CIBMTR Reporting Implementation Guide
0.1.11 - Trial Use 1

This page is part of the CIBMTR Reporting Implementation Guide (v0.1.11: Release) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Resource Profile: CIBMTR Medication Related (mcode)

Official URL: http://fhir.nmdp.org/ig/cibmtr-reporting/StructureDefinition/cibmtr-medications Version: 0.1.11
Draft as of 2026-06-25 Computable Name: CIBMTR_Medications

Overview

Medication-related FHIR resources may be submitted to the CIBMTR Direct FHIR API (see the R4 Connection Guide). These profiles are derived from profiles defined in the US Core and mCODE Implementation Guides. The CIBMTR profiles extend the base profiles by requiring the meta.security element to identify the submitting center and by applying bindings to CIBMTR-defined or RxNorm-based ValueSets where applicable. In some cases, elements that were optional in the original profiles may be required in the CIBMTR profiles.

The MedicationRequest resource is the primary medication-related resource received by CIBMTR. It is patient-specific and represents a medication order or request for an individual subject. Medication details are provided through the medication reference section in MedicationRequest, which points to a Medication resource.

The Medication resource is definitional and provides the medication information referenced by MedicationRequest. A Medication resource may also reference another Medication resource when additional medication details or relationships need to be represented.

Mandatory and Must Support Data Elements

The following data elements must always be present (Must Have) or must be supported if the data is present in the sending system (Must Support).

Each MedicationRequest Must Have:

  • security label
  • status
  • medication information (medicationReference or medicationCodeableConcept)
  • patient reference (subject)
  • authored date

Each MedicationRequest Must Support:

  • requester
  • dosage instruction
  • reason for medication
  • category
  • note
  • encounter reference

Profile-specific Implementation Guidance (CIBMTR)

Security label requirement (meta.security)
The CIBMTR MedicationRequest profile requires a meta.security label identifying the Transplant Center context (e.g., rc_<CCN>). This security tag is used as part of the query pattern for searching and for access scoping.

medication[x]
Medication information in MedicationRequest must be represented using one of the following:

medicationReference — references a Medication resource containing medication details, or medicationCodeableConcept — directly provides the medication code.

At least one representation is required in MedicationRequest.

When medicationReference is used, the referenced Medication resource provides definitional and reusable medication information that may be shared across one or more MedicationRequest resources. A Medication resource may also reference another Medication resource to represent additional medication relationships or details through nested medication references.

subject
The subject element is mandatory and must contain a reference to a Patient resource identifying the subject of the medication request.

Usages:

  • This Profile is not used by any profiles in this Implementation Guide

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. MedicationRequest C 0..* CancerRelatedMedicationRequest Ordering of medication for patient or group
Constraints: us-core-21, mcode-reason-required, termination-reason-code-invariant, termination-reason-invariant
... meta Σ 0..1 Meta Metadata about the resource
.... Slices for security Σ 1..* Coding Security Labels applied to this resource
Slice: Unordered, Open by pattern:system
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
..... security:TransplantCenter SΣ 1..1 Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
...... system Σ 1..1 uri Identity of the terminology system
Required Pattern: http://terminology.cibmtr.org/codesystem/transplant-center
...... code ΣC 1..1 code Symbol in syntax defined by the system
Constraints: sec-rc
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension S 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:treatmentIntent S 0..1 CodeableConcept Procedure Intent Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-procedure-intent
Binding: Procedure Intent Value Set (extensible)
.... extension:normalizationBasis 0..1 CodeableConcept Normalization Basis Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-normalization-basis
Binding: Normalization Basis Value Set (required)
... status ?!SΣ 1..1 code (USCDI) active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
Binding: medicationrequest Status (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.
... statusReason S 0..1 CodeableConcept Reason for current status
Binding: Treatment Termination Reason Value Set (preferred)
... intent ?!SΣC 1..1 code (USCDI) proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
Binding: medicationRequest Intent (required): The kind of medication order.
... Slices for category S 0..* CodeableConcept (USCDI) Type of medication usage
Slice: Unordered, Open by pattern:$this
Binding: medicationRequest Category Codes (example): 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.
.... category:us-core S 0..* CodeableConcept (USCDI) Type of medication usage
Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
... doNotPerform ?!Σ 0..1 boolean True if request is prohibiting action
... reported[x] SΣ 0..1 (USCDI) Reported rather than primary record
.... reportedBoolean boolean S
.... reportedReference Reference S(US Core Practitioner Profile(8.0.0) S | US Core Organization Profile(8.0.0) | US Core Patient Profile(8.0.0) | US Core PractitionerRole Profile(8.0.0) | US Core RelatedPerson Profile(8.0.0))
... medication[x] SΣ 1..1 (USCDI) Medication to be taken
Binding: Medication Clinical Drug . (extensible)
.... medicationCodeableConcept CodeableConcept
.... medicationReference Reference(US Core Medication Profile(8.0.0))
... subject SΣ 1..1 Reference(Cancer Patient Profile) (USCDI) Who or group medication request is for
... encounter S 0..1 Reference(US Core Encounter Profile(8.0.0)) (USCDI) Encounter created as part of encounter/admission/stay
... authoredOn SΣ 1..1 dateTime (USCDI) When request was initially authored
... requester SΣC 0..1 Reference(US Core Practitioner Profile(8.0.0) S | US Core Organization Profile(8.0.0) | Cancer Patient Profile) (USCDI) Who/What requested the Request
... reasonCode S 0..* CodeableConcept (USCDI) Reason or indication for ordering or not ordering the medication
Binding: Cancer Disorder Value Set (extensible)
... reasonReference S 0..* Reference(US Core Condition Problems and Health Concerns Profile(8.0.0)) (USCDI) US Core Condition or Observation that supports the prescription
... dosageInstruction S 0..* Dosage (USCDI) How the medication should be taken
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... text SΣ 0..1 string (USCDI) Free text dosage instructions e.g. SIG
.... timing SΣ 0..1 Timing (USCDI) When medication should be administered
.... doseAndRate SΣ 0..* Element (USCDI) Amount of medication administered
..... dose[x] SΣ 0..1 (USCDI) Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodes Max Binding
...... doseQuantity Quantity S
...... doseRange Range
... dispenseRequest S 0..1 BackboneElement (USCDI) Medication supply authorization
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... numberOfRepeatsAllowed S 0..1 unsignedInt (USCDI) Number of refills authorized
.... quantity S 0..1 SimpleQuantity (USCDI) Amount of medication to supply per dispense

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
MedicationRequest.meta.​security Base extensible SecurityLabels 📍4.0.1 FHIR Std.
MedicationRequest.meta.​security:TransplantCenter Base extensible SecurityLabels 📍4.0.1 FHIR Std.
MedicationRequest.status Base required Medicationrequest status 📦4.0.1 FHIR Std.
MedicationRequest.statusReason Base preferred Treatment Termination Reason Value Set 📦4.0.0 minimal Common Oncology Data Elements v4.0
MedicationRequest.intent Base required Medication request intent 📦4.0.1 FHIR Std.
MedicationRequest.category Base example Medication request category codes 📦4.0.1 FHIR Std.
MedicationRequest.category:us-core Base required Medication request category codes 📦4.0.1 FHIR Std.
MedicationRequest.medication[x] Base extensible Medication Clinical Drug . 📦20240606 VSAC v0.23
MedicationRequest.reasonCode Base extensible Cancer Disorder Value Set 📦4.0.0 minimal Common Oncology Data Elements v4.0
MedicationRequest.dosageInstruction.​doseAndRate.dose[x] Base preferred Common UCUM units 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error MedicationRequest If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error MedicationRequest 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 error MedicationRequest 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 error MedicationRequest If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice MedicationRequest A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
mcode-reason-required warning MedicationRequest One of reasonCode or reasonReference SHALL be present reasonCode.exists() or reasonReference.exists()
sec-rc error MedicationRequest.meta.security:TransplantCenter.code Use transplant center identifier for security tag matches('^rc_[0-9]{5}$')
termination-reason-code-invariant error MedicationRequest When status is stopped, only certain statusReason values are allowed status = 'stopped' and statusReason.exists() and statusReason.coding.exists() implies statusReason.coding.exists(system = 'http://snomed.info/sct' and (code = '182992009' or code = '266721009' or code = '407563006' or code = '160932005' or code = '105480006' or code = '184081006' or code = '309846006' or code = '399307001' or code = '419620001' or code = '7058009' or code = '443729008' or code = '77386006'))
termination-reason-invariant error MedicationRequest Certain statusReason values are allowed only when status is stopped statusReason.exists() and statusReason.coding.exists( system = 'http://snomed.info/sct' and (code = '182992009' or code = '266721009' or code = '407563006' or code = '160932005' or code = '105480006' or code = '184081006' or code = '309846006' or code = '399307001' or code = '419620001' or code = '7058009' or code = '443729008' or code = '77386006')) implies status = 'stopped'
us-core-21 error MedicationRequest requester SHALL be present if intent is "order" (intent='order' or intent='original-order' or intent='reflex-order'or intent='filler-order' or intent='instance-order') implies requester.exists()

This structure is derived from CancerRelatedMedicationRequest

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. MedicationRequest 0..* CancerRelatedMedicationRequest Ordering of medication for patient or group
... meta
.... Slices for security 1..* Coding Security Labels applied to this resource
Slice: Unordered, Open by pattern:system
..... security:TransplantCenter S 1..1 Coding Security Labels applied to this resource
...... system 1..1 uri Identity of the terminology system
Required Pattern: http://terminology.cibmtr.org/codesystem/transplant-center
...... code C 1..1 code Symbol in syntax defined by the system
Constraints: sec-rc
... authoredOn 1..1 dateTime (USCDI) When request was initially authored

doco Documentation for this format

Constraints

Id Grade Path(s) Description Expression
sec-rc error MedicationRequest.meta.security:TransplantCenter.code Use transplant center identifier for security tag matches('^rc_[0-9]{5}$')
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. MedicationRequest C 0..* CancerRelatedMedicationRequest Ordering of medication for patient or group
Constraints: us-core-21, mcode-reason-required, termination-reason-code-invariant, termination-reason-invariant
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ 0..1 id Version specific identifier
.... lastUpdated Σ 0..1 instant When the resource version last changed
.... source Σ 0..1 uri Identifies where the resource comes from
.... profile Σ 0..* canonical(StructureDefinition) Profiles this resource claims to conform to
.... Slices for security Σ 1..* Coding Security Labels applied to this resource
Slice: Unordered, Open by pattern:system
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
..... security:TransplantCenter SΣ 1..1 Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ 1..1 uri Identity of the terminology system
Required Pattern: http://terminology.cibmtr.org/codesystem/transplant-center
...... version Σ 0..1 string Version of the system - if relevant
...... code ΣC 1..1 code Symbol in syntax defined by the system
Constraints: sec-rc
...... display Σ 0..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... tag Σ 0..* Coding Tags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension S 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:treatmentIntent S 0..1 CodeableConcept Procedure Intent Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-procedure-intent
Binding: Procedure Intent Value Set (extensible)
.... extension:normalizationBasis 0..1 CodeableConcept Normalization Basis Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-normalization-basis
Binding: Normalization Basis Value Set (required)
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier 0..* Identifier External ids for this request
... status ?!SΣ 1..1 code (USCDI) active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
Binding: medicationrequest Status (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.
... statusReason S 0..1 CodeableConcept Reason for current status
Binding: Treatment Termination Reason Value Set (preferred)
... intent ?!SΣC 1..1 code (USCDI) proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
Binding: medicationRequest Intent (required): The kind of medication order.
... Slices for category S 0..* CodeableConcept (USCDI) Type of medication usage
Slice: Unordered, Open by pattern:$this
Binding: medicationRequest Category Codes (example): 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.
.... category:us-core S 0..* CodeableConcept (USCDI) Type of medication usage
Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
... priority Σ 0..1 code routine | urgent | asap | stat
Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.
... doNotPerform ?!Σ 0..1 boolean True if request is prohibiting action
... reported[x] SΣ 0..1 (USCDI) Reported rather than primary record
.... reportedBoolean boolean S
.... reportedReference Reference S(US Core Practitioner Profile(8.0.0) S | US Core Organization Profile(8.0.0) | US Core Patient Profile(8.0.0) | US Core PractitionerRole Profile(8.0.0) | US Core RelatedPerson Profile(8.0.0))
... medication[x] SΣ 1..1 (USCDI) Medication to be taken
Binding: Medication Clinical Drug . (extensible)
.... medicationCodeableConcept CodeableConcept
.... medicationReference Reference(US Core Medication Profile(8.0.0))
... subject SΣ 1..1 Reference(Cancer Patient Profile) (USCDI) Who or group medication request is for
... encounter S 0..1 Reference(US Core Encounter Profile(8.0.0)) (USCDI) Encounter created as part of encounter/admission/stay
... supportingInformation 0..* Reference(Resource) Information to support ordering of the medication
... authoredOn SΣ 1..1 dateTime (USCDI) When request was initially authored
... requester SΣC 0..1 Reference(US Core Practitioner Profile(8.0.0) S | US Core Organization Profile(8.0.0) | Cancer Patient Profile) (USCDI) Who/What requested the Request
... performer 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam) Intended performer of administration
... performerType Σ 0..1 CodeableConcept Desired kind of performer of the medication administration
Binding: ProcedurePerformerRoleCodes (example): Identifies the type of individual that is desired to administer the medication.
... recorder 0..1 Reference(Practitioner | PractitionerRole) Person who entered the request
... reasonCode S 0..* CodeableConcept (USCDI) Reason or indication for ordering or not ordering the medication
Binding: Cancer Disorder Value Set (extensible)
... reasonReference S 0..* Reference(US Core Condition Problems and Health Concerns Profile(8.0.0)) (USCDI) US Core Condition or Observation that supports the prescription
... instantiatesCanonical Σ 0..* canonical() Instantiates FHIR protocol or definition
... instantiatesUri Σ 0..* uri Instantiates external protocol or definition
... basedOn Σ 0..* Reference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation) What request fulfills
... groupIdentifier Σ 0..1 Identifier Composite request this is part of
... courseOfTherapyType 0..1 CodeableConcept Overall pattern of medication administration
Binding: medicationRequest Course of Therapy Codes (example): Identifies the overall pattern of medication administratio.
... insurance 0..* Reference(Coverage | ClaimResponse) Associated insurance coverage
... note 0..* Annotation Information about the prescription
... dosageInstruction S 0..* Dosage (USCDI) How the medication should be taken
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 0..1 integer The order of the dosage instructions
.... text SΣ 0..1 string (USCDI) Free text dosage instructions e.g. SIG
.... additionalInstruction Σ 0..* CodeableConcept Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
.... patientInstruction Σ 0..1 string Patient or consumer oriented instructions
.... timing SΣ 0..1 Timing (USCDI) When medication should be administered
.... asNeeded[x] Σ 0..1 Take "as needed" (for x)
Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): 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.
..... asNeededBoolean boolean
..... asNeededCodeableConcept CodeableConcept
.... site Σ 0..1 CodeableConcept Body site to administer to
Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.
.... route Σ 0..1 CodeableConcept How drug should enter body
Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
.... method Σ 0..1 CodeableConcept Technique for administering medication
Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.
.... doseAndRate SΣ 0..* Element (USCDI) Amount of medication administered
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... type Σ 0..1 CodeableConcept The kind of dose or rate specified
Binding: DoseAndRateType (example): The kind of dose or rate specified.
..... dose[x] SΣ 0..1 (USCDI) Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodes Max Binding
...... doseQuantity Quantity S
...... doseRange Range
..... rate[x] Σ 0..1 Amount of medication per unit of time
...... rateRatio Ratio
...... rateRange Range
...... rateQuantity Quantity(SimpleQuantity)
.... maxDosePerPeriod Σ 0..1 Ratio Upper limit on medication per unit of time
.... maxDosePerAdministration Σ 0..1 SimpleQuantity Upper limit on medication per administration
.... maxDosePerLifetime Σ 0..1 SimpleQuantity Upper limit on medication per lifetime of the patient
... dispenseRequest S 0..1 BackboneElement (USCDI) Medication supply authorization
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... initialFill 0..1 BackboneElement First fill details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... quantity 0..1 SimpleQuantity First fill quantity
..... duration 0..1 Duration First fill duration
.... dispenseInterval 0..1 Duration Minimum period of time between dispenses
.... validityPeriod 0..1 Period Time period supply is authorized for
.... numberOfRepeatsAllowed S 0..1 unsignedInt (USCDI) Number of refills authorized
.... quantity S 0..1 SimpleQuantity (USCDI) Amount of medication to supply per dispense
.... expectedSupplyDuration 0..1 Duration Number of days supply per dispense
.... performer 0..1 Reference(Organization) Intended dispenser
... substitution 0..1 BackboneElement Any restrictions on medication substitution
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... allowed[x] 1..1 Whether substitution is allowed or not
Binding: ActSubstanceAdminSubstitutionCode (example): Identifies the type of substitution allowed.
..... allowedBoolean boolean
..... allowedCodeableConcept CodeableConcept
.... reason 0..1 CodeableConcept Why should (not) substitution be made
Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
... priorPrescription 0..1 Reference(MedicationRequest) An order/prescription that is being replaced
... detectedIssue 0..* Reference(DetectedIssue) Clinical Issue with action
... eventHistory 0..* Reference(Provenance) A list of events of interest in the lifecycle

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
MedicationRequest.meta.​security Base extensible SecurityLabels 📍4.0.1 FHIR Std.
MedicationRequest.meta.​security:TransplantCenter Base extensible SecurityLabels 📍4.0.1 FHIR Std.
MedicationRequest.meta.​tag Base example Common Tags 📍4.0.1 FHIR Std.
MedicationRequest.language Base preferred Common Languages 📦4.0.1 FHIR Std.
MedicationRequest.status Base required Medicationrequest status 📦4.0.1 FHIR Std.
MedicationRequest.statusReason Base preferred Treatment Termination Reason Value Set 📦4.0.0 minimal Common Oncology Data Elements v4.0
MedicationRequest.intent Base required Medication request intent 📦4.0.1 FHIR Std.
MedicationRequest.category Base example Medication request category codes 📦4.0.1 FHIR Std.
MedicationRequest.category:us-core Base required Medication request category codes 📦4.0.1 FHIR Std.
MedicationRequest.priority Base required Request priority 📍4.0.1 FHIR Std.
MedicationRequest.medication[x] Base extensible Medication Clinical Drug . 📦20240606 VSAC v0.23
MedicationRequest.performerType Base example Procedure Performer Role Codes 📦4.0.1 FHIR Std.
MedicationRequest.reasonCode Base extensible Cancer Disorder Value Set 📦4.0.0 minimal Common Oncology Data Elements v4.0
MedicationRequest.courseOfTherapyType Base example Medication request course of therapy codes 📦4.0.1 FHIR Std.
MedicationRequest.dosageInstruction.​additionalInstruction Base example SNOMED CT Additional Dosage Instructions 📦4.0.1 FHIR Std.
MedicationRequest.dosageInstruction.​asNeeded[x] Base example SNOMED CT Medication As Needed Reason Codes 📦4.0.1 FHIR Std.
MedicationRequest.dosageInstruction.​site Base example SNOMED CT Anatomical Structure for Administration Site Codes 📦4.0.1 FHIR Std.
MedicationRequest.dosageInstruction.​route Base example SNOMED CT Route Codes 📦4.0.1 FHIR Std.
MedicationRequest.dosageInstruction.​method Base example SNOMED CT Administration Method Codes 📦4.0.1 FHIR Std.
MedicationRequest.dosageInstruction.​doseAndRate.type Base example DoseAndRateType 📦4.0.1 FHIR Std.
MedicationRequest.dosageInstruction.​doseAndRate.dose[x] Base preferred Common UCUM units 📦4.0.1 FHIR Std.
MedicationRequest.substitution.​allowed[x] Base example ActSubstanceAdminSubstitutionCode 📦3.0.0 THO v7.2
MedicationRequest.substitution.​reason Base example SubstanceAdminSubstitutionReason 📦3.0.0 THO v7.2

Constraints

Id Grade Path(s) Description Expression
dom-2 error MedicationRequest If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error MedicationRequest 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 error MedicationRequest 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 error MedicationRequest If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice MedicationRequest A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
mcode-reason-required warning MedicationRequest One of reasonCode or reasonReference SHALL be present reasonCode.exists() or reasonReference.exists()
sec-rc error MedicationRequest.meta.security:TransplantCenter.code Use transplant center identifier for security tag matches('^rc_[0-9]{5}$')
termination-reason-code-invariant error MedicationRequest When status is stopped, only certain statusReason values are allowed status = 'stopped' and statusReason.exists() and statusReason.coding.exists() implies statusReason.coding.exists(system = 'http://snomed.info/sct' and (code = '182992009' or code = '266721009' or code = '407563006' or code = '160932005' or code = '105480006' or code = '184081006' or code = '309846006' or code = '399307001' or code = '419620001' or code = '7058009' or code = '443729008' or code = '77386006'))
termination-reason-invariant error MedicationRequest Certain statusReason values are allowed only when status is stopped statusReason.exists() and statusReason.coding.exists( system = 'http://snomed.info/sct' and (code = '182992009' or code = '266721009' or code = '407563006' or code = '160932005' or code = '105480006' or code = '184081006' or code = '309846006' or code = '399307001' or code = '419620001' or code = '7058009' or code = '443729008' or code = '77386006')) implies status = 'stopped'
us-core-21 error MedicationRequest requester SHALL be present if intent is "order" (intent='order' or intent='original-order' or intent='reflex-order'or intent='filler-order' or intent='instance-order') implies requester.exists()

This structure is derived from CancerRelatedMedicationRequest

Summary

Mandatory: 1 element(4 nested mandatory elements)
Must-Support: 1 element

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of MedicationRequest.meta.security

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. MedicationRequest C 0..* CancerRelatedMedicationRequest Ordering of medication for patient or group
Constraints: us-core-21, mcode-reason-required, termination-reason-code-invariant, termination-reason-invariant
... meta Σ 0..1 Meta Metadata about the resource
.... Slices for security Σ 1..* Coding Security Labels applied to this resource
Slice: Unordered, Open by pattern:system
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
..... security:TransplantCenter SΣ 1..1 Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
...... system Σ 1..1 uri Identity of the terminology system
Required Pattern: http://terminology.cibmtr.org/codesystem/transplant-center
...... code ΣC 1..1 code Symbol in syntax defined by the system
Constraints: sec-rc
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension S 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:treatmentIntent S 0..1 CodeableConcept Procedure Intent Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-procedure-intent
Binding: Procedure Intent Value Set (extensible)
.... extension:normalizationBasis 0..1 CodeableConcept Normalization Basis Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-normalization-basis
Binding: Normalization Basis Value Set (required)
... status ?!SΣ 1..1 code (USCDI) active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
Binding: medicationrequest Status (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.
... statusReason S 0..1 CodeableConcept Reason for current status
Binding: Treatment Termination Reason Value Set (preferred)
... intent ?!SΣC 1..1 code (USCDI) proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
Binding: medicationRequest Intent (required): The kind of medication order.
... Slices for category S 0..* CodeableConcept (USCDI) Type of medication usage
Slice: Unordered, Open by pattern:$this
Binding: medicationRequest Category Codes (example): 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.
.... category:us-core S 0..* CodeableConcept (USCDI) Type of medication usage
Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
... doNotPerform ?!Σ 0..1 boolean True if request is prohibiting action
... reported[x] SΣ 0..1 (USCDI) Reported rather than primary record
.... reportedBoolean boolean S
.... reportedReference Reference S(US Core Practitioner Profile(8.0.0) S | US Core Organization Profile(8.0.0) | US Core Patient Profile(8.0.0) | US Core PractitionerRole Profile(8.0.0) | US Core RelatedPerson Profile(8.0.0))
... medication[x] SΣ 1..1 (USCDI) Medication to be taken
Binding: Medication Clinical Drug . (extensible)
.... medicationCodeableConcept CodeableConcept
.... medicationReference Reference(US Core Medication Profile(8.0.0))
... subject SΣ 1..1 Reference(Cancer Patient Profile) (USCDI) Who or group medication request is for
... encounter S 0..1 Reference(US Core Encounter Profile(8.0.0)) (USCDI) Encounter created as part of encounter/admission/stay
... authoredOn SΣ 1..1 dateTime (USCDI) When request was initially authored
... requester SΣC 0..1 Reference(US Core Practitioner Profile(8.0.0) S | US Core Organization Profile(8.0.0) | Cancer Patient Profile) (USCDI) Who/What requested the Request
... reasonCode S 0..* CodeableConcept (USCDI) Reason or indication for ordering or not ordering the medication
Binding: Cancer Disorder Value Set (extensible)
... reasonReference S 0..* Reference(US Core Condition Problems and Health Concerns Profile(8.0.0)) (USCDI) US Core Condition or Observation that supports the prescription
... dosageInstruction S 0..* Dosage (USCDI) How the medication should be taken
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... text SΣ 0..1 string (USCDI) Free text dosage instructions e.g. SIG
.... timing SΣ 0..1 Timing (USCDI) When medication should be administered
.... doseAndRate SΣ 0..* Element (USCDI) Amount of medication administered
..... dose[x] SΣ 0..1 (USCDI) Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodes Max Binding
...... doseQuantity Quantity S
...... doseRange Range
... dispenseRequest S 0..1 BackboneElement (USCDI) Medication supply authorization
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... numberOfRepeatsAllowed S 0..1 unsignedInt (USCDI) Number of refills authorized
.... quantity S 0..1 SimpleQuantity (USCDI) Amount of medication to supply per dispense

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
MedicationRequest.meta.​security Base extensible SecurityLabels 📍4.0.1 FHIR Std.
MedicationRequest.meta.​security:TransplantCenter Base extensible SecurityLabels 📍4.0.1 FHIR Std.
MedicationRequest.status Base required Medicationrequest status 📦4.0.1 FHIR Std.
MedicationRequest.statusReason Base preferred Treatment Termination Reason Value Set 📦4.0.0 minimal Common Oncology Data Elements v4.0
MedicationRequest.intent Base required Medication request intent 📦4.0.1 FHIR Std.
MedicationRequest.category Base example Medication request category codes 📦4.0.1 FHIR Std.
MedicationRequest.category:us-core Base required Medication request category codes 📦4.0.1 FHIR Std.
MedicationRequest.medication[x] Base extensible Medication Clinical Drug . 📦20240606 VSAC v0.23
MedicationRequest.reasonCode Base extensible Cancer Disorder Value Set 📦4.0.0 minimal Common Oncology Data Elements v4.0
MedicationRequest.dosageInstruction.​doseAndRate.dose[x] Base preferred Common UCUM units 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error MedicationRequest If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error MedicationRequest 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 error MedicationRequest 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 error MedicationRequest If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice MedicationRequest A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
mcode-reason-required warning MedicationRequest One of reasonCode or reasonReference SHALL be present reasonCode.exists() or reasonReference.exists()
sec-rc error MedicationRequest.meta.security:TransplantCenter.code Use transplant center identifier for security tag matches('^rc_[0-9]{5}$')
termination-reason-code-invariant error MedicationRequest When status is stopped, only certain statusReason values are allowed status = 'stopped' and statusReason.exists() and statusReason.coding.exists() implies statusReason.coding.exists(system = 'http://snomed.info/sct' and (code = '182992009' or code = '266721009' or code = '407563006' or code = '160932005' or code = '105480006' or code = '184081006' or code = '309846006' or code = '399307001' or code = '419620001' or code = '7058009' or code = '443729008' or code = '77386006'))
termination-reason-invariant error MedicationRequest Certain statusReason values are allowed only when status is stopped statusReason.exists() and statusReason.coding.exists( system = 'http://snomed.info/sct' and (code = '182992009' or code = '266721009' or code = '407563006' or code = '160932005' or code = '105480006' or code = '184081006' or code = '309846006' or code = '399307001' or code = '419620001' or code = '7058009' or code = '443729008' or code = '77386006')) implies status = 'stopped'
us-core-21 error MedicationRequest requester SHALL be present if intent is "order" (intent='order' or intent='original-order' or intent='reflex-order'or intent='filler-order' or intent='instance-order') implies requester.exists()

Differential View

This structure is derived from CancerRelatedMedicationRequest

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. MedicationRequest 0..* CancerRelatedMedicationRequest Ordering of medication for patient or group
... meta
.... Slices for security 1..* Coding Security Labels applied to this resource
Slice: Unordered, Open by pattern:system
..... security:TransplantCenter S 1..1 Coding Security Labels applied to this resource
...... system 1..1 uri Identity of the terminology system
Required Pattern: http://terminology.cibmtr.org/codesystem/transplant-center
...... code C 1..1 code Symbol in syntax defined by the system
Constraints: sec-rc
... authoredOn 1..1 dateTime (USCDI) When request was initially authored

doco Documentation for this format

Constraints

Id Grade Path(s) Description Expression
sec-rc error MedicationRequest.meta.security:TransplantCenter.code Use transplant center identifier for security tag matches('^rc_[0-9]{5}$')

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. MedicationRequest C 0..* CancerRelatedMedicationRequest Ordering of medication for patient or group
Constraints: us-core-21, mcode-reason-required, termination-reason-code-invariant, termination-reason-invariant
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ 0..1 id Version specific identifier
.... lastUpdated Σ 0..1 instant When the resource version last changed
.... source Σ 0..1 uri Identifies where the resource comes from
.... profile Σ 0..* canonical(StructureDefinition) Profiles this resource claims to conform to
.... Slices for security Σ 1..* Coding Security Labels applied to this resource
Slice: Unordered, Open by pattern:system
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
..... security:TransplantCenter SΣ 1..1 Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ 1..1 uri Identity of the terminology system
Required Pattern: http://terminology.cibmtr.org/codesystem/transplant-center
...... version Σ 0..1 string Version of the system - if relevant
...... code ΣC 1..1 code Symbol in syntax defined by the system
Constraints: sec-rc
...... display Σ 0..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... tag Σ 0..* Coding Tags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension S 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:treatmentIntent S 0..1 CodeableConcept Procedure Intent Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-procedure-intent
Binding: Procedure Intent Value Set (extensible)
.... extension:normalizationBasis 0..1 CodeableConcept Normalization Basis Extension
URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-normalization-basis
Binding: Normalization Basis Value Set (required)
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier 0..* Identifier External ids for this request
... status ?!SΣ 1..1 code (USCDI) active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
Binding: medicationrequest Status (required): A code specifying the state of the prescribing event. Describes the lifecycle of the prescription.
... statusReason S 0..1 CodeableConcept Reason for current status
Binding: Treatment Termination Reason Value Set (preferred)
... intent ?!SΣC 1..1 code (USCDI) proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option
Binding: medicationRequest Intent (required): The kind of medication order.
... Slices for category S 0..* CodeableConcept (USCDI) Type of medication usage
Slice: Unordered, Open by pattern:$this
Binding: medicationRequest Category Codes (example): 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.
.... category:us-core S 0..* CodeableConcept (USCDI) Type of medication usage
Binding: medicationRequest Category Codes (required): The type of medication order. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
... priority Σ 0..1 code routine | urgent | asap | stat
Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.
... doNotPerform ?!Σ 0..1 boolean True if request is prohibiting action
... reported[x] SΣ 0..1 (USCDI) Reported rather than primary record
.... reportedBoolean boolean S
.... reportedReference Reference S(US Core Practitioner Profile(8.0.0) S | US Core Organization Profile(8.0.0) | US Core Patient Profile(8.0.0) | US Core PractitionerRole Profile(8.0.0) | US Core RelatedPerson Profile(8.0.0))
... medication[x] SΣ 1..1 (USCDI) Medication to be taken
Binding: Medication Clinical Drug . (extensible)
.... medicationCodeableConcept CodeableConcept
.... medicationReference Reference(US Core Medication Profile(8.0.0))
... subject SΣ 1..1 Reference(Cancer Patient Profile) (USCDI) Who or group medication request is for
... encounter S 0..1 Reference(US Core Encounter Profile(8.0.0)) (USCDI) Encounter created as part of encounter/admission/stay
... supportingInformation 0..* Reference(Resource) Information to support ordering of the medication
... authoredOn SΣ 1..1 dateTime (USCDI) When request was initially authored
... requester SΣC 0..1 Reference(US Core Practitioner Profile(8.0.0) S | US Core Organization Profile(8.0.0) | Cancer Patient Profile) (USCDI) Who/What requested the Request
... performer 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam) Intended performer of administration
... performerType Σ 0..1 CodeableConcept Desired kind of performer of the medication administration
Binding: ProcedurePerformerRoleCodes (example): Identifies the type of individual that is desired to administer the medication.
... recorder 0..1 Reference(Practitioner | PractitionerRole) Person who entered the request
... reasonCode S 0..* CodeableConcept (USCDI) Reason or indication for ordering or not ordering the medication
Binding: Cancer Disorder Value Set (extensible)
... reasonReference S 0..* Reference(US Core Condition Problems and Health Concerns Profile(8.0.0)) (USCDI) US Core Condition or Observation that supports the prescription
... instantiatesCanonical Σ 0..* canonical() Instantiates FHIR protocol or definition
... instantiatesUri Σ 0..* uri Instantiates external protocol or definition
... basedOn Σ 0..* Reference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation) What request fulfills
... groupIdentifier Σ 0..1 Identifier Composite request this is part of
... courseOfTherapyType 0..1 CodeableConcept Overall pattern of medication administration
Binding: medicationRequest Course of Therapy Codes (example): Identifies the overall pattern of medication administratio.
... insurance 0..* Reference(Coverage | ClaimResponse) Associated insurance coverage
... note 0..* Annotation Information about the prescription
... dosageInstruction S 0..* Dosage (USCDI) How the medication should be taken
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 0..1 integer The order of the dosage instructions
.... text SΣ 0..1 string (USCDI) Free text dosage instructions e.g. SIG
.... additionalInstruction Σ 0..* CodeableConcept Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
.... patientInstruction Σ 0..1 string Patient or consumer oriented instructions
.... timing SΣ 0..1 Timing (USCDI) When medication should be administered
.... asNeeded[x] Σ 0..1 Take "as needed" (for x)
Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): 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.
..... asNeededBoolean boolean
..... asNeededCodeableConcept CodeableConcept
.... site Σ 0..1 CodeableConcept Body site to administer to
Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.
.... route Σ 0..1 CodeableConcept How drug should enter body
Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
.... method Σ 0..1 CodeableConcept Technique for administering medication
Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.
.... doseAndRate SΣ 0..* Element (USCDI) Amount of medication administered
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... type Σ 0..1 CodeableConcept The kind of dose or rate specified
Binding: DoseAndRateType (example): The kind of dose or rate specified.
..... dose[x] SΣ 0..1 (USCDI) Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodes Max Binding
...... doseQuantity Quantity S
...... doseRange Range
..... rate[x] Σ 0..1 Amount of medication per unit of time
...... rateRatio Ratio
...... rateRange Range
...... rateQuantity Quantity(SimpleQuantity)
.... maxDosePerPeriod Σ 0..1 Ratio Upper limit on medication per unit of time
.... maxDosePerAdministration Σ 0..1 SimpleQuantity Upper limit on medication per administration
.... maxDosePerLifetime Σ 0..1 SimpleQuantity Upper limit on medication per lifetime of the patient
... dispenseRequest S 0..1 BackboneElement (USCDI) Medication supply authorization
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... initialFill 0..1 BackboneElement First fill details
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... quantity 0..1 SimpleQuantity First fill quantity
..... duration 0..1 Duration First fill duration
.... dispenseInterval 0..1 Duration Minimum period of time between dispenses
.... validityPeriod 0..1 Period Time period supply is authorized for
.... numberOfRepeatsAllowed S 0..1 unsignedInt (USCDI) Number of refills authorized
.... quantity S 0..1 SimpleQuantity (USCDI) Amount of medication to supply per dispense
.... expectedSupplyDuration 0..1 Duration Number of days supply per dispense
.... performer 0..1 Reference(Organization) Intended dispenser
... substitution 0..1 BackboneElement Any restrictions on medication substitution
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... allowed[x] 1..1 Whether substitution is allowed or not
Binding: ActSubstanceAdminSubstitutionCode (example): Identifies the type of substitution allowed.
..... allowedBoolean boolean
..... allowedCodeableConcept CodeableConcept
.... reason 0..1 CodeableConcept Why should (not) substitution be made
Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
... priorPrescription 0..1 Reference(MedicationRequest) An order/prescription that is being replaced
... detectedIssue 0..* Reference(DetectedIssue) Clinical Issue with action
... eventHistory 0..* Reference(Provenance) A list of events of interest in the lifecycle

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
MedicationRequest.meta.​security Base extensible SecurityLabels 📍4.0.1 FHIR Std.
MedicationRequest.meta.​security:TransplantCenter Base extensible SecurityLabels 📍4.0.1 FHIR Std.
MedicationRequest.meta.​tag Base example Common Tags 📍4.0.1 FHIR Std.
MedicationRequest.language Base preferred Common Languages 📦4.0.1 FHIR Std.
MedicationRequest.status Base required Medicationrequest status 📦4.0.1 FHIR Std.
MedicationRequest.statusReason Base preferred Treatment Termination Reason Value Set 📦4.0.0 minimal Common Oncology Data Elements v4.0
MedicationRequest.intent Base required Medication request intent 📦4.0.1 FHIR Std.
MedicationRequest.category Base example Medication request category codes 📦4.0.1 FHIR Std.
MedicationRequest.category:us-core Base required Medication request category codes 📦4.0.1 FHIR Std.
MedicationRequest.priority Base required Request priority 📍4.0.1 FHIR Std.
MedicationRequest.medication[x] Base extensible Medication Clinical Drug . 📦20240606 VSAC v0.23
MedicationRequest.performerType Base example Procedure Performer Role Codes 📦4.0.1 FHIR Std.
MedicationRequest.reasonCode Base extensible Cancer Disorder Value Set 📦4.0.0 minimal Common Oncology Data Elements v4.0
MedicationRequest.courseOfTherapyType Base example Medication request course of therapy codes 📦4.0.1 FHIR Std.
MedicationRequest.dosageInstruction.​additionalInstruction Base example SNOMED CT Additional Dosage Instructions 📦4.0.1 FHIR Std.
MedicationRequest.dosageInstruction.​asNeeded[x] Base example SNOMED CT Medication As Needed Reason Codes 📦4.0.1 FHIR Std.
MedicationRequest.dosageInstruction.​site Base example SNOMED CT Anatomical Structure for Administration Site Codes 📦4.0.1 FHIR Std.
MedicationRequest.dosageInstruction.​route Base example SNOMED CT Route Codes 📦4.0.1 FHIR Std.
MedicationRequest.dosageInstruction.​method Base example SNOMED CT Administration Method Codes 📦4.0.1 FHIR Std.
MedicationRequest.dosageInstruction.​doseAndRate.type Base example DoseAndRateType 📦4.0.1 FHIR Std.
MedicationRequest.dosageInstruction.​doseAndRate.dose[x] Base preferred Common UCUM units 📦4.0.1 FHIR Std.
MedicationRequest.substitution.​allowed[x] Base example ActSubstanceAdminSubstitutionCode 📦3.0.0 THO v7.2
MedicationRequest.substitution.​reason Base example SubstanceAdminSubstitutionReason 📦3.0.0 THO v7.2

Constraints

Id Grade Path(s) Description Expression
dom-2 error MedicationRequest If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error MedicationRequest 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 error MedicationRequest 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 error MedicationRequest If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice MedicationRequest A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
mcode-reason-required warning MedicationRequest One of reasonCode or reasonReference SHALL be present reasonCode.exists() or reasonReference.exists()
sec-rc error MedicationRequest.meta.security:TransplantCenter.code Use transplant center identifier for security tag matches('^rc_[0-9]{5}$')
termination-reason-code-invariant error MedicationRequest When status is stopped, only certain statusReason values are allowed status = 'stopped' and statusReason.exists() and statusReason.coding.exists() implies statusReason.coding.exists(system = 'http://snomed.info/sct' and (code = '182992009' or code = '266721009' or code = '407563006' or code = '160932005' or code = '105480006' or code = '184081006' or code = '309846006' or code = '399307001' or code = '419620001' or code = '7058009' or code = '443729008' or code = '77386006'))
termination-reason-invariant error MedicationRequest Certain statusReason values are allowed only when status is stopped statusReason.exists() and statusReason.coding.exists( system = 'http://snomed.info/sct' and (code = '182992009' or code = '266721009' or code = '407563006' or code = '160932005' or code = '105480006' or code = '184081006' or code = '309846006' or code = '399307001' or code = '419620001' or code = '7058009' or code = '443729008' or code = '77386006')) implies status = 'stopped'
us-core-21 error MedicationRequest requester SHALL be present if intent is "order" (intent='order' or intent='original-order' or intent='reflex-order'or intent='filler-order' or intent='instance-order') implies requester.exists()

This structure is derived from CancerRelatedMedicationRequest

Summary

Mandatory: 1 element(4 nested mandatory elements)
Must-Support: 1 element

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of MedicationRequest.meta.security

 

Other representations of profile: CSV, Excel, Schematron

Notes:

medicationReference vs medicationCodeableConcept

MedicationRequest may reference a Medication resource through the medicationReference element. This has the form:

  "medicationReference" : {
    "reference" : "Medication/<resource Id>"
  }

This approach is useful when the same medication needs to be reused across multiple MedicationRequest resources or when the medication description is more complex than a single RxNorm code, such as medications containing multiple ingredients.

Alternatively, medication information may be represented using the medicationCodeableConcept element. In this case, medication codes are provided directly within the MedicationRequest resource. This approach is appropriate when the medication can be represented using one or more equivalent RxNorm codes, typically for medications with a single ingredient.

The following example shows multiple RxNorm codes representing equivalent medication concepts:

  "medicationCodeableConcept" : {
    "coding" : [
      {
        "system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
        "code" : "4179",
        "display" : "etoposide"
      },
      {
        "system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
        "code" : "310248",
        "display" : "etoposide 20 MG/ML Injectable Solution"
      },
      {
        "system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
        "code" : "362972",
        "display" : "etoposide Injectable Solution [Vepesid]"
      },
      {
        "system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
        "code" : "206832",
        "display" : "etoposide 20 MG/ML Injectable Solution [Vepesid]"
      }
    ],
    "text" : "ETOPOSIDE 20 MG/ML IV SOLN"
  }

reasonCode

MedicationRequest provides elements to describe the reason why a medication was requested. This information is often useful to CIBMTR for understanding the clinical context of the medication request.

Reason codes may be represented using SNOMED CT codes, ICD-10 codes, or both when the codes are clinically equivalent.

The following example shows equivalent SNOMED CT and ICD-10 reason codes:

"reasonCode" : [
    {
      "coding" : [
        {
          "system" : "http://snomed.info/sct",
          "code" : "363346000",
          "display" : "Malignant neoplastic disease (disorder)"
        },
        {
          "system" : "http://hl7.org/fhir/sid/icd-10-cm",
          "code" : "C80.1",
          "display" : "Malignant (primary) neoplasm, unspecified"
        }
      ],
      "text" : "Cancer (CMS/HCC)"
    }
  ]

RxNorm ValueSets

Medication profiles that bind to these ValueSets:

Examples

MedicationRequest

Medication