN-MS) When the event occurs
                                  Control 0..*
                                  Type dateTime
                                  Is Modifier false
                                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                  Must Support true
                                  Summary true
                                  Requirements

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

                                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  178. MedicationRequest.dosageInstruction.timing.repeat
                                  Definition

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

                                  Short (NHSN-MS)(QI-Core) When the event is to occur
                                  Control 0..1
                                  Type Element
                                  Is Modifier false
                                  Must Support true
                                  Summary true
                                  Requirements

                                  Many timing schedules are determined by regular repetitions.

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

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

                                  Short Unique id for inter-element referencing
                                  Control 0..1
                                  Type string
                                  Is Modifier false
                                  XML Format In the XML format, this property is represented as an attribute.
                                  Summary false
                                  182. MedicationRequest.dosageInstruction.timing.repeat.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.

                                  Short Additional content defined by implementations
                                  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.

                                  Control 0..*
                                  Type Extension
                                  Is Modifier false
                                  Summary false
                                  Alternate Names extensions, user content
                                  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())
                                  Slicing This element introduces a set of slices on MedicationRequest.dosageInstruction.timing.repeat.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • value @ url
                                  • 184. MedicationRequest.dosageInstruction.timing.repeat.bounds[x]
                                    Definition

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

                                    Short (NHSN-MS)(QI-Core) Length/Range of lengths, or (Start and/or end) limits
                                    Control 0..1
                                    Type Choice of: Duration, Range, Period
                                    [x] Note SeeChoice of Data Typesfor further information about how to use [x]
                                    Is Modifier false
                                    Must Support true
                                    Must Support Types No must-support rules about the choice of types/profiles
                                    Summary true
                                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    186. MedicationRequest.dosageInstruction.timing.repeat.count
                                    Definition

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

                                    Short (NHSN-MS) Number of times to repeat
                                    Comments

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

                                    Control 0..1
                                    Type positiveInt
                                    Is Modifier false
                                    Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                    Must Support true
                                    Summary true
                                    Requirements

                                    Repetitions may be limited by end time or total occurrences.

                                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    188. MedicationRequest.dosageInstruction.timing.repeat.countMax
                                    Definition

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

                                    Short (NHSN-MS) Maximum number of times to repeat
                                    Control 0..1
                                    Type positiveInt
                                    Is Modifier false
                                    Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                    Must Support true
                                    Summary true
                                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    190. MedicationRequest.dosageInstruction.timing.repeat.duration
                                    Definition

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

                                    Short (NHSN-MS) How long when it happens
                                    Comments

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

                                    Control 0..1
                                    Type decimal
                                    Is Modifier false
                                    Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                    Must Support true
                                    Summary true
                                    Requirements

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

                                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    192. MedicationRequest.dosageInstruction.timing.repeat.durationMax
                                    Definition

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

                                    Short (NHSN-MS) How long when it happens (Max)
                                    Comments

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

                                    Control 0..1
                                    Type decimal
                                    Is Modifier false
                                    Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                    Must Support true
                                    Summary true
                                    Requirements

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

                                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    194. MedicationRequest.dosageInstruction.timing.repeat.durationUnit
                                    Definition

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

                                    Short (NHSN-MS) s | min | h | d | wk | mo | a - unit of time (UCUM)
                                    Control 0..1
                                    Binding The codes SHALL be taken from UnitsOfTime
                                    (required to http://hl7.org/fhir/ValueSet/units-of-time|4.0.1)

                                    A unit of time (units from UCUM).

                                    Type code
                                    Is Modifier false
                                    Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                    Must Support true
                                    Summary true
                                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    196. MedicationRequest.dosageInstruction.timing.repeat.frequency
                                    Definition

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

                                    Short (NHSN-MS)(QI-Core) Event occurs frequency times per period
                                    Control 0..1
                                    Type positiveInt
                                    Is Modifier false
                                    Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                    Must Support true
                                    Summary true
                                    Meaning if Missing If no frequency is stated, the assumption is that the event occurs once per period, but systems SHOULD always be specific about this
                                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    198. MedicationRequest.dosageInstruction.timing.repeat.frequencyMax
                                    Definition

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

                                    Short (NHSN-MS)(QI-Core) Event occurs frequencyMax times per period
                                    Control 0..1
                                    Type positiveInt
                                    Is Modifier false
                                    Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                    Must Support true
                                    Summary true
                                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    200. MedicationRequest.dosageInstruction.timing.repeat.period
                                    Definition

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

                                    Short (NHSN-MS)(QI-Core) Event occurs frequency times per period
                                    Control 0..1
                                    Type decimal
                                    Is Modifier false
                                    Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                    Must Support true
                                    Summary true
                                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    202. MedicationRequest.dosageInstruction.timing.repeat.periodMax
                                    Definition

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

                                    Short (NHSN-MS)(QI-Core) Upper limit of period (3-4 hours)
                                    Control 0..1
                                    Type decimal
                                    Is Modifier false
                                    Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                    Must Support true
                                    Summary true
                                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    204. MedicationRequest.dosageInstruction.timing.repeat.periodUnit
                                    Definition

                                    The units of time for the period in UCUM units.

                                    Short (NHSN-MS)(QI-Core) s | min | h | d | wk | mo | a - unit of time (UCUM)
                                    Control 0..1
                                    Binding The codes SHALL be taken from UnitsOfTime
                                    (required to http://hl7.org/fhir/ValueSet/units-of-time|4.0.1)

                                    A unit of time (units from UCUM).

                                    Type code
                                    Is Modifier false
                                    Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                    Must Support true
                                    Summary true
                                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    206. MedicationRequest.dosageInstruction.timing.repeat.dayOfWeek
                                    Definition

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

                                    Short (NHSN-MS) mon | tue | wed | thu | fri | sat | sun
                                    Comments

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

                                    Control 0..*
                                    Binding The codes SHALL be taken from DaysOfWeek
                                    (required to http://hl7.org/fhir/ValueSet/days-of-week|4.0.1)
                                    Type code
                                    Is Modifier false
                                    Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                    Must Support true
                                    Summary true
                                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    208. MedicationRequest.dosageInstruction.timing.repeat.timeOfDay
                                    Definition

                                    Specified time of day for action to take place.

                                    Short (NHSN-MS) Time of day for action
                                    Comments

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

                                    Control 0..*
                                    Type time
                                    Is Modifier false
                                    Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                    Must Support true
                                    Summary true
                                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    210. MedicationRequest.dosageInstruction.timing.repeat.when
                                    Definition

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

                                    Short (NHSN-MS) Code for time period of occurrence
                                    Comments

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

                                    Control 0..*
                                    Binding The codes SHALL be taken from EventTiming
                                    (required to http://hl7.org/fhir/ValueSet/event-timing|4.0.1)

                                    Real world event relating to the schedule.

                                    Type code
                                    Is Modifier false
                                    Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                    Must Support true
                                    Summary true
                                    Requirements

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

                                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    212. MedicationRequest.dosageInstruction.timing.repeat.offset
                                    Definition

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

                                    Short (NHSN-MS) Minutes from event (before or after)
                                    Control 0..1
                                    Type unsignedInt
                                    Is Modifier false
                                    Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                    Must Support true
                                    Summary true
                                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    214. MedicationRequest.dosageInstruction.timing.code
                                    Definition

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

                                    Short (NHSN-MS) BID | TID | QID | AM | PM | QD | QOD | +
                                    Comments

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

                                    Control 0..1
                                    Binding The codes SHOULD be taken from TimingAbbreviation
                                    (preferred to http://hl7.org/fhir/ValueSet/timing-abbreviation|4.0.1)

                                    Code for a known / defined timing pattern.

                                    Type CodeableConcept
                                    Is Modifier false
                                    Must Support true
                                    Summary true
                                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    216. 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).

                                    Short icon Changed:(NHSN-MS)(QI-Core) Take "as needed" (for x)
                                    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".

                                    Control 0..1
                                    Binding For example codes, see SNOMEDCTMedicationAsNeededReasonCodes
                                    (example to http://hl7.org/fhir/ValueSet/medication-as-needed-reason)

                                    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.

                                    Type Choice of: boolean, CodeableConcept
                                    [x] Note SeeChoice of Data Typesfor further information about how to use [x]
                                    Is Modifier false
                                    Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                    Must Support true
                                    Must Support Types No must-support rules about the choice of types/profiles
                                    Summary true
                                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    218. MedicationRequest.dosageInstruction.site
                                    Definition

                                    Body site to administer to.

                                    Short icon Changed:(NHSN-MS) Body site to administer to
                                    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.

                                    Control 0..1
                                    Binding For example codes, see SNOMEDCTAnatomicalStructureForAdministrationSiteCodes
                                    (example to http://hl7.org/fhir/ValueSet/approach-site-codes)

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

                                    Type CodeableConcept
                                    Is Modifier false
                                    Must Support true
                                    Summary true
                                    Requirements

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

                                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    220. MedicationRequest.dosageInstruction.route
                                    Definition

                                    How drug should enter body.

                                    Short icon Changed:(NHSN-MS) How drug should enter body
                                    Control icon Changed:1..1
                                    Binding Unless not suitable, these codes SHALL be taken from SNOMEDCTRouteCodes
                                    (extensible to http://hl7.org/fhir/ValueSet/route-codes)
                                    Type CodeableConcept
                                    Is Modifier false
                                    Must Support true
                                    Summary true
                                    Requirements

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

                                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    222. MedicationRequest.dosageInstruction.method
                                    Definition

                                    Technique for administering medication.

                                    Short icon Changed:(NHSN-MS) Technique for administering medication
                                    Comments

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

                                    Control 0..1
                                    Binding For example codes, see SNOMEDCTAdministrationMethodCodes
                                    (example to http://hl7.org/fhir/ValueSet/administration-method-codes)

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

                                    Type CodeableConcept
                                    Is Modifier false
                                    Must Support true
                                    Summary true
                                    Requirements

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

                                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    224. MedicationRequest.dosageInstruction.doseAndRate
                                    Definition

                                    The amount of medication administered.

                                    Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Amount of medication administered
                                    Control 0..*
                                    Type Element
                                    Is Modifier false
                                    Must Support true
                                    Summary true
                                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    226. 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.

                                    Short Unique id for inter-element referencing
                                    Control 0..1
                                    Type string
                                    Is Modifier false
                                    XML Format In the XML format, this property is represented as an attribute.
                                    Summary false
                                    228. 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.

                                    Short Additional content defined by implementations
                                    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.

                                    Control 0..*
                                    Type Extension
                                    Is Modifier false
                                    Summary false
                                    Alternate Names extensions, user content
                                    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())
                                    Slicing This element introduces a set of slices on MedicationRequest.dosageInstruction.doseAndRate.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                    • value @ url
                                    • 230. MedicationRequest.dosageInstruction.doseAndRate.type
                                      Definition

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

                                      Short icon Changed:(NHSN-MS) The kind of dose or rate specified
                                      Control 0..1
                                      Binding For example codes, see DoseAndRateType
                                      (example to http://hl7.org/fhir/ValueSet/dose-rate-type)

                                      The kind of dose or rate specified.

                                      Type CodeableConcept
                                      Is Modifier false
                                      Must Support true
                                      Summary true
                                      Requirements

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

                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      232. MedicationRequest.dosageInstruction.doseAndRate.dose[x]
                                      Definition

                                      Amount of medication per dose.

                                      Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Amount of medication per dose
                                      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.

                                      Control 0..1
                                      Binding The codes SHOULD be taken from Common UCUM units
                                      (preferred to http://hl7.org/fhir/ValueSet/ucum-common)
                                      Additional Bindings Purpose
                                      UCUMCodes Max Binding
                                      Type Choice of: Quantity, Range
                                      [x] Note SeeChoice of Data Typesfor further information about how to use [x]
                                      Is Modifier false
                                      Must Support true
                                      Must Support Types Quantity
                                      Summary true
                                      Requirements

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

                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      234. MedicationRequest.dosageInstruction.doseAndRate.rate[x]
                                      Definition

                                      Amount of medication per unit of time.

                                      Short icon Changed:(NHSN-MS) Amount of medication per unit of time
                                      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.

                                      Control 0..1
                                      Type Choice of: Ratio, Range, Quantity(SimpleQuantity)
                                      [x] Note SeeChoice of Data Typesfor further information about how to use [x]
                                      Is Modifier false
                                      Must Support true
                                      Must Support Types No must-support rules about the choice of types/profiles
                                      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.

                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      236. MedicationRequest.dosageInstruction.maxDosePerPeriod
                                      Definition

                                      Upper limit on medication per unit of time.

                                      Short Upper limit on medication per unit of time
                                      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".

                                      Control 0..1
                                      Type Ratio
                                      Is Modifier false
                                      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.

                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      238. MedicationRequest.dosageInstruction.maxDosePerAdministration
                                      Definition

                                      Upper limit on medication per administration.

                                      Short Upper limit on medication 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.

                                      Control 0..1
                                      Type Quantity(SimpleQuantity)
                                      Is Modifier false
                                      Summary true
                                      Requirements

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

                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      240. MedicationRequest.dosageInstruction.maxDosePerLifetime
                                      Definition

                                      Upper limit on medication per lifetime of the patient.

                                      Short Upper limit on medication per lifetime of the patient
                                      Control 0..1
                                      Type Quantity(SimpleQuantity)
                                      Is Modifier false
                                      Summary true
                                      Requirements

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

                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      242. 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.

                                      Short icon Changed:(QI-Core)(USCDI) Medication supply authorization
                                      Control 0..1
                                      Type BackboneElement
                                      Is Modifier false
                                      Must Support icon Added:true
                                      Summary false
                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      244. 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.

                                      Short Unique id for inter-element referencing
                                      Control 0..1
                                      Type string
                                      Is Modifier false
                                      XML Format In the XML format, this property is represented as an attribute.
                                      Summary false
                                      246. 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.

                                      Short Additional content defined by implementations
                                      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.

                                      Control 0..*
                                      Type Extension
                                      Is Modifier false
                                      Summary false
                                      Alternate Names extensions, user content
                                      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())
                                      248. 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).

                                      Short Extensions that cannot be ignored even if unrecognized
                                      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.

                                      Control 0..*
                                      Type Extension
                                      Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                      Summary true
                                      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.

                                      Alternate Names extensions, user content, modifiers
                                      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())
                                      250. MedicationRequest.dispenseRequest.initialFill
                                      Definition

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

                                      Short First fill details
                                      Comments

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

                                      Control 0..1
                                      Type BackboneElement
                                      Is Modifier false
                                      Summary false
                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      252. 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.

                                      Short Unique id for inter-element referencing
                                      Control 0..1
                                      Type string
                                      Is Modifier false
                                      XML Format In the XML format, this property is represented as an attribute.
                                      Summary false
                                      254. 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.

                                      Short Additional content defined by implementations
                                      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.

                                      Control 0..*
                                      Type Extension
                                      Is Modifier false
                                      Summary false
                                      Alternate Names extensions, user content
                                      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())
                                      256. 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).

                                      Short Extensions that cannot be ignored even if unrecognized
                                      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.

                                      Control 0..*
                                      Type Extension
                                      Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                      Summary true
                                      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.

                                      Alternate Names extensions, user content, modifiers
                                      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())
                                      258. MedicationRequest.dispenseRequest.initialFill.quantity
                                      Definition

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

                                      Short First fill quantity
                                      Control 0..1
                                      Type Quantity(SimpleQuantity)
                                      Is Modifier false
                                      Summary false
                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      260. MedicationRequest.dispenseRequest.initialFill.duration
                                      Definition

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

                                      Short First fill duration
                                      Control 0..1
                                      Type Duration
                                      Is Modifier false
                                      Summary false
                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      262. MedicationRequest.dispenseRequest.dispenseInterval
                                      Definition

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

                                      Short icon Changed:(QI-Core) Minimum period of time between dispenses
                                      Control 0..1
                                      Type Duration
                                      Is Modifier false
                                      Summary false
                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      264. MedicationRequest.dispenseRequest.validityPeriod
                                      Definition

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

                                      Short Time period supply is authorized for
                                      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.

                                      Control 0..1
                                      Type Period
                                      Is Modifier false
                                      Summary false
                                      Requirements

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

                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      266. 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.

                                      Short icon Changed:(QI-Core)(USCDI) Number of refills authorized
                                      Comments

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

                                      Control 0..1
                                      Type unsignedInt
                                      Is Modifier false
                                      Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                      Must Support icon Added:true
                                      Summary false
                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      268. MedicationRequest.dispenseRequest.quantity
                                      Definition

                                      The amount that is to be dispensed for one fill.

                                      Short icon Changed:(QI-Core)(USCDI) Amount of medication to supply per dispense
                                      Control 0..1
                                      Type Quantity(SimpleQuantity)
                                      Is Modifier false
                                      Must Support icon Added:true
                                      Summary false
                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      270. 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.

                                      Short icon Changed:(QI-Core) Number of days supply per dispense
                                      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.

                                      Control 0..1
                                      Type Duration
                                      Is Modifier false
                                      Summary false
                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      272. MedicationRequest.dispenseRequest.performer
                                      Definition

                                      Indicates the intended dispensing Organization specified by the prescriber.

                                      Short Intended dispenser
                                      Control 0..1
                                      Type Reference(Organization)
                                      Is Modifier false
                                      Summary false
                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      274. 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.

                                      Short Any restrictions on medication substitution
                                      Control 0..1
                                      Type BackboneElement
                                      Is Modifier false
                                      Summary false
                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      276. 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.

                                      Short Unique id for inter-element referencing
                                      Control 0..1
                                      Type string
                                      Is Modifier false
                                      XML Format In the XML format, this property is represented as an attribute.
                                      Summary false
                                      278. 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.

                                      Short Additional content defined by implementations
                                      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.

                                      Control 0..*
                                      Type Extension
                                      Is Modifier false
                                      Summary false
                                      Alternate Names extensions, user content
                                      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())
                                      280. 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).

                                      Short Extensions that cannot be ignored even if unrecognized
                                      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.

                                      Control 0..*
                                      Type Extension
                                      Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                      Summary true
                                      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.

                                      Alternate Names extensions, user content, modifiers
                                      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())
                                      282. MedicationRequest.substitution.allowed[x]
                                      Definition

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

                                      Short Whether substitution is allowed or not
                                      Comments

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

                                      Control 1..1
                                      Binding For example codes, see ActSubstanceAdminSubstitutionCode (3.0.0)
                                      (example to http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode|3.0.0)

                                      Identifies the type of substitution allowed.

                                      Type Choice of: boolean, CodeableConcept
                                      [x] Note SeeChoice of Data Typesfor further information about how to use [x]
                                      Is Modifier false
                                      Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                      Summary false
                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      284. MedicationRequest.substitution.reason
                                      Definition

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

                                      Short Why should (not) substitution be made
                                      Control 0..1
                                      Binding For example codes, see SubstanceAdminSubstitutionReason (3.0.0)
                                      (example to http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason|3.0.0)

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

                                      Type CodeableConcept
                                      Is Modifier false
                                      Summary false
                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      286. MedicationRequest.priorPrescription
                                      Definition

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

                                      Short An order/prescription that is being replaced
                                      Control 0..1
                                      Type Reference(MedicationRequest)
                                      Is Modifier false
                                      Summary false
                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      288. 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.

                                      Short Clinical Issue with action
                                      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.

                                      Control 0..*
                                      Type Reference(DetectedIssue)
                                      Is Modifier false
                                      Summary false
                                      Alternate Names Contraindication, Drug Utilization Review (DUR), Alert
                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      290. 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.

                                      Short A list of events of interest in the lifecycle
                                      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.).

                                      Control 0..*
                                      Type Reference(Provenance)
                                      Is Modifier false
                                      Summary false
                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

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