US Veterans Health Administration FHIR Map Set Implementation Guide
1.6.49 - 250701 United States of America flag

Publication Build: This will be filled in by the publication tooling

Resource Profile: MedicationRequestOutpatient - Detailed Descriptions

Draft as of 2025-06-13

Definitions for the MedicationRequestOutpatient 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.

ShortOrdering of medication for patient or group
Comments

-

Control0..*
Is Modifierfalse
Must Supportfalse
Summaryfalse
Alternate NamesPrescription, Order
Invariantsdom-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())
2. MedicationRequest.id
Definition

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

ShortLogical 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.

Control0..1
Typeidstring
Is Modifierfalse
Must Supporttrue
Summarytrue
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.

ShortA 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.

Control0..1
Typeuri
Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
6. MedicationRequest.extension
Definition

An Extension


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.

ShortExtensionAdditional 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.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-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())
SlicingThis element introduces a set of slices on MedicationRequest.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 8. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus
    Slice Namemedicationrequest-pharmacyOrderStatus
    Definition

    Extension medicationrequest-pharmacyOrderStatus

    ShortExtension
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(MedicationRequestPharmacyOrderStatus) (Extension Type: Coding)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-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())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    10. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.extension
    Definition

    An Extension


    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.

    ShortExtensionAdditional 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.

    Control0..0*
    TypeExtension
    Is Modifierfalse
    Summaryfalse
    Alternate Namesextensions, user content
    Invariantsele-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())
    SlicingThis element introduces a set of slices on MedicationRequest.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 12. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.url
      Definition

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

      Shortidentifies the meaning of the extension
      Comments

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

      Control1..1
      Typeuri
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      Fixed Valuehttp://va.gov/fhir/StructureDefinition/medicationrequest-pharmacyOrderStatus
      14. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x]
      Definition

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

      ShortValue of extension
      Control0..1
      TypeCoding, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      16. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].system
      Definition

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

      ShortIdentity of the terminology system
      Comments

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

      Control0..1
      Typeuri
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Requirements

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

      Pattern Valuehttp://va.gov/terminology/vistaDefinedTerms/52-100
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      mro-27-1746-1: If P then fixed value http://va.gov/terminology/vistaDefinedTerms/52-100 (true)
      18. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].code
      Definition

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

      ShortSymbol in syntax defined by the system
      Control0..1
      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Requirements

      Need to refer to a particular code in the system.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      mro-27-1746: If (52-11) is P then fixed value #active-parked (true)
      20. MedicationRequest.extension:medicationrequest-cancelDate
      Slice Namemedicationrequest-cancelDate
      Definition

      Extension medicationrequest-cancelDate

      ShortExtension
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(MedicationRequestCancelDate) (Extension Type: dateTime)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-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())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      22. MedicationRequest.extension:medicationrequest-cancelDate.extension
      Definition

      An Extension


      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.

      ShortExtensionAdditional 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.

      Control0..0*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Alternate Namesextensions, user content
      Invariantsele-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())
      SlicingThis element introduces a set of slices on MedicationRequest.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 24. MedicationRequest.extension:medicationrequest-cancelDate.url
        Definition

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

        Shortidentifies the meaning of the extension
        Comments

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

        Control1..1
        Typeuri
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        Fixed Valuehttp://va.gov/fhir/StructureDefinition/medicationrequest-cancelDate
        26. MedicationRequest.extension:medicationrequest-cancelDate.value[x]
        Definition

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

        ShortValue of extension
        Control0..1
        TypedateTime, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        28. MedicationRequest.extension:medicationrequest-includeIndicationInSig
        Slice Namemedicationrequest-includeIndicationInSig
        Definition

        Extension medicationrequest-includeIndicationInSig

        ShortExtension
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(MedicationRequestIncludeIndicationInSig) (Extension Type: boolean)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-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())
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        30. MedicationRequest.extension:medicationrequest-includeIndicationInSig.extension
        Definition

        An Extension


        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.

        ShortExtensionAdditional 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.

        Control0..0*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-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())
        SlicingThis element introduces a set of slices on MedicationRequest.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 32. MedicationRequest.extension:medicationrequest-includeIndicationInSig.url
          Definition

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

          Shortidentifies the meaning of the extension
          Comments

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

          Control1..1
          Typeuri
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          Fixed Valuehttp://va.gov/fhir/StructureDefinition/medicationrequest-includeIndicationInSig
          34. MedicationRequest.extension:medicationrequest-includeIndicationInSig.value[x]
          Definition

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

          ShortValue of extension
          Comments

          see mapping VF_Boolean

          Control0..1
          Typeboolean, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, Expression, Signature, unsignedInt, time
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          36. MedicationRequest.extension:medicationrequest-remainingRefillCount
          Slice Namemedicationrequest-remainingRefillCount
          Definition

          Extension medicationrequest-remainingRefillCount

          ShortExtension
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(MedicationrequestRemainingRefillCount) (Extension Type: integer)
          Is Modifierfalse
          Summaryfalse
          Invariantsele-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())
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          38. MedicationRequest.extension:medicationrequest-remainingRefillCount.extension
          Definition

          An Extension


          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.

          ShortExtensionAdditional 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.

          Control0..0*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Alternate Namesextensions, user content
          Invariantsele-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())
          SlicingThis element introduces a set of slices on MedicationRequest.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 40. MedicationRequest.extension:medicationrequest-remainingRefillCount.url
            Definition

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

            Shortidentifies the meaning of the extension
            Comments

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

            Control1..1
            Typeuri
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            Fixed Valuehttp://va.gov/fhir/StructureDefinition/medicationrequest-remainingRefillCount
            42. MedicationRequest.extension:medicationrequest-remainingRefillCount.value[x]
            Definition

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

            ShortValue of extension
            Control0..1
            Typeinteger, date, Meta, Address, Attachment, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            44. 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).

            ShortExtensions 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.

            Control0..*
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
            Summaryfalse
            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 Namesextensions, user content
            Invariantsele-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())
            46. 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.

            ShortExternal ids for this request
            Comments

            This is a business identifier, not a resource identifier.

            NoteThis is a business identifier, not a resource identifier (see discussion)
            Control0..*
            TypeIdentifier
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            48. MedicationRequest.identifier.use
            Definition

            The purpose of this identifier.

            Shortusual | official | temp | secondary | old (If known)
            Comments

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

            Control0..1
            BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
            (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

            Identifies the purpose for this identifier, if known .

            Typecode
            Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

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

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            50. MedicationRequest.identifier.type
            Definition

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

            ShortDescription of identifier
            Comments

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

            Control0..1
            BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-type
            (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

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

            TypeCodeableConcept
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Requirements

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

            Pattern Value{
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                "code" : "FILL"
              }]
            }
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            52. MedicationRequest.identifier.value
            Definition

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

            ShortThe value that is unique
            Comments

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

            Control0..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Example<br/><b>General</b>:123456
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            54. MedicationRequest.status
            Definition

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

            Shortactive | 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.

            Control1..1
            BindingThe codes SHALL be taken from OutMedRequestStatus FHIRhttp://hl7.org/fhir/ValueSet/medicationrequest-status|4.0.1
            (required to http://va.gov/fhir/ValueSet/OutMedRequestStatus)

            see mapping VF_OutMedRequestStatus


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

            Typecode
            Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            56. MedicationRequest.intent
            Definition

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

            Shortproposal | 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.

            Control1..1
            BindingThe 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.

            Typecode
            Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Pattern Valueorder
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            58. 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)).

            ShortType of medication usage
            Comments

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

            Control0..*
            BindingFor example codes, see medicationRequest Category Codeshttp://hl7.org/fhir/ValueSet/medicationrequest-category
            (example to http://hl7.org/fhir/ValueSet/medicationrequest-category)

            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.

            TypeCodeableConcept
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Pattern Value{
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                "code" : "outpatient"
              }]
            }
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            SlicingThis element introduces a set of slices on MedicationRequest.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • pattern @ $this
            • 60. MedicationRequest.category:us-core
              Slice Nameus-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)).

              ShortType of medication usage
              Comments

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

              Control0..*
              BindingThe codes SHALL be taken from For example codes, see medicationRequest Category Codeshttp://hl7.org/fhir/ValueSet/medicationrequest-category
              (required to http://hl7.org/fhir/ValueSet/medicationrequest-category)

              The type of medication order.


              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.

              TypeCodeableConcept
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              62. MedicationRequest.doNotPerform
              Definition

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

              ShortTrue if request is prohibiting action
              Comments

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

              Control0..1
              Typeboolean
              Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              64. 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.

              ShortReported rather than primary record
              Control0..1
              TypeChoice of: boolean, Reference(US Core Practitioner Profile, US Core Organization Profile, US Core Patient Profile, US Core PractitionerRole Profile, US Core RelatedPerson Profile, Patient, Practitioner, PractitionerRole, RelatedPerson, Organization)
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Must Support TypesChoice of: boolean, Reference(US Core Practitioner Profile)
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              SlicingThis element introduces a set of slices on MedicationRequest.reported[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
              • type @ $this
              • 66. MedicationRequest.reported[x]:reportedBoolean
                Slice NamereportedBoolean
                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.

                ShortReported rather than primary record
                Control0..1
                Typeboolean, Reference(Patient, Practitioner, PractitionerRole, RelatedPerson, Organization)
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Must Support Typesboolean
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                68. MedicationRequest.reported[x]:reportedReference
                Slice NamereportedReference
                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.

                ShortReported rather than primary record
                Control0..1
                TypeReference(US Core Practitioner Profile, US Core Organization Profile, US Core Patient Profile, US Core PractitionerRole Profile, US Core RelatedPerson Profile, Patient, Practitioner, PractitionerRole, RelatedPerson, Organization), boolean
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Is Modifierfalse
                Must Supporttrue
                Must Support TypesReferenceboolean(US Core Practitioner Profile)
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                70. 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.

                ShortMedication 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.

                Control1..1
                BindingUnless not suitable, these codes SHALL be taken from For example codes, see Medication Clinical Drug .http://hl7.org/fhir/ValueSet/medication-codes
                (extensible to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4)
                TypeChoice of: CodeableConcept, Reference(US Core Medication Profile, Medication)
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Is Modifierfalse
                Must Supporttrue
                Must Support TypesNo must-support rules about the choice of types/profiles
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                SlicingThis 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
                • 72. MedicationRequest.medication[x]:medicationCodeableConcept
                  Slice NamemedicationCodeableConcept
                  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.

                  ShortMedication 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.

                  Control01..1
                  BindingUnless not suitable, these codes SHALL be taken from For example codes, see Medication Clinical Drug .http://hl7.org/fhir/ValueSet/medication-codes
                  (extensible to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4)
                  TypeCodeableConcept, Reference(Medication)
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  74. MedicationRequest.medication[x]:medicationCodeableConcept.coding
                  Definition

                  A reference to a code defined by a terminology system.

                  ShortCode 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.

                  Control0..*
                  TypeCoding
                  Is Modifierfalse
                  Summarytrue
                  Requirements

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

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  76. MedicationRequest.medication[x]:medicationCodeableConcept.coding.system
                  Definition

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

                  ShortIdentity of the terminology system
                  Comments

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

                  Control0..1
                  Typeuri
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

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

                  Pattern Valuehttp://www.nlm.nih.gov/research/umls/rxnorm
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  78. MedicationRequest.medication[x]:medicationCodeableConcept.coding.code
                  Definition

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

                  ShortSymbol in syntax defined by the system
                  Control0..1
                  Typecode
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Need to refer to a particular code in the system.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  80. 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.

                  ShortPlain text representation of the concept
                  Comments

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

                  Control0..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  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.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  82. MedicationRequest.medication[x]:medicationReference
                  Slice NamemedicationReference
                  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.

                  ShortMedication 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.

                  Control01..1
                  TypeReference(US Core Medication Profile, Medication), CodeableConcept
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  84. MedicationRequest.subject
                  Definition

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

                  ShortWho 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.

                  Control1..1
                  TypeReference(Patient, Patient, Group)
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  86. MedicationRequest.encounter
                  Definition

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

                  ShortEncounter 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.

                  Control0..1
                  TypeReference(US Core Encounter Profile, Encounter)
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  88. MedicationRequest.authoredOn
                  Definition

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

                  ShortWhen request was initially authored
                  Control0..1
                  TypedateTime
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  90. MedicationRequest.requester
                  Definition

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

                  ShortWho/What requested the Request
                  Control10..1
                  TypeReference(Practitioner, Practitioner, PractitionerRole, Organization, Patient, RelatedPerson, Device)
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  92. MedicationRequest.reasonCode
                  Definition

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

                  ShortReason 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.

                  Control0..*
                  BindingFor example codes, see Condition/Problem/DiagnosisCodeshttp://hl7.org/fhir/ValueSet/condition-code
                  (example to http://hl7.org/fhir/ValueSet/condition-code)

                  A coded concept indicating why the medication was ordered.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  94. MedicationRequest.reasonCode.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.

                  ShortPlain text representation of the concept
                  Comments

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

                  Control0..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  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.

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

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

                  ShortHow 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.

                  Control0..*
                  TypeDosage
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  98. 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).

                  ShortExtensions 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.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  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 Namesextensions, user content, modifiers
                  Invariantsele-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())
                  100. MedicationRequest.dosageInstruction.text
                  Definition

                  Free text dosage instructions e.g. SIG.

                  ShortFree text dosage instructions e.g. SIG
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  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.

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

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

                  ShortPatient or consumer oriented instructions
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Invariantsele-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.

                  ShortHow drug should enter body
                  Control0..1
                  BindingFor example codes, see SNOMEDCTRouteCodeshttp://hl7.org/fhir/ValueSet/route-codes
                  (example to http://hl7.org/fhir/ValueSet/route-codes)

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

                  TypeCodeableConcept
                  Is Modifierfalse
                  Summarytrue
                  Requirements

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

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

                  A reference to a code defined by a terminology system.

                  ShortCode 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.

                  Control0..*
                  TypeCoding
                  Is Modifierfalse
                  Summarytrue
                  Requirements

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

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  108. MedicationRequest.dosageInstruction.route.coding.system
                  Definition

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

                  ShortIdentity of the terminology system
                  Comments

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

                  Control0..1
                  Typeuri
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

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

                  Pattern Valuehttp://va.gov/terminology/vistaDefinedTerms/53.1-3
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  110. MedicationRequest.dosageInstruction.route.coding.code
                  Definition

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

                  ShortSymbol in syntax defined by the system
                  Control0..1
                  Typecode
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Need to refer to a particular code in the system.

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

                  The amount of medication administered.

                  ShortAmount of medication administered
                  Control0..*
                  TypeElement
                  Is Modifierfalse
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  114. MedicationRequest.dosageInstruction.doseAndRate.extension:originalText
                  Slice NameoriginalText
                  Definition

                  A human language representation of the concept (resource/element) as seen/selected/uttered by the user who entered the data and/or which represents the full intended meaning of the user. This can be provided either directly as text, or as a url that is a reference to a portion of the narrative of a resource (DomainResource.text or Composition.section.text). When it a url, the value should end with a #{id} where the id identifies a specific portion of the referenced content (via an XHTML id attribute).

                  ShortOriginal Text that represents the data as seen/selected/uttered originally
                  Comments

                  The data in the element does not always capture the correct meaning with all the nuances of the original text. In these cases, the text is used to capture the full meaning of the source. This is commonly used to provide "what did the user actually see/type". Note that this extension has the same definition as CodeableConcept.text and SHALL NOT be used on CodeableConcept with type = string in place of CodeableConcept.text but MAY be used with type url. If present on a CodeableConcept with type url as well as CodeableConcept.text, then the CodeableConcept.text SHALL match the referenced narrative.

                  It's also possible to link to the resource narrative using the narrativeLink extension which does not claim that the data is derived from the text.

                  Control0..1
                  TypeExtension(Original Text) (Extension Type: Choice of: string, url)
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-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())
                  116. MedicationRequest.dosageInstruction.doseAndRate.extension:originalText.extension
                  Definition

                  An Extension


                  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.

                  ShortExtensionAdditional 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.

                  Control0..0*
                  TypeExtension
                  Is Modifierfalse
                  Summaryfalse
                  Alternate Namesextensions, user content
                  Invariantsele-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())
                  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())
                  SlicingThis element introduces a set of slices on MedicationRequest.dosageInstruction.doseAndRate.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 118. MedicationRequest.dosageInstruction.doseAndRate.extension:originalText.url
                    Definition

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

                    Shortidentifies the meaning of the extension
                    Comments

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

                    Control1..1
                    Typeuri
                    Is Modifierfalse
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Summaryfalse
                    Fixed Valuehttp://hl7.org/fhir/StructureDefinition/originalText
                    120. MedicationRequest.dosageInstruction.doseAndRate.extension:originalText.value[x]
                    Definition

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


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

                    ShortValue of extension
                    Control10..1
                    This element is affected by the following invariants: ext-1
                    TypeChoice of: string, url, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supporttrue
                    Must Support TypesNo must-support rules about the choice of types/profiles
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    mro-27-841: If not a number then source value from (52-113 > 52.0113-.01) (true)
                    ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    122. MedicationRequest.dosageInstruction.doseAndRate.dose[x]
                    Definition

                    Amount of medication per dose.

                    ShortAmount 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.

                    Control0..1
                    TypeChoice of: Range, Quantity(SimpleQuantity)
                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                    Is Modifierfalse
                    Summarytrue
                    Requirements

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

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    SlicingThis element introduces a set of slices on MedicationRequest.dosageInstruction.doseAndRate.dose[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • type @ $this
                    • 124. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity
                      Slice NamedoseQuantity
                      Definition

                      Amount of medication per dose.

                      ShortAmount 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.

                      Control0..1
                      TypeQuantity(SimpleQuantity), Range
                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                      Is Modifierfalse
                      Summarytrue
                      Requirements

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

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

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

                      ShortNumerical value (with implicit precision)
                      Comments

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

                      Control0..1
                      Typedecimal
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Must Supporttrue
                      Summarytrue
                      Requirements

                      Precision is handled implicitly in almost all cases of measurement.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      mro-27-811: If number then source value from (52-113 > 52.0113-.01) (true)
                      128. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.comparator
                      Definition

                      Not allowed to be used in this context


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

                      Short< | <= | >= | > - how to understand the value
                      Control0..01
                      BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
                      (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                      How the Quantity should be understood and represented.

                      Typecode
                      Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Requirements

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

                      Meaning if MissingIf there is no comparator, then there is no modification of the value
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      130. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.unit
                      Definition

                      A human-readable form of the unit.

                      ShortUnit representation
                      Control0..1
                      Typestring
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Must Supporttrue
                      Summarytrue
                      Requirements

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

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      132. 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.

                      ShortMedication supply authorization
                      Control0..1
                      TypeBackboneElement
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      134. 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).

                      ShortExtensions 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.

                      Control0..*
                      TypeExtension
                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                      Summarytrue
                      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 Namesextensions, user content, modifiers
                      Invariantsele-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())
                      136. MedicationRequest.dispenseRequest.validityPeriod
                      Definition

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

                      ShortTime 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.

                      Control0..1
                      TypePeriod
                      Is Modifierfalse
                      Summaryfalse
                      Requirements

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

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      138. MedicationRequest.dispenseRequest.validityPeriod.end
                      Definition

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

                      ShortEnd time with inclusive boundary, if not ongoing
                      Comments

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

                      Control0..1
                      This element is affected by the following invariants: per-1
                      TypedateTime
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Must Supporttrue
                      Summarytrue
                      Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      140. 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.

                      ShortNumber of refills authorized
                      Comments

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

                      Control0..1
                      TypeunsignedInt
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Must Supporttrue
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      142. MedicationRequest.dispenseRequest.quantity
                      Definition

                      The amount that is to be dispensed for one fill.

                      ShortAmount of medication to supply per dispense
                      Control0..1
                      TypeQuantity(SimpleQuantity)
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      144. MedicationRequest.dispenseRequest.quantity.value
                      Definition

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

                      ShortNumerical value (with implicit precision)
                      Comments

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

                      Control0..1
                      Typedecimal
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Must Supporttrue
                      Summarytrue
                      Requirements

                      Precision is handled implicitly in almost all cases of measurement.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      146. MedicationRequest.dispenseRequest.quantity.comparator
                      Definition

                      Not allowed to be used in this context


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

                      Short< | <= | >= | > - how to understand the value
                      Control0..01
                      BindingThe codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
                      (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                      How the Quantity should be understood and represented.

                      Typecode
                      Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Requirements

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

                      Meaning if MissingIf there is no comparator, then there is no modification of the value
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      148. 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.

                      ShortNumber 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.

                      Control0..1
                      TypeDuration
                      Is Modifierfalse
                      Must Supporttrue
                      Summaryfalse
                      Invariantsele-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
                      Must Supporttrue
                      4. MedicationRequest.extension
                      SlicingThis element introduces a set of slices on MedicationRequest.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 6. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus
                        Slice Namemedicationrequest-pharmacyOrderStatus
                        Control0..1
                        TypeExtension(MedicationRequestPharmacyOrderStatus) (Extension Type: Coding)
                        8. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x]
                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        10. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].system
                        Must Supporttrue
                        Pattern Valuehttp://va.gov/terminology/vistaDefinedTerms/52-100
                        Invariantsmro-27-1746-1: If P then fixed value http://va.gov/terminology/vistaDefinedTerms/52-100 (true)
                        12. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].code
                        Must Supporttrue
                        Invariantsmro-27-1746: If (52-11) is P then fixed value #active-parked (true)
                        14. MedicationRequest.extension:medicationrequest-cancelDate
                        Slice Namemedicationrequest-cancelDate
                        Control0..1
                        TypeExtension(MedicationRequestCancelDate) (Extension Type: dateTime)
                        16. MedicationRequest.extension:medicationrequest-cancelDate.value[x]
                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        Must Supporttrue
                        18. MedicationRequest.extension:medicationrequest-includeIndicationInSig
                        Slice Namemedicationrequest-includeIndicationInSig
                        Control0..1
                        TypeExtension(MedicationRequestIncludeIndicationInSig) (Extension Type: boolean)
                        20. MedicationRequest.extension:medicationrequest-includeIndicationInSig.value[x]
                        Comments

                        see mapping VF_Boolean

                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        Must Supporttrue
                        22. MedicationRequest.extension:medicationrequest-remainingRefillCount
                        Slice Namemedicationrequest-remainingRefillCount
                        Control0..1
                        TypeExtension(MedicationrequestRemainingRefillCount) (Extension Type: integer)
                        24. MedicationRequest.extension:medicationrequest-remainingRefillCount.value[x]
                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        Must Supporttrue
                        26. MedicationRequest.identifier
                        NoteThis is a business identifier, not a resource identifier (see discussion)
                        28. MedicationRequest.identifier.type
                        Must Supporttrue
                        Pattern Value{
                          "coding" : [{
                            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                            "code" : "FILL"
                          }]
                        }
                        30. MedicationRequest.identifier.value
                        Must Supporttrue
                        32. MedicationRequest.status
                        BindingThe codes SHALL be taken from OutMedRequestStatus FHIR
                        (required to http://va.gov/fhir/ValueSet/OutMedRequestStatus)

                        see mapping VF_OutMedRequestStatus

                        34. MedicationRequest.intent
                        Pattern Valueorder
                        36. MedicationRequest.category
                        Pattern Value{
                          "coding" : [{
                            "system" : "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                            "code" : "outpatient"
                          }]
                        }
                        38. MedicationRequest.reported[x]
                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        SlicingThis element introduces a set of slices on MedicationRequest.reported[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • type @ $this
                        • 40. MedicationRequest.reported[x]:reportedBoolean
                          Slice NamereportedBoolean
                          Control0..1
                          Typeboolean
                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          42. MedicationRequest.reported[x]:reportedReference
                          Slice NamereportedReference
                          Control0..1
                          TypeReference(US Core Practitioner Profile, US Core Organization Profile, US Core Patient Profile, US Core PractitionerRole Profile, US Core RelatedPerson Profile)
                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                          44. MedicationRequest.medication[x]
                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                          SlicingThis 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
                          • 46. MedicationRequest.medication[x]:medicationCodeableConcept
                            Slice NamemedicationCodeableConcept
                            Control0..1
                            TypeCodeableConcept
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            48. MedicationRequest.medication[x]:medicationCodeableConcept.coding
                            50. MedicationRequest.medication[x]:medicationCodeableConcept.coding.system
                            Must Supporttrue
                            Pattern Valuehttp://www.nlm.nih.gov/research/umls/rxnorm
                            52. MedicationRequest.medication[x]:medicationCodeableConcept.coding.code
                            Must Supporttrue
                            54. MedicationRequest.medication[x]:medicationCodeableConcept.text
                            Must Supporttrue
                            56. MedicationRequest.medication[x]:medicationReference
                            Slice NamemedicationReference
                            Control0..1
                            TypeReference(US Core Medication Profile)
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            58. MedicationRequest.subject
                            TypeReference(Patient)
                            60. MedicationRequest.encounter
                            62. MedicationRequest.authoredOn
                            64. MedicationRequest.requester
                            TypeReference(Practitioner)
                            66. MedicationRequest.reasonCode
                            68. MedicationRequest.reasonCode.text
                            Must Supporttrue
                            70. MedicationRequest.dosageInstruction
                            72. MedicationRequest.dosageInstruction.text
                            74. MedicationRequest.dosageInstruction.patientInstruction
                            Must Supporttrue
                            76. MedicationRequest.dosageInstruction.route
                            78. MedicationRequest.dosageInstruction.route.coding
                            80. MedicationRequest.dosageInstruction.route.coding.system
                            Must Supporttrue
                            Pattern Valuehttp://va.gov/terminology/vistaDefinedTerms/53.1-3
                            82. MedicationRequest.dosageInstruction.route.coding.code
                            Must Supporttrue
                            84. MedicationRequest.dosageInstruction.doseAndRate
                            86. MedicationRequest.dosageInstruction.doseAndRate.extension:originalText
                            Slice NameoriginalText
                            Control0..1
                            TypeExtension(Original Text) (Extension Type: Choice of: string, url)
                            88. MedicationRequest.dosageInstruction.doseAndRate.extension:originalText.value[x]
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            Must Supporttrue
                            Invariantsmro-27-841: If not a number then source value from (52-113 > 52.0113-.01) (true)
                            90. MedicationRequest.dosageInstruction.doseAndRate.dose[x]
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            SlicingThis element introduces a set of slices on MedicationRequest.dosageInstruction.doseAndRate.dose[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • type @ $this
                            • 92. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity
                              Slice NamedoseQuantity
                              Control0..1
                              TypeQuantity(SimpleQuantity)
                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                              94. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.value
                              Must Supporttrue
                              Invariantsmro-27-811: If number then source value from (52-113 > 52.0113-.01) (true)
                              96. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.unit
                              Must Supporttrue
                              98. MedicationRequest.dispenseRequest
                              100. MedicationRequest.dispenseRequest.validityPeriod
                              102. MedicationRequest.dispenseRequest.validityPeriod.end
                              Must Supporttrue
                              104. MedicationRequest.dispenseRequest.numberOfRepeatsAllowed
                              Must Supporttrue
                              106. MedicationRequest.dispenseRequest.quantity
                              108. MedicationRequest.dispenseRequest.quantity.value
                              Must Supporttrue
                              110. MedicationRequest.dispenseRequest.expectedSupplyDuration
                              Must Supporttrue

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

                              0. MedicationRequest
                              Definition

                              -

                              ShortOrdering of medication for patient or group
                              Comments

                              -

                              Control0..*
                              Is Modifierfalse
                              Must Supportfalse
                              Summaryfalse
                              Alternate NamesPrescription, Order
                              Invariantsdom-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())
                              2. MedicationRequest.id
                              Definition

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

                              ShortLogical 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.

                              Control0..1
                              Typeid
                              Is Modifierfalse
                              Must Supporttrue
                              Summarytrue
                              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.

                              ShortMetadata about the resource
                              Control0..1
                              TypeMeta
                              Is Modifierfalse
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              6. 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.

                              ShortA 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.

                              Control0..1
                              Typeuri
                              Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              8. MedicationRequest.language
                              Definition

                              The base language in which the resource is written.

                              ShortLanguage 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).

                              Control0..1
                              BindingThe codes SHOULD be taken from CommonLanguages
                              (preferred to http://hl7.org/fhir/ValueSet/languages)

                              A human language.

                              Additional BindingsPurpose
                              AllLanguagesMax Binding
                              Typecode
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              10. 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.

                              ShortText 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.

                              Control0..1
                              TypeNarrative
                              Is Modifierfalse
                              Summaryfalse
                              Alternate Namesnarrative, html, xhtml, display
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              12. 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.

                              ShortContained, 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.

                              Control0..*
                              TypeResource
                              Is Modifierfalse
                              Summaryfalse
                              Alternate Namesinline resources, anonymous resources, contained resources
                              14. MedicationRequest.extension
                              Definition

                              An Extension

                              ShortExtension
                              Control0..*
                              TypeExtension
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-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())
                              SlicingThis element introduces a set of slices on MedicationRequest.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ url
                              • 16. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus
                                Slice Namemedicationrequest-pharmacyOrderStatus
                                Definition

                                Extension medicationrequest-pharmacyOrderStatus

                                ShortExtension
                                Control0..1
                                This element is affected by the following invariants: ele-1
                                TypeExtension(MedicationRequestPharmacyOrderStatus) (Extension Type: Coding)
                                Is Modifierfalse
                                Summaryfalse
                                Invariantsele-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())
                                18. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.id
                                Definition

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

                                ShortUnique id for inter-element referencing
                                Control0..1
                                Typestring
                                Is Modifierfalse
                                XML FormatIn the XML format, this property is represented as an attribute.
                                Summaryfalse
                                20. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.extension
                                Definition

                                An Extension

                                ShortExtension
                                Control0..0
                                TypeExtension
                                Is Modifierfalse
                                Summaryfalse
                                Invariantsele-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())
                                SlicingThis element introduces a set of slices on MedicationRequest.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • value @ url
                                • 22. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.url
                                  Definition

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

                                  Shortidentifies the meaning of the extension
                                  Comments

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

                                  Control1..1
                                  Typeuri
                                  Is Modifierfalse
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  Summaryfalse
                                  Fixed Valuehttp://va.gov/fhir/StructureDefinition/medicationrequest-pharmacyOrderStatus
                                  24. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x]
                                  Definition

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

                                  ShortValue of extension
                                  Control0..1
                                  TypeCoding
                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                  Is Modifierfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  26. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].id
                                  Definition

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

                                  ShortUnique id for inter-element referencing
                                  Control0..1
                                  Typestring
                                  Is Modifierfalse
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  Summaryfalse
                                  28. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].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.

                                  ShortAdditional 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.

                                  Control0..*
                                  TypeExtension
                                  Is Modifierfalse
                                  Summaryfalse
                                  Alternate Namesextensions, user content
                                  Invariantsele-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())
                                  SlicingThis element introduces a set of slices on MedicationRequest.extension.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • value @ url
                                  • 30. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].system
                                    Definition

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

                                    ShortIdentity of the terminology system
                                    Comments

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

                                    Control0..1
                                    Typeuri
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Must Supporttrue
                                    Summarytrue
                                    Requirements

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

                                    Pattern Valuehttp://va.gov/terminology/vistaDefinedTerms/52-100
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    mro-27-1746-1: If P then fixed value http://va.gov/terminology/vistaDefinedTerms/52-100 (true)
                                    32. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].version
                                    Definition

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

                                    ShortVersion of the system - if relevant
                                    Comments

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

                                    NoteThis is a business version Id, not a resource version Id (see discussion)
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    34. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].code
                                    Definition

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

                                    ShortSymbol in syntax defined by the system
                                    Control0..1
                                    Typecode
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Must Supporttrue
                                    Summarytrue
                                    Requirements

                                    Need to refer to a particular code in the system.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    mro-27-1746: If (52-11) is P then fixed value #active-parked (true)
                                    36. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].display
                                    Definition

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

                                    ShortRepresentation defined by the system
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Requirements

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

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    38. MedicationRequest.extension:medicationrequest-pharmacyOrderStatus.value[x].userSelected
                                    Definition

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

                                    ShortIf this coding was chosen directly by the user
                                    Comments

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

                                    Control0..1
                                    Typeboolean
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Requirements

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

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    40. MedicationRequest.extension:medicationrequest-cancelDate
                                    Slice Namemedicationrequest-cancelDate
                                    Definition

                                    Extension medicationrequest-cancelDate

                                    ShortExtension
                                    Control0..1
                                    This element is affected by the following invariants: ele-1
                                    TypeExtension(MedicationRequestCancelDate) (Extension Type: dateTime)
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-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())
                                    42. MedicationRequest.extension:medicationrequest-cancelDate.id
                                    Definition

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

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    44. MedicationRequest.extension:medicationrequest-cancelDate.extension
                                    Definition

                                    An Extension

                                    ShortExtension
                                    Control0..0
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-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())
                                    SlicingThis element introduces a set of slices on MedicationRequest.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                    • value @ url
                                    • 46. MedicationRequest.extension:medicationrequest-cancelDate.url
                                      Definition

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

                                      Shortidentifies the meaning of the extension
                                      Comments

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

                                      Control1..1
                                      Typeuri
                                      Is Modifierfalse
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      Summaryfalse
                                      Fixed Valuehttp://va.gov/fhir/StructureDefinition/medicationrequest-cancelDate
                                      48. MedicationRequest.extension:medicationrequest-cancelDate.value[x]
                                      Definition

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

                                      ShortValue of extension
                                      Control0..1
                                      TypedateTime
                                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Must Supporttrue
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      50. MedicationRequest.extension:medicationrequest-includeIndicationInSig
                                      Slice Namemedicationrequest-includeIndicationInSig
                                      Definition

                                      Extension medicationrequest-includeIndicationInSig

                                      ShortExtension
                                      Control0..1
                                      This element is affected by the following invariants: ele-1
                                      TypeExtension(MedicationRequestIncludeIndicationInSig) (Extension Type: boolean)
                                      Is Modifierfalse
                                      Summaryfalse
                                      Invariantsele-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())
                                      52. MedicationRequest.extension:medicationrequest-includeIndicationInSig.id
                                      Definition

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

                                      ShortUnique id for inter-element referencing
                                      Control0..1
                                      Typestring
                                      Is Modifierfalse
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      Summaryfalse
                                      54. MedicationRequest.extension:medicationrequest-includeIndicationInSig.extension
                                      Definition

                                      An Extension

                                      ShortExtension
                                      Control0..0
                                      TypeExtension
                                      Is Modifierfalse
                                      Summaryfalse
                                      Invariantsele-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())
                                      SlicingThis element introduces a set of slices on MedicationRequest.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                      • value @ url
                                      • 56. MedicationRequest.extension:medicationrequest-includeIndicationInSig.url
                                        Definition

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

                                        Shortidentifies the meaning of the extension
                                        Comments

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

                                        Control1..1
                                        Typeuri
                                        Is Modifierfalse
                                        XML FormatIn the XML format, this property is represented as an attribute.
                                        Summaryfalse
                                        Fixed Valuehttp://va.gov/fhir/StructureDefinition/medicationrequest-includeIndicationInSig
                                        58. MedicationRequest.extension:medicationrequest-includeIndicationInSig.value[x]
                                        Definition

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

                                        ShortValue of extension
                                        Comments

                                        see mapping VF_Boolean

                                        Control0..1
                                        Typeboolean
                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Must Supporttrue
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        60. MedicationRequest.extension:medicationrequest-remainingRefillCount
                                        Slice Namemedicationrequest-remainingRefillCount
                                        Definition

                                        Extension medicationrequest-remainingRefillCount

                                        ShortExtension
                                        Control0..1
                                        This element is affected by the following invariants: ele-1
                                        TypeExtension(MedicationrequestRemainingRefillCount) (Extension Type: integer)
                                        Is Modifierfalse
                                        Summaryfalse
                                        Invariantsele-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())
                                        62. MedicationRequest.extension:medicationrequest-remainingRefillCount.id
                                        Definition

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

                                        ShortUnique id for inter-element referencing
                                        Control0..1
                                        Typestring
                                        Is Modifierfalse
                                        XML FormatIn the XML format, this property is represented as an attribute.
                                        Summaryfalse
                                        64. MedicationRequest.extension:medicationrequest-remainingRefillCount.extension
                                        Definition

                                        An Extension

                                        ShortExtension
                                        Control0..0
                                        TypeExtension
                                        Is Modifierfalse
                                        Summaryfalse
                                        Invariantsele-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())
                                        SlicingThis element introduces a set of slices on MedicationRequest.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                        • value @ url
                                        • 66. MedicationRequest.extension:medicationrequest-remainingRefillCount.url
                                          Definition

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

                                          Shortidentifies the meaning of the extension
                                          Comments

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

                                          Control1..1
                                          Typeuri
                                          Is Modifierfalse
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          Summaryfalse
                                          Fixed Valuehttp://va.gov/fhir/StructureDefinition/medicationrequest-remainingRefillCount
                                          68. MedicationRequest.extension:medicationrequest-remainingRefillCount.value[x]
                                          Definition

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

                                          ShortValue of extension
                                          Control0..1
                                          Typeinteger
                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Must Supporttrue
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          70. 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).

                                          ShortExtensions 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.

                                          Control0..*
                                          TypeExtension
                                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                                          Summaryfalse
                                          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 Namesextensions, user content
                                          Invariantsele-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())
                                          72. 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.

                                          ShortExternal ids for this request
                                          Comments

                                          This is a business identifier, not a resource identifier.

                                          NoteThis is a business identifier, not a resource identifier (see discussion)
                                          Control0..*
                                          TypeIdentifier
                                          Is Modifierfalse
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          74. MedicationRequest.identifier.id
                                          Definition

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

                                          ShortUnique id for inter-element referencing
                                          Control0..1
                                          Typestring
                                          Is Modifierfalse
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          Summaryfalse
                                          76. MedicationRequest.identifier.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.

                                          ShortAdditional 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.

                                          Control0..*
                                          TypeExtension
                                          Is Modifierfalse
                                          Summaryfalse
                                          Alternate Namesextensions, user content
                                          Invariantsele-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())
                                          SlicingThis element introduces a set of slices on MedicationRequest.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                          • value @ url
                                          • 78. MedicationRequest.identifier.use
                                            Definition

                                            The purpose of this identifier.

                                            Shortusual | official | temp | secondary | old (If known)
                                            Comments

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

                                            Control0..1
                                            BindingThe codes SHALL be taken from IdentifierUse
                                            (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                                            Identifies the purpose for this identifier, if known .

                                            Typecode
                                            Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            Requirements

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

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            80. MedicationRequest.identifier.type
                                            Definition

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

                                            ShortDescription of identifier
                                            Comments

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

                                            Control0..1
                                            BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                                            (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

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

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Must Supporttrue
                                            Summarytrue
                                            Requirements

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

                                            Pattern Value{
                                              "coding" : [{
                                                "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                                                "code" : "FILL"
                                              }]
                                            }
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            82. MedicationRequest.identifier.system
                                            Definition

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

                                            ShortThe namespace for the identifier value
                                            Comments

                                            Identifier.system is always case sensitive.

                                            Control0..1
                                            Typeuri
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            Requirements

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

                                            Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            84. MedicationRequest.identifier.value
                                            Definition

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

                                            ShortThe value that is unique
                                            Comments

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

                                            Control0..1
                                            Typestring
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Must Supporttrue
                                            Summarytrue
                                            Example<br/><b>General</b>:123456
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            86. MedicationRequest.identifier.period
                                            Definition

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

                                            ShortTime period when id is/was valid for use
                                            Control0..1
                                            TypePeriod
                                            Is Modifierfalse
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            88. MedicationRequest.identifier.assigner
                                            Definition

                                            Organization that issued/manages the identifier.

                                            ShortOrganization that issued id (may be just text)
                                            Comments

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

                                            Control0..1
                                            TypeReference(Organization)
                                            Is Modifierfalse
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            90. MedicationRequest.status
                                            Definition

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

                                            Shortactive | 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.

                                            Control1..1
                                            BindingThe codes SHALL be taken from OutMedRequestStatus FHIR
                                            (required to http://va.gov/fhir/ValueSet/OutMedRequestStatus)

                                            see mapping VF_OutMedRequestStatus

                                            Typecode
                                            Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Must Supporttrue
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            92. MedicationRequest.statusReason
                                            Definition

                                            Captures the reason for the current state of the MedicationRequest.

                                            ShortReason 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.

                                            Control0..1
                                            BindingFor example codes, see medicationRequest Status Reason Codes
                                            (example to http://hl7.org/fhir/ValueSet/medicationrequest-status-reason)

                                            Identifies the reasons for a given status.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summaryfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            94. MedicationRequest.intent
                                            Definition

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

                                            Shortproposal | 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.

                                            Control1..1
                                            BindingThe codes SHALL be taken from medicationRequest Intent
                                            (required to http://hl7.org/fhir/ValueSet/medicationrequest-intent)

                                            The kind of medication order.

                                            Typecode
                                            Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Must Supporttrue
                                            Summarytrue
                                            Pattern Valueorder
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            96. 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)).

                                            ShortType of medication usage
                                            Comments

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

                                            Control0..*
                                            BindingFor example codes, see medicationRequest Category Codes
                                            (example to http://hl7.org/fhir/ValueSet/medicationrequest-category)

                                            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.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Must Supporttrue
                                            Summaryfalse
                                            Pattern Value{
                                              "coding" : [{
                                                "system" : "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                                                "code" : "outpatient"
                                              }]
                                            }
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            SlicingThis element introduces a set of slices on MedicationRequest.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                            • pattern @ $this
                                            • 98. MedicationRequest.category:us-core
                                              Slice Nameus-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)).

                                              ShortType of medication usage
                                              Comments

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

                                              Control0..*
                                              BindingThe codes SHALL be taken from medicationRequest Category Codes
                                              (required to http://hl7.org/fhir/ValueSet/medicationrequest-category)

                                              The type of medication order.

                                              TypeCodeableConcept
                                              Is Modifierfalse
                                              Must Supporttrue
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              100. MedicationRequest.priority
                                              Definition

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

                                              Shortroutine | urgent | asap | stat
                                              Control0..1
                                              BindingThe 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.

                                              Typecode
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Summarytrue
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              102. MedicationRequest.doNotPerform
                                              Definition

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

                                              ShortTrue if request is prohibiting action
                                              Comments

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

                                              Control0..1
                                              Typeboolean
                                              Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Summarytrue
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              104. 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.

                                              ShortReported rather than primary record
                                              Control0..1
                                              TypeChoice of: boolean, Reference(US Core Practitioner Profile, US Core Organization Profile, US Core Patient Profile, US Core PractitionerRole Profile, US Core RelatedPerson Profile)
                                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Must Supporttrue
                                              Must Support TypesChoice of: boolean, Reference(US Core Practitioner Profile)
                                              Summarytrue
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              SlicingThis element introduces a set of slices on MedicationRequest.reported[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                              • type @ $this
                                              • 106. MedicationRequest.reported[x]:reportedBoolean
                                                Slice NamereportedBoolean
                                                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.

                                                ShortReported rather than primary record
                                                Control0..1
                                                Typeboolean
                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Must Support Typesboolean
                                                Summarytrue
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                108. MedicationRequest.reported[x]:reportedReference
                                                Slice NamereportedReference
                                                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.

                                                ShortReported rather than primary record
                                                Control0..1
                                                TypeReference(US Core Practitioner Profile, US Core Organization Profile, US Core Patient Profile, US Core PractitionerRole Profile, US Core RelatedPerson Profile)
                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Must Support TypesReference(US Core Practitioner Profile)
                                                Summarytrue
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                110. 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.

                                                ShortMedication 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.

                                                Control1..1
                                                BindingUnless not suitable, these codes SHALL be taken from Medication Clinical Drug .
                                                (extensible to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4)
                                                TypeChoice of: CodeableConcept, Reference(US Core Medication Profile)
                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                Is Modifierfalse
                                                Must Supporttrue
                                                Must Support TypesNo must-support rules about the choice of types/profiles
                                                Summarytrue
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                SlicingThis 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
                                                • 112. MedicationRequest.medication[x]:medicationCodeableConcept
                                                  Slice NamemedicationCodeableConcept
                                                  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.

                                                  ShortMedication 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.

                                                  Control0..1
                                                  BindingUnless not suitable, these codes SHALL be taken from Medication Clinical Drug .
                                                  (extensible to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4)
                                                  TypeCodeableConcept
                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  114. 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.

                                                  ShortUnique id for inter-element referencing
                                                  Control0..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  Summaryfalse
                                                  116. 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.

                                                  ShortAdditional 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.

                                                  Control0..*
                                                  TypeExtension
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Alternate Namesextensions, user content
                                                  Invariantsele-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())
                                                  SlicingThis 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
                                                  • 118. MedicationRequest.medication[x]:medicationCodeableConcept.coding
                                                    Definition

                                                    A reference to a code defined by a terminology system.

                                                    ShortCode 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.

                                                    Control0..*
                                                    TypeCoding
                                                    Is Modifierfalse
                                                    Summarytrue
                                                    Requirements

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

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    120. MedicationRequest.medication[x]:medicationCodeableConcept.coding.id
                                                    Definition

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

                                                    ShortUnique id for inter-element referencing
                                                    Control0..1
                                                    Typestring
                                                    Is Modifierfalse
                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                    Summaryfalse
                                                    122. MedicationRequest.medication[x]:medicationCodeableConcept.coding.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.

                                                    ShortAdditional 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.

                                                    Control0..*
                                                    TypeExtension
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Alternate Namesextensions, user content
                                                    Invariantsele-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())
                                                    SlicingThis element introduces a set of slices on MedicationRequest.medication[x].coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                    • value @ url
                                                    • 124. MedicationRequest.medication[x]:medicationCodeableConcept.coding.system
                                                      Definition

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

                                                      ShortIdentity of the terminology system
                                                      Comments

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

                                                      Control0..1
                                                      Typeuri
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Must Supporttrue
                                                      Summarytrue
                                                      Requirements

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

                                                      Pattern Valuehttp://www.nlm.nih.gov/research/umls/rxnorm
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      126. MedicationRequest.medication[x]:medicationCodeableConcept.coding.version
                                                      Definition

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

                                                      ShortVersion of the system - if relevant
                                                      Comments

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

                                                      NoteThis is a business version Id, not a resource version Id (see discussion)
                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      128. MedicationRequest.medication[x]:medicationCodeableConcept.coding.code
                                                      Definition

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

                                                      ShortSymbol in syntax defined by the system
                                                      Control0..1
                                                      Typecode
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Must Supporttrue
                                                      Summarytrue
                                                      Requirements

                                                      Need to refer to a particular code in the system.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      130. MedicationRequest.medication[x]:medicationCodeableConcept.coding.display
                                                      Definition

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

                                                      ShortRepresentation defined by the system
                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      Requirements

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

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      132. MedicationRequest.medication[x]:medicationCodeableConcept.coding.userSelected
                                                      Definition

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

                                                      ShortIf this coding was chosen directly by the user
                                                      Comments

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

                                                      Control0..1
                                                      Typeboolean
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      Requirements

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

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      134. 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.

                                                      ShortPlain text representation of the concept
                                                      Comments

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

                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Must Supporttrue
                                                      Summarytrue
                                                      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.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      136. MedicationRequest.medication[x]:medicationReference
                                                      Slice NamemedicationReference
                                                      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.

                                                      ShortMedication 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.

                                                      Control0..1
                                                      TypeReference(US Core Medication Profile)
                                                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                      Is Modifierfalse
                                                      Must Supporttrue
                                                      Summarytrue
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      138. MedicationRequest.subject
                                                      Definition

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

                                                      ShortWho 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.

                                                      Control1..1
                                                      TypeReference(Patient)
                                                      Is Modifierfalse
                                                      Must Supporttrue
                                                      Summarytrue
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      140. MedicationRequest.encounter
                                                      Definition

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

                                                      ShortEncounter 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.

                                                      Control0..1
                                                      TypeReference(US Core Encounter Profile)
                                                      Is Modifierfalse
                                                      Must Supporttrue
                                                      Summaryfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      142. MedicationRequest.supportingInformation
                                                      Definition

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

                                                      ShortInformation to support ordering of the medication
                                                      Control0..*
                                                      TypeReference(Resource)
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      144. MedicationRequest.authoredOn
                                                      Definition

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

                                                      ShortWhen request was initially authored
                                                      Control0..1
                                                      TypedateTime
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Must Supporttrue
                                                      Summarytrue
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      146. MedicationRequest.requester
                                                      Definition

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

                                                      ShortWho/What requested the Request
                                                      Control1..1
                                                      TypeReference(Practitioner)
                                                      Is Modifierfalse
                                                      Must Supporttrue
                                                      Summarytrue
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      148. MedicationRequest.performer
                                                      Definition

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

                                                      ShortIntended performer of administration
                                                      Control0..1
                                                      TypeReference(Practitioner, PractitionerRole, Organization, Patient, Device, RelatedPerson, CareTeam)
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      150. MedicationRequest.performerType
                                                      Definition

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

                                                      ShortDesired 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.

                                                      Control0..1
                                                      BindingFor 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.

                                                      TypeCodeableConcept
                                                      Is Modifierfalse
                                                      Summarytrue
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      152. 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.

                                                      ShortPerson who entered the request
                                                      Control0..1
                                                      TypeReference(Practitioner, PractitionerRole)
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      154. MedicationRequest.reasonCode
                                                      Definition

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

                                                      ShortReason 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.

                                                      Control0..*
                                                      BindingFor example codes, see Condition/Problem/DiagnosisCodes
                                                      (example to http://hl7.org/fhir/ValueSet/condition-code)

                                                      A coded concept indicating why the medication was ordered.

                                                      TypeCodeableConcept
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      156. MedicationRequest.reasonCode.id
                                                      Definition

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

                                                      ShortUnique id for inter-element referencing
                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                      Summaryfalse
                                                      158. MedicationRequest.reasonCode.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.

                                                      ShortAdditional 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.

                                                      Control0..*
                                                      TypeExtension
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Alternate Namesextensions, user content
                                                      Invariantsele-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())
                                                      SlicingThis element introduces a set of slices on MedicationRequest.reasonCode.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                      • value @ url
                                                      • 160. MedicationRequest.reasonCode.coding
                                                        Definition

                                                        A reference to a code defined by a terminology system.

                                                        ShortCode 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.

                                                        Control0..*
                                                        TypeCoding
                                                        Is Modifierfalse
                                                        Summarytrue
                                                        Requirements

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

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

                                                        ShortPlain text representation of the concept
                                                        Comments

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

                                                        Control0..1
                                                        Typestring
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Must Supporttrue
                                                        Summarytrue
                                                        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.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        164. MedicationRequest.reasonReference
                                                        Definition

                                                        Condition or observation that supports why the medication was ordered.

                                                        ShortCondition 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.

                                                        Control0..*
                                                        TypeReference(Condition, Observation)
                                                        Is Modifierfalse
                                                        Summaryfalse
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        166. 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.

                                                        ShortInstantiates FHIR protocol or definition
                                                        Control0..*
                                                        Typecanonical
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summarytrue
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        168. 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.

                                                        ShortInstantiates external protocol or definition
                                                        Control0..*
                                                        Typeuri
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summarytrue
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        170. MedicationRequest.basedOn
                                                        Definition

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

                                                        ShortWhat request fulfills
                                                        Control0..*
                                                        TypeReference(CarePlan, MedicationRequest, ServiceRequest, ImmunizationRecommendation)
                                                        Is Modifierfalse
                                                        Summarytrue
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        172. 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.

                                                        ShortComposite request this is part of
                                                        Control0..1
                                                        TypeIdentifier
                                                        Is Modifierfalse
                                                        Summarytrue
                                                        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.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        174. MedicationRequest.courseOfTherapyType
                                                        Definition

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

                                                        ShortOverall pattern of medication administration
                                                        Comments

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

                                                        Control0..1
                                                        BindingFor 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.

                                                        TypeCodeableConcept
                                                        Is Modifierfalse
                                                        Summaryfalse
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        176. MedicationRequest.insurance
                                                        Definition

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

                                                        ShortAssociated insurance coverage
                                                        Control0..*
                                                        TypeReference(Coverage, ClaimResponse)
                                                        Is Modifierfalse
                                                        Summaryfalse
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        178. MedicationRequest.note
                                                        Definition

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

                                                        ShortInformation about the prescription
                                                        Control0..*
                                                        TypeAnnotation
                                                        Is Modifierfalse
                                                        Summaryfalse
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        180. MedicationRequest.dosageInstruction
                                                        Definition

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

                                                        ShortHow 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.

                                                        Control0..*
                                                        TypeDosage
                                                        Is Modifierfalse
                                                        Must Supporttrue
                                                        Summaryfalse
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        182. 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.

                                                        ShortUnique id for inter-element referencing
                                                        Control0..1
                                                        Typestring
                                                        Is Modifierfalse
                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                        Summaryfalse
                                                        184. 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.

                                                        ShortAdditional 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.

                                                        Control0..*
                                                        TypeExtension
                                                        Is Modifierfalse
                                                        Summaryfalse
                                                        Alternate Namesextensions, user content
                                                        Invariantsele-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())
                                                        SlicingThis 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
                                                        • 186. 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).

                                                          ShortExtensions 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.

                                                          Control0..*
                                                          TypeExtension
                                                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                          Summarytrue
                                                          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 Namesextensions, user content, modifiers
                                                          Invariantsele-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())
                                                          188. MedicationRequest.dosageInstruction.sequence
                                                          Definition

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

                                                          ShortThe order of the dosage instructions
                                                          Control0..1
                                                          Typeinteger
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summarytrue
                                                          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.

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

                                                          Free text dosage instructions e.g. SIG.

                                                          ShortFree text dosage instructions e.g. SIG
                                                          Control0..1
                                                          Typestring
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Must Supporttrue
                                                          Summarytrue
                                                          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.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          192. 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").

                                                          ShortSupplemental 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.

                                                          Control0..*
                                                          BindingFor 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".

                                                          TypeCodeableConcept
                                                          Is Modifierfalse
                                                          Summarytrue
                                                          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.

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

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

                                                          ShortPatient or consumer oriented instructions
                                                          Control0..1
                                                          Typestring
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Must Supporttrue
                                                          Summarytrue
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          196. MedicationRequest.dosageInstruction.timing
                                                          Definition

                                                          When medication should be administered.

                                                          ShortWhen 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.

                                                          Control0..1
                                                          TypeTiming
                                                          Is Modifierfalse
                                                          Summarytrue
                                                          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.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          198. 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).

                                                          ShortTake "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".

                                                          Control0..1
                                                          BindingFor 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.

                                                          TypeChoice of: boolean, CodeableConcept
                                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summarytrue
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          200. MedicationRequest.dosageInstruction.site
                                                          Definition

                                                          Body site to administer to.

                                                          ShortBody 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.

                                                          Control0..1
                                                          BindingFor 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.

                                                          TypeCodeableConcept
                                                          Is Modifierfalse
                                                          Summarytrue
                                                          Requirements

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

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

                                                          How drug should enter body.

                                                          ShortHow drug should enter body
                                                          Control0..1
                                                          BindingFor example codes, see SNOMEDCTRouteCodes
                                                          (example to http://hl7.org/fhir/ValueSet/route-codes)

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

                                                          TypeCodeableConcept
                                                          Is Modifierfalse
                                                          Summarytrue
                                                          Requirements

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

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

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

                                                          ShortUnique id for inter-element referencing
                                                          Control0..1
                                                          Typestring
                                                          Is Modifierfalse
                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                          Summaryfalse
                                                          206. MedicationRequest.dosageInstruction.route.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.

                                                          ShortAdditional 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.

                                                          Control0..*
                                                          TypeExtension
                                                          Is Modifierfalse
                                                          Summaryfalse
                                                          Alternate Namesextensions, user content
                                                          Invariantsele-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())
                                                          SlicingThis element introduces a set of slices on MedicationRequest.dosageInstruction.route.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                          • value @ url
                                                          • 208. MedicationRequest.dosageInstruction.route.coding
                                                            Definition

                                                            A reference to a code defined by a terminology system.

                                                            ShortCode 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.

                                                            Control0..*
                                                            TypeCoding
                                                            Is Modifierfalse
                                                            Summarytrue
                                                            Requirements

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

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

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

                                                            ShortUnique id for inter-element referencing
                                                            Control0..1
                                                            Typestring
                                                            Is Modifierfalse
                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                            Summaryfalse
                                                            212. MedicationRequest.dosageInstruction.route.coding.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.

                                                            ShortAdditional 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.

                                                            Control0..*
                                                            TypeExtension
                                                            Is Modifierfalse
                                                            Summaryfalse
                                                            Alternate Namesextensions, user content
                                                            Invariantsele-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())
                                                            SlicingThis element introduces a set of slices on MedicationRequest.dosageInstruction.route.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                            • value @ url
                                                            • 214. MedicationRequest.dosageInstruction.route.coding.system
                                                              Definition

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

                                                              ShortIdentity of the terminology system
                                                              Comments

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

                                                              Control0..1
                                                              Typeuri
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Must Supporttrue
                                                              Summarytrue
                                                              Requirements

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

                                                              Pattern Valuehttp://va.gov/terminology/vistaDefinedTerms/53.1-3
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              216. MedicationRequest.dosageInstruction.route.coding.version
                                                              Definition

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

                                                              ShortVersion of the system - if relevant
                                                              Comments

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

                                                              NoteThis is a business version Id, not a resource version Id (see discussion)
                                                              Control0..1
                                                              Typestring
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Summarytrue
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              218. MedicationRequest.dosageInstruction.route.coding.code
                                                              Definition

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

                                                              ShortSymbol in syntax defined by the system
                                                              Control0..1
                                                              Typecode
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Must Supporttrue
                                                              Summarytrue
                                                              Requirements

                                                              Need to refer to a particular code in the system.

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

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

                                                              ShortRepresentation defined by the system
                                                              Control0..1
                                                              Typestring
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Summarytrue
                                                              Requirements

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

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              222. MedicationRequest.dosageInstruction.route.coding.userSelected
                                                              Definition

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

                                                              ShortIf this coding was chosen directly by the user
                                                              Comments

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

                                                              Control0..1
                                                              Typeboolean
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Summarytrue
                                                              Requirements

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

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              224. MedicationRequest.dosageInstruction.route.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.

                                                              ShortPlain text representation of the concept
                                                              Comments

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

                                                              Control0..1
                                                              Typestring
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Summarytrue
                                                              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.

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

                                                              Technique for administering medication.

                                                              ShortTechnique for administering medication
                                                              Comments

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

                                                              Control0..1
                                                              BindingFor 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.

                                                              TypeCodeableConcept
                                                              Is Modifierfalse
                                                              Summarytrue
                                                              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.

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

                                                              The amount of medication administered.

                                                              ShortAmount of medication administered
                                                              Control0..*
                                                              TypeElement
                                                              Is Modifierfalse
                                                              Summarytrue
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              230. 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.

                                                              ShortUnique id for inter-element referencing
                                                              Control0..1
                                                              Typestring
                                                              Is Modifierfalse
                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                              Summaryfalse
                                                              232. 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.

                                                              ShortAdditional 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.

                                                              Control0..*
                                                              TypeExtension
                                                              Is Modifierfalse
                                                              Summaryfalse
                                                              Alternate Namesextensions, user content
                                                              Invariantsele-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())
                                                              SlicingThis 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
                                                              • 234. MedicationRequest.dosageInstruction.doseAndRate.extension:originalText
                                                                Slice NameoriginalText
                                                                Definition

                                                                A human language representation of the concept (resource/element) as seen/selected/uttered by the user who entered the data and/or which represents the full intended meaning of the user. This can be provided either directly as text, or as a url that is a reference to a portion of the narrative of a resource (DomainResource.text or Composition.section.text). When it a url, the value should end with a #{id} where the id identifies a specific portion of the referenced content (via an XHTML id attribute).

                                                                ShortOriginal Text that represents the data as seen/selected/uttered originally
                                                                Comments

                                                                The data in the element does not always capture the correct meaning with all the nuances of the original text. In these cases, the text is used to capture the full meaning of the source. This is commonly used to provide "what did the user actually see/type". Note that this extension has the same definition as CodeableConcept.text and SHALL NOT be used on CodeableConcept with type = string in place of CodeableConcept.text but MAY be used with type url. If present on a CodeableConcept with type url as well as CodeableConcept.text, then the CodeableConcept.text SHALL match the referenced narrative.

                                                                It's also possible to link to the resource narrative using the narrativeLink extension which does not claim that the data is derived from the text.

                                                                Control0..1
                                                                TypeExtension(Original Text) (Extension Type: Choice of: string, url)
                                                                Is Modifierfalse
                                                                Summaryfalse
                                                                Invariantsele-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())
                                                                236. MedicationRequest.dosageInstruction.doseAndRate.extension:originalText.id
                                                                Definition

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

                                                                ShortUnique id for inter-element referencing
                                                                Control0..1
                                                                This element is affected by the following invariants: ele-1
                                                                Typeid
                                                                Is Modifierfalse
                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                Summaryfalse
                                                                238. MedicationRequest.dosageInstruction.doseAndRate.extension:originalText.extension
                                                                Definition

                                                                An Extension

                                                                ShortExtension
                                                                Control0..0
                                                                TypeExtension
                                                                Is Modifierfalse
                                                                Summaryfalse
                                                                Invariantsele-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())
                                                                SlicingThis element introduces a set of slices on MedicationRequest.dosageInstruction.doseAndRate.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                • value @ url
                                                                • 240. MedicationRequest.dosageInstruction.doseAndRate.extension:originalText.url
                                                                  Definition

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

                                                                  Shortidentifies the meaning of the extension
                                                                  Comments

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

                                                                  Control1..1
                                                                  Typeuri
                                                                  Is Modifierfalse
                                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                                  Summaryfalse
                                                                  Fixed Valuehttp://hl7.org/fhir/StructureDefinition/originalText
                                                                  242. MedicationRequest.dosageInstruction.doseAndRate.extension:originalText.value[x]
                                                                  Definition

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

                                                                  ShortValue of extension
                                                                  Control1..1
                                                                  This element is affected by the following invariants: ext-1
                                                                  TypeChoice of: string, url
                                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                  Is Modifierfalse
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Must Supporttrue
                                                                  Must Support TypesNo must-support rules about the choice of types/profiles
                                                                  Summaryfalse
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  mro-27-841: If not a number then source value from (52-113 > 52.0113-.01) (true)
                                                                  244. MedicationRequest.dosageInstruction.doseAndRate.type
                                                                  Definition

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

                                                                  ShortThe kind of dose or rate specified
                                                                  Control0..1
                                                                  BindingFor example codes, see DoseAndRateType
                                                                  (example to http://hl7.org/fhir/ValueSet/dose-rate-type)

                                                                  The kind of dose or rate specified.

                                                                  TypeCodeableConcept
                                                                  Is Modifierfalse
                                                                  Summarytrue
                                                                  Requirements

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

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

                                                                  Amount of medication per dose.

                                                                  ShortAmount 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.

                                                                  Control0..1
                                                                  TypeChoice of: Range, Quantity(SimpleQuantity)
                                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                  Is Modifierfalse
                                                                  Summarytrue
                                                                  Requirements

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

                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  SlicingThis element introduces a set of slices on MedicationRequest.dosageInstruction.doseAndRate.dose[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                  • type @ $this
                                                                  • 248. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity
                                                                    Slice NamedoseQuantity
                                                                    Definition

                                                                    Amount of medication per dose.

                                                                    ShortAmount 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.

                                                                    Control0..1
                                                                    TypeQuantity(SimpleQuantity)
                                                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                    Is Modifierfalse
                                                                    Summarytrue
                                                                    Requirements

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

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

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

                                                                    ShortUnique id for inter-element referencing
                                                                    Control0..1
                                                                    Typestring
                                                                    Is Modifierfalse
                                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                                    Summaryfalse
                                                                    252. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.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.

                                                                    ShortAdditional 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.

                                                                    Control0..*
                                                                    TypeExtension
                                                                    Is Modifierfalse
                                                                    Summaryfalse
                                                                    Alternate Namesextensions, user content
                                                                    Invariantsele-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())
                                                                    SlicingThis element introduces a set of slices on MedicationRequest.dosageInstruction.doseAndRate.dose[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                    • value @ url
                                                                    • 254. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.value
                                                                      Definition

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

                                                                      ShortNumerical value (with implicit precision)
                                                                      Comments

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

                                                                      Control0..1
                                                                      Typedecimal
                                                                      Is Modifierfalse
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      Must Supporttrue
                                                                      Summarytrue
                                                                      Requirements

                                                                      Precision is handled implicitly in almost all cases of measurement.

                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      mro-27-811: If number then source value from (52-113 > 52.0113-.01) (true)
                                                                      256. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.comparator
                                                                      Definition

                                                                      Not allowed to be used in this context

                                                                      Short< | <= | >= | > - how to understand the value
                                                                      Control0..0
                                                                      BindingThe codes SHALL be taken from QuantityComparator
                                                                      (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                                      How the Quantity should be understood and represented.

                                                                      Typecode
                                                                      Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      Summarytrue
                                                                      Requirements

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

                                                                      Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      258. MedicationRequest.dosageInstruction.doseAndRate.dose[x]:doseQuantity.unit
                                                                      Definition

                                                                      A human-readable form of the unit.

                                                                      ShortUnit representation
                                                                      Control0..1
                                                                      Typestring
                                                                      Is Modifierfalse
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      Must Supporttrue
                                                                      Summarytrue
                                                                      Requirements

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

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

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

                                                                      ShortSystem that defines coded unit form
                                                                      Control0..1
                                                                      This element is affected by the following invariants: qty-3
                                                                      Typeuri
                                                                      Is Modifierfalse
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      Summarytrue
                                                                      Requirements

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

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

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

                                                                      ShortCoded form of the unit
                                                                      Comments

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

                                                                      Control0..1
                                                                      Typecode
                                                                      Is Modifierfalse
                                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                      Summarytrue
                                                                      Requirements

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

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

                                                                      Amount of medication per unit of time.

                                                                      ShortAmount 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.

                                                                      Control0..1
                                                                      TypeChoice of: Ratio, Range, Quantity(SimpleQuantity)
                                                                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                      Is Modifierfalse
                                                                      Summarytrue
                                                                      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.

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

                                                                      Upper limit on medication per unit of time.

                                                                      ShortUpper 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".

                                                                      Control0..1
                                                                      TypeRatio
                                                                      Is Modifierfalse
                                                                      Summarytrue
                                                                      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.

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

                                                                      Upper limit on medication per administration.

                                                                      ShortUpper 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.

                                                                      Control0..1
                                                                      TypeQuantity(SimpleQuantity)
                                                                      Is Modifierfalse
                                                                      Summarytrue
                                                                      Requirements

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

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

                                                                      Upper limit on medication per lifetime of the patient.

                                                                      ShortUpper limit on medication per lifetime of the patient
                                                                      Control0..1
                                                                      TypeQuantity(SimpleQuantity)
                                                                      Is Modifierfalse
                                                                      Summarytrue
                                                                      Requirements

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

                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      272. 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.

                                                                      ShortMedication supply authorization
                                                                      Control0..1
                                                                      TypeBackboneElement
                                                                      Is Modifierfalse
                                                                      Summaryfalse
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      274. 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.

                                                                      ShortUnique id for inter-element referencing
                                                                      Control0..1
                                                                      Typestring
                                                                      Is Modifierfalse
                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                      Summaryfalse
                                                                      276. 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.

                                                                      ShortAdditional 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.

                                                                      Control0..*
                                                                      TypeExtension
                                                                      Is Modifierfalse
                                                                      Summaryfalse
                                                                      Alternate Namesextensions, user content
                                                                      Invariantsele-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())
                                                                      278. 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).

                                                                      ShortExtensions 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.

                                                                      Control0..*
                                                                      TypeExtension
                                                                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                      Summarytrue
                                                                      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 Namesextensions, user content, modifiers
                                                                      Invariantsele-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.dispenseRequest.initialFill
                                                                      Definition

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

                                                                      ShortFirst fill details
                                                                      Comments

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

                                                                      Control0..1
                                                                      TypeBackboneElement
                                                                      Is Modifierfalse
                                                                      Summaryfalse
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      282. 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.

                                                                      ShortUnique id for inter-element referencing
                                                                      Control0..1
                                                                      Typestring
                                                                      Is Modifierfalse
                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                      Summaryfalse
                                                                      284. 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.

                                                                      ShortAdditional 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.

                                                                      Control0..*
                                                                      TypeExtension
                                                                      Is Modifierfalse
                                                                      Summaryfalse
                                                                      Alternate Namesextensions, user content
                                                                      Invariantsele-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())
                                                                      286. 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).

                                                                      ShortExtensions 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.

                                                                      Control0..*
                                                                      TypeExtension
                                                                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                      Summarytrue
                                                                      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 Namesextensions, user content, modifiers
                                                                      Invariantsele-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())
                                                                      288. MedicationRequest.dispenseRequest.initialFill.quantity
                                                                      Definition

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

                                                                      ShortFirst fill quantity
                                                                      Control0..1
                                                                      TypeQuantity(SimpleQuantity)
                                                                      Is Modifierfalse
                                                                      Summaryfalse
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      290. MedicationRequest.dispenseRequest.initialFill.duration
                                                                      Definition

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

                                                                      ShortFirst fill duration
                                                                      Control0..1
                                                                      TypeDuration
                                                                      Is Modifierfalse
                                                                      Summaryfalse
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      292. MedicationRequest.dispenseRequest.dispenseInterval
                                                                      Definition

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

                                                                      ShortMinimum period of time between dispenses
                                                                      Control0..1
                                                                      TypeDuration
                                                                      Is Modifierfalse
                                                                      Summaryfalse
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      294. MedicationRequest.dispenseRequest.validityPeriod
                                                                      Definition

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

                                                                      ShortTime 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.

                                                                      Control0..1
                                                                      TypePeriod
                                                                      Is Modifierfalse
                                                                      Summaryfalse
                                                                      Requirements

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

                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      296. MedicationRequest.dispenseRequest.validityPeriod.id
                                                                      Definition

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

                                                                      ShortUnique id for inter-element referencing
                                                                      Control0..1
                                                                      Typestring
                                                                      Is Modifierfalse
                                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                                      Summaryfalse
                                                                      298. MedicationRequest.dispenseRequest.validityPeriod.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.

                                                                      ShortAdditional 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.

                                                                      Control0..*
                                                                      TypeExtension
                                                                      Is Modifierfalse
                                                                      Summaryfalse
                                                                      Alternate Namesextensions, user content
                                                                      Invariantsele-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())
                                                                      SlicingThis element introduces a set of slices on MedicationRequest.dispenseRequest.validityPeriod.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                      • value @ url
                                                                      • 300. MedicationRequest.dispenseRequest.validityPeriod.start
                                                                        Definition

                                                                        The start of the period. The boundary is inclusive.

                                                                        ShortStarting time with inclusive boundary
                                                                        Comments

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

                                                                        Control0..1
                                                                        This element is affected by the following invariants: per-1
                                                                        TypedateTime
                                                                        Is Modifierfalse
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Summarytrue
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        302. MedicationRequest.dispenseRequest.validityPeriod.end
                                                                        Definition

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

                                                                        ShortEnd time with inclusive boundary, if not ongoing
                                                                        Comments

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

                                                                        Control0..1
                                                                        This element is affected by the following invariants: per-1
                                                                        TypedateTime
                                                                        Is Modifierfalse
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Must Supporttrue
                                                                        Summarytrue
                                                                        Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        304. 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.

                                                                        ShortNumber of refills authorized
                                                                        Comments

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

                                                                        Control0..1
                                                                        TypeunsignedInt
                                                                        Is Modifierfalse
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Must Supporttrue
                                                                        Summaryfalse
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        306. MedicationRequest.dispenseRequest.quantity
                                                                        Definition

                                                                        The amount that is to be dispensed for one fill.

                                                                        ShortAmount of medication to supply per dispense
                                                                        Control0..1
                                                                        TypeQuantity(SimpleQuantity)
                                                                        Is Modifierfalse
                                                                        Summaryfalse
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        308. MedicationRequest.dispenseRequest.quantity.id
                                                                        Definition

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

                                                                        ShortUnique id for inter-element referencing
                                                                        Control0..1
                                                                        Typestring
                                                                        Is Modifierfalse
                                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                                        Summaryfalse
                                                                        310. MedicationRequest.dispenseRequest.quantity.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.

                                                                        ShortAdditional 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.

                                                                        Control0..*
                                                                        TypeExtension
                                                                        Is Modifierfalse
                                                                        Summaryfalse
                                                                        Alternate Namesextensions, user content
                                                                        Invariantsele-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())
                                                                        SlicingThis element introduces a set of slices on MedicationRequest.dispenseRequest.quantity.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                        • value @ url
                                                                        • 312. MedicationRequest.dispenseRequest.quantity.value
                                                                          Definition

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

                                                                          ShortNumerical value (with implicit precision)
                                                                          Comments

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

                                                                          Control0..1
                                                                          Typedecimal
                                                                          Is Modifierfalse
                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                          Must Supporttrue
                                                                          Summarytrue
                                                                          Requirements

                                                                          Precision is handled implicitly in almost all cases of measurement.

                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          314. MedicationRequest.dispenseRequest.quantity.comparator
                                                                          Definition

                                                                          Not allowed to be used in this context

                                                                          Short< | <= | >= | > - how to understand the value
                                                                          Control0..0
                                                                          BindingThe codes SHALL be taken from QuantityComparator
                                                                          (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                                          How the Quantity should be understood and represented.

                                                                          Typecode
                                                                          Is Modifiertrue because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                          Summarytrue
                                                                          Requirements

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

                                                                          Meaning if MissingIf there is no comparator, then there is no modification of the value
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          316. MedicationRequest.dispenseRequest.quantity.unit
                                                                          Definition

                                                                          A human-readable form of the unit.

                                                                          ShortUnit representation
                                                                          Control0..1
                                                                          Typestring
                                                                          Is Modifierfalse
                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                          Summarytrue
                                                                          Requirements

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

                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          318. MedicationRequest.dispenseRequest.quantity.system
                                                                          Definition

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

                                                                          ShortSystem that defines coded unit form
                                                                          Control0..1
                                                                          This element is affected by the following invariants: qty-3
                                                                          Typeuri
                                                                          Is Modifierfalse
                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                          Summarytrue
                                                                          Requirements

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

                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          320. MedicationRequest.dispenseRequest.quantity.code
                                                                          Definition

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

                                                                          ShortCoded form of the unit
                                                                          Comments

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

                                                                          Control0..1
                                                                          Typecode
                                                                          Is Modifierfalse
                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                          Summarytrue
                                                                          Requirements

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

                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          322. 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.

                                                                          ShortNumber 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.

                                                                          Control0..1
                                                                          TypeDuration
                                                                          Is Modifierfalse
                                                                          Must Supporttrue
                                                                          Summaryfalse
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          324. MedicationRequest.dispenseRequest.performer
                                                                          Definition

                                                                          Indicates the intended dispensing Organization specified by the prescriber.

                                                                          ShortIntended dispenser
                                                                          Control0..1
                                                                          TypeReference(Organization)
                                                                          Is Modifierfalse
                                                                          Summaryfalse
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          326. 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.

                                                                          ShortAny restrictions on medication substitution
                                                                          Control0..1
                                                                          TypeBackboneElement
                                                                          Is Modifierfalse
                                                                          Summaryfalse
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          328. 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.

                                                                          ShortUnique id for inter-element referencing
                                                                          Control0..1
                                                                          Typestring
                                                                          Is Modifierfalse
                                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                                          Summaryfalse
                                                                          330. 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.

                                                                          ShortAdditional 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.

                                                                          Control0..*
                                                                          TypeExtension
                                                                          Is Modifierfalse
                                                                          Summaryfalse
                                                                          Alternate Namesextensions, user content
                                                                          Invariantsele-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())
                                                                          332. 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).

                                                                          ShortExtensions 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.

                                                                          Control0..*
                                                                          TypeExtension
                                                                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                                          Summarytrue
                                                                          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 Namesextensions, user content, modifiers
                                                                          Invariantsele-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())
                                                                          334. MedicationRequest.substitution.allowed[x]
                                                                          Definition

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

                                                                          ShortWhether substitution is allowed or not
                                                                          Comments

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

                                                                          Control1..1
                                                                          BindingFor example codes, see ActSubstanceAdminSubstitutionCode
                                                                          (example to http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode)

                                                                          Identifies the type of substitution allowed.

                                                                          TypeChoice of: boolean, CodeableConcept
                                                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                          Is Modifierfalse
                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                          Summaryfalse
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          336. MedicationRequest.substitution.reason
                                                                          Definition

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

                                                                          ShortWhy should (not) substitution be made
                                                                          Control0..1
                                                                          BindingFor example codes, see SubstanceAdminSubstitutionReason
                                                                          (example to http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason)

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

                                                                          TypeCodeableConcept
                                                                          Is Modifierfalse
                                                                          Summaryfalse
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          338. MedicationRequest.priorPrescription
                                                                          Definition

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

                                                                          ShortAn order/prescription that is being replaced
                                                                          Control0..1
                                                                          TypeReference(MedicationRequest)
                                                                          Is Modifierfalse
                                                                          Summaryfalse
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          340. 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.

                                                                          ShortClinical 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.

                                                                          Control0..*
                                                                          TypeReference(DetectedIssue)
                                                                          Is Modifierfalse
                                                                          Summaryfalse
                                                                          Alternate NamesContraindication, Drug Utilization Review (DUR), Alert
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          342. 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.

                                                                          ShortA 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.).

                                                                          Control0..*
                                                                          TypeReference(Provenance)
                                                                          Is Modifierfalse
                                                                          Summaryfalse
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))