Release 4 R6 Ballot (1st Full Ballot)

This page is part of the FHIR Specification (v4.0.1: R4 - Mixed Normative and STU v6.0.0-ballot4: Release 6 Ballot (1st Full Ballot) (see Ballot Notes ) in it's permanent home (it will always be available at this URL). ). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions for published versions icon . Page versions: R5 R4B R4 R3

11.1 14.1 Resource MedicationRequest - Content

Responsible Owner: Pharmacy icon Work Group Maturity Level : 3   Trial Use Normative Security Category : Patient Compartments : Encounter , Group , Patient , Practitioner

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.

11.1.1 14.1.1 Scope and Usage

This resource covers all type of orders for medications for a patient. This includes inpatient medication orders as well as community orders (whether filled by the prescriber or by a pharmacy). It also includes orders for over-the-counter medications (e.g. (e.g., Aspirin), total parenteral nutrition and diet/ vitamin diet/vitamin supplements. It may be used to support the order of medication-related devices e.g., prefilled syringes such as patient-controlled analgesia (PCA) syringes, or syringes used to administer other types of medications. e.g., insulin, narcotics. It can can also be used to order medication or substances NOT be taken.

This resource would not be used when ordering a device(s) that may have a medication coating e.g. heparin coated stints, or similar types of devices. These types of devices would be ordered using the Device Request or the SupplyRequest resources.

It is not intended for use in prescribing particular diets, or for ordering non-medication-related items (eyeglasses, supplies, etc.). In addition, the MedicationRequest may be used to report orders/request from external systems that have been reported for informational purposes and are not authoritative and are not expected to be acted upon (e.g. dispensed or administered).

The MedicationRequest resource is a "request" resource from a FHIR workflow perspective - see Workflow Request.

The MedicationRequest resource allows requesting only a single medication. If a workflow requires requesting multiple items simultaneously, this is done using multiple instances of this resource. These instances can be linked in different ways, depending on the needs of the workflow. For guidance, refer to the Request pattern .

11.1.2 14.1.2 Boundaries and Relationships

The MedicationRequest resource is used to request or order medication for a subject. It may also be used to report a medication request or order from one organization or source to another. When requesting supplies or devices when there is a patient focus or instructions regarding their use, SupplyRequest icon or DeviceRequest should be used instead. When reporting on the usage of a medication by a patient, the MedicationStatement t resource should be used.

The Medication domain includes a number of related resources

MedicationRequest An order for both supply of the medication and the instructions for administration of the medicine to a patient.
MedicationDispense Provision of a supply of a medication with the intention that it is subsequently consumed by a patient (usually in response to a prescription). prescription or order or request).
MedicationAdministration When a patient actually consumes a medicine, or it is otherwise administered to them them.
MedicationStatement This is a record of medication being taken by a patient, or that the medication has been given to a patient where the record is the result of a report from the patient, or another clinician. A medication statement is not a part of the prescribe->dispense->administer sequence but is a report that such a sequence (or at least a part of it) did take place resulting in a belief that the patient has received a particular medication.

This The MedicationRequest resource represents an authorization for both a dispense and an administration to be provided. Details about the fulfillment of the authorization are typically handled by the Task resource. For further information about this separation of responsibilities, refer to the link Fulfillment/Execution section of the Request pattern.

MedicationRequests can be instantiated from a protocol which is referenced represented by a Definition resource - ActivityDefinition or PlanDefinition. For more information on protocols, see applying a PlanDefinition icon.

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 MedicationRequest resources 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. In general, each prescribed drug will be a separate Medication Request.

When drug orders are grouped together at the time of order entry, but each of the drugs can be manipulated independently e.g. changing the status of one order to 'completed' or 'cancelled', changing another order status to 'on-hold', the method to 'group' all of the medication requests together is to use MedicationRequest.groupIdentifier element. All of the orders grouped together in this manner will have the same groupIdentifier, and separately, each order in the group may have a unique identifier. There are cases that require grouping of Medication orders together when it is necessary to specify optionality e.g. order two drugs at one time, but stating either of these drugs may be used to treat the patient. The use of a RequestOrchestration should be used as a parent for the Medication orders that require this type of grouping. An example when it may be necessary to group medication orders together is when you specify timing relationships e.g. order drug 'xyz' with dose 123, then taper the same drug to a different dose after some interval of time precedence:

  • e.g. give drug 'abc' followed by drug 'def'
  • e.g. give drug 30 minutes before some procedure was performed
  • more generically this supports - hierarchical groups of actions, where each specific action references the action to be performed (in terms of a Request resource), and each group describes additional behavior, relationships, and applicable conditions between the actions in the overall group.
  • Note that one should NOT use the List or Composition resource to accomplish the above requirements. You may use List or Composition for other business requirements, but not to address the specific requirements of grouping medication orders.

Note to Balloters: The elements around Dosage have been subject to breaking changes in R6:

  • A new data type DosageDetails is introduced, containing rendered instructions and simple or structured Dosage .
  • dosageInstruction is now 0..1, and uses the new data type. The composition of complex dosages (with segments, repetitions etc.) can be done using the structure in that data type.
  • renderedDosageInstruction is removed from the resource and placed in DosageDetails.renderedInstruction in the DosageDetails data type.
  • A set of examples is provided to show how structured dosages can be represented.

Note to Balloters: The code system used in medication request category is presented here but is expected to move to terminology.hl7.org icon.

14.1.3 References to this Resource

11.1.3 14.1.4 Resource Content

Structure

Type True if request 0..1 Reported rather than primary record reportedBoolean boolean reportedReference medication[x] Σ 1..1 Σ 1..1 Who 0..1 Reason or indication 0..* Condition or observation that supports why Σ Instantiates FHIR protocol Σ 0..* Instantiates external protocol or definition Σ Σ 0..1 CodeableConcept Overall pattern of Information about the prescription 0..* How
Name Flags Card. Type Description & Constraints      Filter: Filters doco
. . MedicationRequest TU N DomainResource Ordering of medication for patient or group

Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier 0..* Identifier External ids for this request

. . status . basedOn Σ ?! 0..* Reference ( CarePlan | MedicationRequest | ServiceRequest | RequestOrchestration ) A plan or request that is fulfilled in whole or in part by this medication request

. . . priorPrescription 0..1 Reference ( MedicationRequest ) Reference to an order/prescription that is being replaced by this MedicationRequest
... groupIdentifier Σ 0..1 Identifier Composite request this is part of
1..1
. . . status ?! Σ 1..1 code active | on-hold | cancelled ended | stopped | completed | entered-in-error cancelled | stopped entered-in-error | draft | unknown
Medicationrequest status Binding: medicationrequest Status ( Required )
. . . statusReason 0..1 CodeableConcept Reason for current status
Medication request status reason codes Binding: medicationRequest Status Reason Codes ( Example )
. . . statusChanged 0..1 dateTime When the status was changed
. . . intent ?! Σ 1..1 code proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option (immutable)
Medication request intent Binding: medicationRequest Intent ( Required )
. . . category 0..* CodeableConcept Grouping or category of medication usage Medication request category codes
Binding: MedicationRequest Category Codes ( Example )

. . . priority Σ 0..1 code routine | urgent | asap | stat
Request priority Binding: RequestPriority ( Required )
. . . doNotPerform ?! Σ 0..1 boolean If true, indicates the provider is prohibiting action ordering a patient should not take the specified medication
. . reported[x] . medication Σ 1..1 Reference CodeableReference ( Patient | Practitioner | PractitionerRole | RelatedPerson | Organization Medication ) Medication to be taken
Binding: SNOMED CT Medication Codes ( Example )
. . medicationCodeableConcept CodeableConcept . subject medicationReference Σ 1..1 Reference ( Medication Patient | Group ) Individual or group for whom the medication has been requested
. . . subject informationSource 0..* Reference ( Patient | Practitioner | PractitionerRole | RelatedPerson | Organization | Group ) The person or group medication request organization who provided the information about this request, if the source is for someone other than the requestor

. . . encounter 0..1 Reference ( Encounter ) Encounter created as part of encounter/admission/stay
. . . supportingInformation 0..* Reference ( Any ) Information to support ordering fulfilling of the medication

. . . authoredOn Σ 0..1 dateTime When request was initially authored
. . . requester Σ 0..1 Reference ( Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device ) Who/What requested the Request
. . performer . isRecordOfRequest Σ 0..1 Reference ( Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam boolean ) Intended performer Whether this is record of administration a Medication Request or the actual request itself
. . . performerType Σ 0..1 CodeableConcept Desired kind of performer of the medication administration
Procedure Binding: Medication Intended Performer Role Codes ( Example Extensible )
. . . recorder performer 0..* Reference ( Practitioner | PractitionerRole | Organization | Patient | DeviceDefinition | RelatedPerson | CareTeam | HealthcareService | Group ) Intended performer of administration

Person who entered the request
. . reasonCode . device 0..* CodeableConcept CodeableReference ( DeviceDefinition ) Intended type of device for ordering or not ordering the medication administration
Condition/Problem/Diagnosis Codes ( Example )
. . . reasonReference recorder 0..1 Reference ( Condition Practitioner | Observation PractitionerRole ) Person who entered the prescription is being written request
. . . instantiatesCanonical reason 0..* canonical CodeableReference () ( Condition | Observation | DiagnosticReport | Procedure | AllergyIntolerance ) Reason or definition indication for ordering or not ordering the medication
Binding: Condition/Problem/Diagnosis Codes ( Example )

. . instantiatesUri . courseOfTherapyType 0..1 uri CodeableConcept Overall pattern of medication administration
Binding: medicationRequest Course of Therapy Codes ( Extensible )
. . . basedOn insurance 0..* Reference ( CarePlan | MedicationRequest | ServiceRequest Coverage | ImmunizationRecommendation ClaimResponse ) Associated insurance coverage
What request fulfills
. . . groupIdentifier note 0..* Identifier Annotation Information about the prescription

Composite request this is part of
. . courseOfTherapyType . effectiveTiming[x] 0..1 Period over which the medication administration is to be taken, can be specified as a duration or a range
Medication request course of therapy codes ( Example )
. . insurance . . effectiveTimingDuration 0..* Reference ( Coverage | ClaimResponse Duration ) Associated insurance coverage
. . . . note effectiveTimingRange Range
. . . . effectiveTimingPeriod 0..* Annotation Period
. . . dosageInstruction 0..1 Dosage DosageDetails Specific instructions for how the medication should be taken
. . . dispenseRequest 0..1 BackboneElement Medication supply authorization
. . . . initialFill 0..1 BackboneElement First fill details
. . . . . 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 0..1 unsignedInt Number of refills authorized
. . . . quantity 0..1 SimpleQuantity Amount of medication to supply per dispense
. . . . expectedSupplyDuration 0..1 Duration Number of days supply per dispense
. . . performer . dispenser 0..1 Reference ( Organization ) Intended performer of dispense
.... dispenserInstruction 0..* CodeableConcept Additional information for the dispenser
Binding: medicationrequest dispenser-instructions ( Example )

. . . substitution . doseAdministrationAid 0..1 CodeableConcept Type of adherence packaging to use for the dispense
Binding: Medication Dose Aids ( Example )
. . . . destination 0..1 Reference ( Location ) Where the medication is expected to be delivered
BackboneElement
. . . substitution 0..1 BackboneElement Any restrictions on medication substitution
. . . . allowed[x] 1..1 Whether substitution is allowed or not
Binding: ActSubstanceAdminSubstitutionCode icon V3 Value SetActSubstanceAdminSubstitutionCode ( Example Preferred )
. . . . . allowedBoolean boolean
. . . . . allowedCodeableConcept CodeableConcept
. . . . reason 0..1 CodeableConcept Why should (not) substitution be made
Binding: SubstanceAdminSubstitutionReason icon V3 Value SetSubstanceAdminSubstitutionReason ( Example ) 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 icon

See the Extensions for this resource

UML Diagram ( Legend )

MedicationRequest ( DomainResource ) 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 identifier : Identifier [0..*] Whenever the medication request is being issued because of another request, eg. a procedure that is being planned (ServiceRequest) and MedicationRequests are known to be needed, this element documents those requests basedOn : Reference [0..*] « CarePlan | MedicationRequest | ServiceRequest | RequestOrchestration » Reference to an order/prescription that is being replaced by this MedicationRequest priorPrescription : Reference [0..1] « MedicationRequest » A shared identifier common to multiple independent Request instances that were activated/authorized more or less simultaneously by a single author. The presence of the same identifier on each request ties those requests together and may have business ramifications in terms of reporting of results, billing, etc. E.g. a requisition number shared by a set of lab tests ordered together, or a prescription number shared by all meds ordered at one time groupIdentifier : Identifier [0..1] A code specifying the current state of the order. Generally, this will be active or completed state (this element modifies the meaning of other elements) status : code [1..1] « A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription. null (Strength=Required) medicationrequest Status MedicationrequestStatus ! » Captures the reason for the current state of the MedicationRequest statusReason : CodeableConcept [0..1] « Identifies the reasons for a given status. null (Strength=Example) medicationRequest Status Reas... MedicationRequestStatusReason... ?? » The date (and perhaps time) when the status was changed statusChanged : dateTime [0..1] Whether the request is a proposal, plan, or an original order (this element modifies the meaning of other elements) intent : code [1..1] « The kind of medication order. null (Strength=Required) medicationRequest Intent MedicationRequestIntent ! » Indicates the type An arbitrary categorization or grouping of medication request (for example, where the medication is expected request. It could be used for indicating where meds are intended to be consumed or administered (i.e. administered, eg. in an inpatient setting or outpatient)) in a patient's home, or a legal category of the medication category : CodeableConcept [0..*] « 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. null (Strength=Example) medicationRequest Category MedicationRequestCategoryCodes ?? » Indicates how quickly the Medication Request should be addressed with respect to other requests priority : code [0..1] « Identifies the level of importance to be assigned to actioning the request. null (Strength=Required) RequestPriority ! » If true true, indicates that the provider is asking ordering a patient should not take the specified medication. The reason for this order can be provided in the medication .reason element. A MedicationRequest with .doNotPerform = true will not result in any dispense or administration. A request not to occur take or administer medication is a standalone request, and does not update any other medication request. When true, active orders that may exist for the same medication are expected to be canceled/ended, and new orders for the same medication are not expected (this element modifies the meaning of other elements) doNotPerform : boolean [0..1] 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 reported[x] : Type [0..1] « boolean | Reference ( Patient | Practitioner | PractitionerRole | RelatedPerson | Organization ) » 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 medication[x] medication : Type CodeableReference [1..1] « CodeableConcept | Reference ( Medication ); ; A coded concept identifying substance or product that can be ordered. null (Strength=Example) SNOMEDCTMedicationCodes ?? » A link to a resource representing the person The individual or set of individuals to group for whom the medication will be given has been requested subject : Reference [1..1] « Patient | Group » The person or organization who provided the information about this request, if the source is someone other than the requestor. The informationSource element is generally used when details of a prescription are being reported by someone who is not the requestor, e.g., I indicate that I received a prescription for a med out of my jurisdiction and the details are recorded in the system as a MedicationRequest. Normally when this element is populated, the .isRecordOfRequest element would be set to "true" informationSource : Reference [0..*] « Patient | Practitioner | PractitionerRole | RelatedPerson | Organization | Group » The Encounter during which this [x] was created or to which the creation of this record is tightly associated encounter : Reference [0..1] « Encounter » Include additional information (for Information to support fulfilling (i.e. dispensing or administering) of the medication, for example, patient height and weight) that supports the ordering of weight, a MedicationStatement for the medication patient) supportingInformation : Reference [0..*] « Any » The date (and perhaps time) when the prescription was initially written or authored on authoredOn : dateTime [0..1] The individual, organization, or device that initiated the request and has responsibility for its activation requester : Reference [0..1] « Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device » The information in this instance is a record of the Medication Request and is not request or order itself and should not be considered as such, i.e. the information should not be used for medication dispense | supply and administration isRecordOfRequest : boolean [0..1] Indicates the type of performer of the administration of the medication performerType : CodeableConcept [0..1] « null (Strength=Extensible) MedicationIntendedPerformerRo... + » The specified desired performer of the medication treatment (e.g. the performer of the medication administration) administration). For devices, this is the device that is intended to perform the administration of the medication. An IV Pump would be an example of a device that is performing the administration. Both the IV Pump and the practitioner that set the rate or bolus on the pump can be listed as performers performer : Reference [0..1] [0..*] « Practitioner | PractitionerRole | Organization | Patient | Device DeviceDefinition | RelatedPerson | CareTeam | HealthcareService | Group » Indicates the The intended type of performer of device that is to be used for the administration of the medication (for example, PCA Pump) performerType device : CodeableConcept CodeableReference [0..1] [0..*] « Identifies the type of individual that is desired to administer the medication. (Strength=Example) ProcedurePerformerRoleCodes DeviceDefinition ?? » The person who entered the order on behalf of another individual for example in the case of a verbal or a telephone order recorder : Reference [0..1] « Practitioner | PractitionerRole » The reason or the indication for ordering or not ordering the medication reasonCode : CodeableConcept [0..*] « A coded concept indicating why When the medication request was ordered. (Strength=Example) Condition/Problem/DiagnosisCo... ?? » Condition or observation issued as a result of something that supports why the medication was ordered occurred, i.e. a lab test or a performed procedure, this documents those reasons reasonReference reason : Reference CodeableReference [0..*] « Condition | Observation » | The URL pointing to a protocol, guideline, orderset, or other definition that is adhered to in whole or in part by this MedicationRequest instantiatesCanonical : canonical DiagnosticReport [0..*] « » 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 instantiatesUri | Procedure : uri | AllergyIntolerance [0..*] ; A plan or request that is fulfilled in whole or in part by this medication request null (Strength=Example) basedOn : Reference [0..*] « CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation » 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 groupIdentifier : Identifier ConditionProblemDiagnosisCodes [0..1] ?? » The description of the overall patte3rn pattern of the administration of the medication to the patient courseOfTherapyType : CodeableConcept [0..1] « Identifies the overall pattern of medication administratio. (Strength=Example) null (Strength=Extensible) medicationRequest Course of T... MedicationRequestCourseOfTher... ?? + » Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be required for delivering the requested service insurance : Reference [0..*] « Coverage | ClaimResponse » Extra information about the prescription that could not be conveyed by the other attributes note : Annotation [0..*] Indicates how The period over which the medication is to be used by the patient dosageInstruction : Dosage [0..*] A link to taken. Can be specified as a resource representing an earlier order related order duration or prescription a range. Where there are multiple dosageInstruction lines (for example, tapering doses), this is the earliest date and the latest end date of the dosageInstructions priorPrescription effectiveTiming[x] : Reference DataType [0..1] « MedicationRequest Duration | Range | Period » Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions Specific instructions for a patient; e.g. Drug-drug interaction, duplicate therapy, dosage alert etc how the medication is to be used by the patient detectedIssue dosageInstruction : Reference [0..*] « DetectedIssue DosageDetails » [0..1] 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 eventHistory : Reference [0..*] « Provenance » DispenseRequest The minimum period of time that must occur between dispenses of the medication dispenseInterval : Duration [0..1] This indicates the validity period of a prescription (stale dating the Prescription) validityPeriod : Period [0..1] 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 numberOfRepeatsAllowed : unsignedInt [0..1] The amount that is to be dispensed for one fill quantity : Quantity ( SimpleQuantity ) [0..1] 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 expectedSupplyDuration : Duration [0..1] Indicates the intended dispensing performing Organization that will dispense the medication as specified by the prescriber performer dispenser : Reference [0..1] « Organization » Provides additional information to the dispenser, for example, counselling to be provided to the patient dispenserInstruction : CodeableConcept [0..*] « null (Strength=Example) Medicationrequestdispenser-in... ?? » Provides information about the type of adherence packaging to be supplied for the medication dispense doseAdministrationAid : CodeableConcept [0..1] « null (Strength=Example) MedicationDoseAids ?? » Identification of the facility/location where the medication is expected to be delivered destination : Reference [0..1] « Location » InitialFill The amount or quantity to provide as part of the first dispense quantity : Quantity ( SimpleQuantity ) [0..1] The length of time that the first dispense is expected to last duration : Duration [0..1] Substitution True if the prescriber allows a different drug to be dispensed from what was prescribed allowed[x] : Type DataType [1..1] « boolean | CodeableConcept ; Identifies the type of substitution allowed. (Strength=Example) null (Strength=Preferred) v3.ActSubstanceAdminSubstitut... ActSubstanceAdminSubstitution... ?? ? » Indicates the reason for the substitution, or why substitution must or must not be performed reason : CodeableConcept [0..1] « A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed. (Strength=Example) v3.SubstanceAdminSubstitution... SubstanceAdminSubstitutionRea... ?? » Indicates the quantity or duration for the first dispense of the medication initialFill [0..1] 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 dispenseRequest [0..1] 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 substitution [0..1]

XML Template 

<MedicationRequest xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier External ids for this request --></identifier>
 <

 <basedOn><!-- 0..* Reference(CarePlan|MedicationRequest|RequestOrchestration|
   ServiceRequest) A plan or request that is fulfilled in whole or in part by this medication request --></basedOn>

 <priorPrescription><!-- 0..1 Reference(MedicationRequest) Reference to an order/prescription that is being replaced by this MedicationRequest --></priorPrescription>
 <groupIdentifier><!-- 0..1 Identifier Composite request this is part of --></groupIdentifier>
 <status value="[code]"/><!-- 1..1 active | on-hold | ended | stopped | completed | cancelled | entered-in-error | draft | unknown -->

 <statusReason><!-- 0..1 CodeableConcept Reason for current status --></statusReason>
 <
 <</category>

 <statusChanged value="[dateTime]"/><!-- 0..1 When the status was changed -->
 <intent value="[code]"/><!-- 1..1 proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option (immutable) -->
 <category><!-- 0..* CodeableConcept Grouping or category of medication request --></category>

 <priority value="[code]"/><!-- 0..1 routine | urgent | asap | stat -->
 <
 <|
   </reported[x]>
 <</medication[x]>
 <</subject>

 <doNotPerform value="[boolean]"/><!-- 0..1 If true, indicates the provider is ordering a patient should not take the specified medication -->
 <medication><!-- 1..1 CodeableReference(Medication) Medication to be taken --></medication>
 <subject><!-- 1..1 Reference(Group|Patient) Individual or group for whom the medication has been requested --></subject>
 <informationSource><!-- 0..* Reference(Group|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) The person or organization who provided the information about this request, if the source is someone other than the requestor --></informationSource>
 <encounter><!-- 0..1 Reference(Encounter) Encounter created as part of encounter/admission/stay --></encounter>
 <</supportingInformation>

 <supportingInformation><!-- 0..* Reference(Any) Information to support fulfilling of the medication --></supportingInformation>

 <authoredOn value="[dateTime]"/><!-- 0..1 When request was initially authored -->
 <|
   </requester>
 <|
   </performer>
 <</performerType>

 <requester><!-- 0..1 Reference(Device|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) Who/What requested the Request --></requester>

 <isRecordOfRequest value="[boolean]"/><!-- 0..1 Whether this is record of a Medication Request or the actual request itself -->
 <performerType><!-- 0..1 CodeableConcept Desired kind of performer of the medication administration --></performerType>
 <performer><!-- 0..* Reference(CareTeam|DeviceDefinition|Group|HealthcareService|
   Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) Intended performer of administration --></performer>

 <device><!-- 0..* CodeableReference(DeviceDefinition) Intended type of device for the administration --></device>

 <recorder><!-- 0..1 Reference(Practitioner|PractitionerRole) Person who entered the request --></recorder>
 <</reasonCode>
 <</reasonReference>
 <
 <
 <|
   </basedOn>
 <</groupIdentifier>
 <</courseOfTherapyType>
 <</insurance>

 <reason><!-- 0..* CodeableReference(AllergyIntolerance|Condition|
   DiagnosticReport|Observation|Procedure) Reason or indication for ordering or not ordering the medication --></reason>

 <courseOfTherapyType><!-- 0..1 CodeableConcept Overall pattern of medication administration --></courseOfTherapyType>
 <insurance><!-- 0..* Reference(ClaimResponse|Coverage) Associated insurance coverage --></insurance>

 <note><!-- 0..* Annotation Information about the prescription --></note>
 <</dosageInstruction>

 <effectiveTiming[x]><!-- 0..1 Duration|Range|Period Period over which the medication is to be taken, can be specified as a duration or a range --></effectiveTiming[x]>
 <dosageInstruction><!-- 0..1 DosageDetails Specific instructions for how the medication should be taken --></dosageInstruction>

 <dispenseRequest>  <!-- 0..1 Medication supply authorization -->
  <initialFill>  <!-- 0..1 First fill details -->
   <quantity><!-- 0..1 Quantity(SimpleQuantity) First fill quantity --></quantity>
   <duration><!-- 0..1 Duration First fill duration --></duration>
  </initialFill>
  <dispenseInterval><!-- 0..1 Duration Minimum period of time between dispenses --></dispenseInterval>
  <validityPeriod><!-- 0..1 Period Time period supply is authorized for --></validityPeriod>
  <numberOfRepeatsAllowed value="[unsignedInt]"/><!-- 0..1 Number of refills authorized -->
  <quantity><!-- 0..1 Quantity(SimpleQuantity) Amount of medication to supply per dispense --></quantity>
  <expectedSupplyDuration><!-- 0..1 Duration Number of days supply per dispense --></expectedSupplyDuration>
  <</performer>

  <dispenser><!-- 0..1 Reference(Organization) Intended performer of dispense --></dispenser>
  <dispenserInstruction><!-- 0..* CodeableConcept Additional information for the dispenser --></dispenserInstruction>
  <doseAdministrationAid><!-- 0..1 CodeableConcept Type of adherence packaging to use for the dispense --></doseAdministrationAid>
  <destination><!-- 0..1 Reference(Location) Where the medication is expected to be delivered --></destination>

 </dispenseRequest>
 <substitution>  <!-- 0..1 Any restrictions on medication substitution -->
  <</allowed[x]>
  <</reason>

  <allowed[x]><!-- 1..1 boolean|CodeableConcept Whether substitution is allowed or not icon --></allowed[x]>
  <reason><!-- 0..1 CodeableConcept Why should (not) substitution be made icon --></reason>

 </substitution>
 <</priorPrescription>
 <</detectedIssue>

 <eventHistory><!-- 0..* Reference(Provenance) A list of events of interest in the lifecycle --></eventHistory>
</MedicationRequest>

JSON Template 

{doco
  "resourceType" : "MedicationRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External ids for this request
  "

  "basedOn" : [{ Reference(CarePlan|MedicationRequest|RequestOrchestration|
   ServiceRequest) }], // A plan or request that is fulfilled in whole or in part by this medication request

  "priorPrescription" : { Reference(MedicationRequest) }, // Reference to an order/prescription that is being replaced by this MedicationRequest
  "groupIdentifier" : { Identifier }, // Composite request this is part of
  "status" : "<code>", // R!  active | on-hold | ended | stopped | completed | cancelled | entered-in-error | draft | unknown

  "statusReason" : { CodeableConcept }, // Reason for current status
  "
  "

  "statusChanged" : "<dateTime>", // When the status was changed
  "intent" : "<code>", // R!  proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option (immutable)
  "category" : [{ CodeableConcept }], // Grouping or category of medication request

  "priority" : "<code>", // routine | urgent | asap | stat
  "
  
  ">,
  "|
    },
  
  " },
  " },
  "

  "doNotPerform" : <boolean>, // If true, indicates the provider is ordering a patient should not take the specified medication
  "medication" : { CodeableReference(Medication) }, // R!  Medication to be taken
  "subject" : { Reference(Group|Patient) }, // R!  Individual or group for whom the medication has been requested
  "informationSource" : [{ Reference(Group|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) }], // The person or organization who provided the information about this request, if the source is someone other than the requestor
  "encounter" : { Reference(Encounter) }, // Encounter created as part of encounter/admission/stay
  "

  "supportingInformation" : [{ Reference(Any) }], // Information to support fulfilling of the medication

  "authoredOn" : "<dateTime>", // When request was initially authored
  "|
   
  "|
   
  "

  "requester" : { Reference(Device|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) }, // Who/What requested the Request

  "isRecordOfRequest" : <boolean>, // Whether this is record of a Medication Request or the actual request itself
  "performerType" : { CodeableConcept }, // Desired kind of performer of the medication administration
  "performer" : [{ Reference(CareTeam|DeviceDefinition|Group|HealthcareService|
   Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) }], // Intended performer of administration

  "device" : [{ CodeableReference(DeviceDefinition) }], // Intended type of device for the administration

  "recorder" : { Reference(Practitioner|PractitionerRole) }, // Person who entered the request
  "
  "
  "
  "
  "|
   
  "
  "
  "

  "reason" : [{ CodeableReference(AllergyIntolerance|Condition|
   DiagnosticReport|Observation|Procedure) }], // Reason or indication for ordering or not ordering the medication

  "courseOfTherapyType" : { CodeableConcept }, // Overall pattern of medication administration
  "insurance" : [{ Reference(ClaimResponse|Coverage) }], // Associated insurance coverage

  "note" : [{ Annotation }], // Information about the prescription
  "

  // effectiveTiming[x]: 
     Period over which the medication is to be taken, can be specified as a duration or a range. One of these 3:
  "effectiveTimingDuration" : { Duration },
  "effectiveTimingRange" : { Range },
  "effectiveTimingPeriod" : { Period },
  "dosageInstruction" : { DosageDetails }, // Specific instructions for how the medication should be taken

  "dispenseRequest" : { // Medication supply authorization
    "initialFill" : { // First fill details
      "quantity" : { Quantity(SimpleQuantity) }, // First fill quantity
      "duration" : { Duration } // First fill duration
    },
    "dispenseInterval" : { Duration }, // Minimum period of time between dispenses
    "validityPeriod" : { Period }, // Time period supply is authorized for
    "numberOfRepeatsAllowed" : "<unsignedInt>", // Number of refills authorized
    "quantity" : { Quantity(SimpleQuantity) }, // Amount of medication to supply per dispense
    "expectedSupplyDuration" : { Duration }, // Number of days supply per dispense
    "

    "dispenser" : { Reference(Organization) }, // Intended performer of dispense
    "dispenserInstruction" : [{ CodeableConcept }], // Additional information for the dispenser
    "doseAdministrationAid" : { CodeableConcept }, // Type of adherence packaging to use for the dispense
    "destination" : { Reference(Location) } // Where the medication is expected to be delivered

  },
  "substitution" : { // Any restrictions on medication substitution
    // allowed[x]: Whether substitution is allowed or not. One of these 2:
    "allowedBoolean" : <boolean>,
    "allowedCodeableConcept" : { CodeableConcept },
    "

    "reason" : { CodeableConcept } // Why should (not) substitution be made icon

  },
  "
  "

  "eventHistory" : [{ Reference(Provenance) }] // A list of events of interest in the lifecycle
}

Turtle Template 

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:MedicationRequest;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from 
  # from 
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  # . One of these 2
    fhir: ]
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  # . One of these 2
    fhir: ]
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    ];
    fhir:
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  ];
  fhir:
    # . One of these 2
      fhir: ]
      fhir: ]
    fhir:
  ];
  fhir:
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  fhir:

  # from Resource: fhir:id, fhir:meta, fhir:implicitRules, and fhir:language
  # from DomainResource: fhir:text, fhir:contained, fhir:extension, and fhir:modifierExtension
  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* External ids for this request
  fhir:basedOn  ( [ Reference(CarePlan|MedicationRequest|RequestOrchestration|ServiceRequest) ] ... ) ; # 0..* A plan or request that is fulfilled in whole or in part by this medication request
  fhir:priorPrescription [ Reference(MedicationRequest) ] ; # 0..1 Reference to an order/prescription that is being replaced by this MedicationRequest
  fhir:groupIdentifier [ Identifier ] ; # 0..1 Composite request this is part of
  fhir:status [ code ] ; # 1..1 active | on-hold | ended | stopped | completed | cancelled | entered-in-error | draft | unknown
  fhir:statusReason [ CodeableConcept ] ; # 0..1 Reason for current status
  fhir:statusChanged [ dateTime ] ; # 0..1 When the status was changed
  fhir:intent [ code ] ; # 1..1 proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option (immutable)
  fhir:category  ( [ CodeableConcept ] ... ) ; # 0..* Grouping or category of medication request
  fhir:priority [ code ] ; # 0..1 routine | urgent | asap | stat
  fhir:doNotPerform [ boolean ] ; # 0..1 If true, indicates the provider is ordering a patient should not take the specified medication
  fhir:medication [ CodeableReference(Medication) ] ; # 1..1 Medication to be taken
  fhir:subject [ Reference(Group|Patient) ] ; # 1..1 Individual or group for whom the medication has been requested
  fhir:informationSource  ( [ Reference(Group|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ... ) ; # 0..* The person or organization who provided the information about this request, if the source is someone other than the requestor
  fhir:encounter [ Reference(Encounter) ] ; # 0..1 Encounter created as part of encounter/admission/stay
  fhir:supportingInformation  ( [ Reference(Any) ] ... ) ; # 0..* Information to support fulfilling of the medication
  fhir:authoredOn [ dateTime ] ; # 0..1 When request was initially authored
  fhir:requester [ Reference(Device|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ; # 0..1 Who/What requested the Request
  fhir:isRecordOfRequest [ boolean ] ; # 0..1 Whether this is record of a Medication Request or the actual request itself
  fhir:performerType [ CodeableConcept ] ; # 0..1 Desired kind of performer of the medication administration
  fhir:performer  ( [ Reference(CareTeam|DeviceDefinition|Group|HealthcareService|Organization|Patient|
  Practitioner|PractitionerRole|RelatedPerson) ] ... ) ; # 0..* Intended performer of administration

  fhir:device  ( [ CodeableReference(DeviceDefinition) ] ... ) ; # 0..* Intended type of device for the administration
  fhir:recorder [ Reference(Practitioner|PractitionerRole) ] ; # 0..1 Person who entered the request
  fhir:reason  ( [ CodeableReference(AllergyIntolerance|Condition|DiagnosticReport|Observation|Procedure) ] ... ) ; # 0..* Reason or indication for ordering or not ordering the medication
  fhir:courseOfTherapyType [ CodeableConcept ] ; # 0..1 Overall pattern of medication administration
  fhir:insurance  ( [ Reference(ClaimResponse|Coverage) ] ... ) ; # 0..* Associated insurance coverage
  fhir:note  ( [ Annotation ] ... ) ; # 0..* Information about the prescription
  # effectiveTiming[x] : 0..1 Period over which the medication is to be taken, can be specified as a duration or a range. One of these 3
    fhir:effectiveTiming [  a fhir:Duration ; Duration ]
    fhir:effectiveTiming [  a fhir:Range ; Range ]
    fhir:effectiveTiming [  a fhir:Period ; Period ]
  fhir:dosageInstruction [ DosageDetails ] ; # 0..1 Specific instructions for how the medication should be taken
  fhir:dispenseRequest [ # 0..1 Medication supply authorization
    fhir:initialFill [ # 0..1 First fill details
      fhir:quantity [ Quantity(SimpleQuantity) ] ; # 0..1 First fill quantity
      fhir:duration [ Duration ] ; # 0..1 First fill duration
    ] ;
    fhir:dispenseInterval [ Duration ] ; # 0..1 Minimum period of time between dispenses
    fhir:validityPeriod [ Period ] ; # 0..1 Time period supply is authorized for
    fhir:numberOfRepeatsAllowed [ unsignedInt ] ; # 0..1 Number of refills authorized
    fhir:quantity [ Quantity(SimpleQuantity) ] ; # 0..1 Amount of medication to supply per dispense
    fhir:expectedSupplyDuration [ Duration ] ; # 0..1 Number of days supply per dispense
    fhir:dispenser [ Reference(Organization) ] ; # 0..1 Intended performer of dispense
    fhir:dispenserInstruction  ( [ CodeableConcept ] ... ) ; # 0..* Additional information for the dispenser
    fhir:doseAdministrationAid [ CodeableConcept ] ; # 0..1 Type of adherence packaging to use for the dispense
    fhir:destination [ Reference(Location) ] ; # 0..1 Where the medication is expected to be delivered
  ] ;
  fhir:substitution [ # 0..1 Any restrictions on medication substitution
    # allowed[x] : 1..1 Whether substitution is allowed or not. One of these 2
      fhir:allowed [  a fhir:Boolean ; boolean ]
      fhir:allowed [  a fhir:CodeableConcept ; CodeableConcept ]
    fhir:reason [ CodeableConcept ] ; # 0..1 Why should (not) substitution be made
  ] ;
  fhir:eventHistory  ( [ Reference(Provenance) ] ... ) ; # 0..* A list of events of interest in the lifecycle

]

Changes since R3 from R5 to R6

MedicationRequest
MedicationRequest.basedOn
  • Type Reference: Added Target Type RequestOrchestration
  • Type Reference: Removed Target Type ImmunizationRecommendation
MedicationRequest.status
  • Min Cardinality changed from 0 to 1 Remove codes stopped , completed , cancelled
MedicationRequest.intent
  • Change value set Remove codes original-order , reflex-order , filler-order , instance-order
MedicationRequest.informationSource
  • Type Reference: Added Target Type Group
MedicationRequest.isRecordOfRequest
  • Renamed from http://hl7.org/fhir/ValueSet/medication-request-status reported to http://hl7.org/fhir/ValueSet/medicationrequest-status|4.0.1 isRecordOfRequest
MedicationRequest.statusReason MedicationRequest.performer
  • Type Reference: Added Element Target Type Group
MedicationRequest.intent MedicationRequest.effectiveTiming[x]
  • Change value set Renamed from http://hl7.org/fhir/ValueSet/medication-request-intent effectiveDosePeriod to http://hl7.org/fhir/ValueSet/medicationrequest-intent|4.0.1 effectiveTiming[x]
  • Add Types Duration, Range
MedicationRequest.category MedicationRequest.dosageInstruction
  • Max Cardinality changed from * to 1
  • Type changed from Dosage to * DosageDetails
MedicationRequest.priority MedicationRequest.dispenseRequest.dispenserInstruction
  • Change value set Type changed from http://hl7.org/fhir/ValueSet/medication-request-priority Annotation to http://hl7.org/fhir/ValueSet/request-priority|4.0.1 CodeableConcept
MedicationRequest.doNotPerform MedicationRequest.dispenseRequest.destination
  • Added Element
MedicationRequest.reported[x] MedicationRequest.renderedDosageInstruction
  • Added Element Deleted

Changes from R4 and R4B to R6

MedicationRequest.encounter MedicationRequest
MedicationRequest.basedOn
  • Type Reference: Added Element Target Type RequestOrchestration
  • Type Reference: Removed Target Type ImmunizationRecommendation
MedicationRequest.requester MedicationRequest.status
  • Type changed from BackboneElement to Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device) Remove codes cancelled , completed , stopped
  • Add code ended
MedicationRequest.performer MedicationRequest.statusChanged
  • Added Element
MedicationRequest.performerType MedicationRequest.intent
  • Added Element Remove codes original-order , reflex-order , filler-order , instance-order
MedicationRequest.recorder MedicationRequest.medication
  • Renamed from medication[x] to medication
  • Add Type Reference: Added Target Type PractitionerRole CodeableReference
  • Remove Types CodeableConcept, Reference(Medication)
MedicationRequest.instantiatesCanonical MedicationRequest.informationSource
  • Added Element
MedicationRequest.instantiatesUri MedicationRequest.isRecordOfRequest
  • Added Element Renamed from reported[x] to isRecordOfRequest
  • Remove Type Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | Organization)
MedicationRequest.basedOn MedicationRequest.performerType
  • Add Binding `http://hl7.org/fhir/ValueSet/medication-intended-performer-role` (extensible)
MedicationRequest.performer
  • Max Cardinality changed from 1 to *
  • Type Reference: Added Target Types ServiceRequest, ImmunizationRecommendation DeviceDefinition, HealthcareService, Group
  • Type Reference: Removed Target Types ProcedureRequest, ReferralRequest Type Device
MedicationRequest.courseOfTherapyType MedicationRequest.device
  • Added Element
MedicationRequest.insurance MedicationRequest.reason
  • Added Element
  • Merged both reasonCode and reasonReference into reason
MedicationRequest.dispenseRequest.initialFill MedicationRequest.courseOfTherapyType
  • Added Element Add Binding `http://hl7.org/fhir/ValueSet/medicationrequest-course-of-therapy` (extensible)
MedicationRequest.dispenseRequest.initialFill.quantity MedicationRequest.effectiveTiming[x]
  • Added Element
MedicationRequest.dosageInstruction
  • Max Cardinality changed from * to 1
  • Type changed from Dosage to DosageDetails
MedicationRequest.dispenseRequest.dispenser
  • Renamed from performer to dispenser
MedicationRequest.dispenseRequest.initialFill.duration MedicationRequest.dispenseRequest.dispenserInstruction
  • Added Element
MedicationRequest.dispenseRequest.dispenseInterval MedicationRequest.dispenseRequest.doseAdministrationAid
  • Added Element
MedicationRequest.dispenseRequest.numberOfRepeatsAllowed MedicationRequest.dispenseRequest.destination
  • Type changed from positiveInt to unsignedInt Added Element
MedicationRequest.substitution.allowed[x] MedicationRequest.reasonCode
  • Renamed from allowed to allowed[x] Add Type CodeableConcept No longer marked as Modifier Deleted (-> reason.concept)
MedicationRequest.definition MedicationRequest.reasonReference
  • deleted Deleted (-> reason.reference)
MedicationRequest.context MedicationRequest.instantiatesCanonical
  • deleted Deleted
MedicationRequest.requester.agent MedicationRequest.instantiatesUri
  • deleted Deleted
MedicationRequest.requester.onBehalfOf MedicationRequest.detectedIssue
  • deleted Deleted

See the Full Difference for further information

This analysis is available for R4 as XML or JSON . See R3 <--> R4 Conversion Maps (status = 36 tests that all execute ok. 8 fail round-trip testing and 36 r3 resources are invalid (0 errors). ) for R4B as XML or JSON .

Structure

Type True if request 0..1 Reported rather than primary record reportedBoolean boolean reportedReference medication[x] Σ 1..1 Σ 1..1 Who 0..1 Reason or indication 0..* Condition or observation that supports why Σ Instantiates FHIR protocol Σ 0..* Instantiates external protocol or definition Σ Σ 0..1 CodeableConcept Overall pattern of Information about the prescription 0..* How
Name Flags Card. Type Description & Constraints      Filter: Filters doco
. . MedicationRequest TU N DomainResource Ordering of medication for patient or group

Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier 0..* Identifier External ids for this request

. . status . basedOn Σ ?! 0..* Reference ( CarePlan | MedicationRequest | ServiceRequest | RequestOrchestration ) A plan or request that is fulfilled in whole or in part by this medication request

. . . priorPrescription 0..1 Reference ( MedicationRequest ) Reference to an order/prescription that is being replaced by this MedicationRequest
... groupIdentifier Σ 0..1 Identifier 1..1 Composite request this is part of
. . . status ?! Σ 1..1 code active | on-hold | cancelled ended | stopped | completed | entered-in-error cancelled | stopped entered-in-error | draft | unknown
Medicationrequest status Binding: medicationrequest Status ( Required )
. . . statusReason 0..1 CodeableConcept Reason for current status
Medication request status reason codes Binding: medicationRequest Status Reason Codes ( Example )
. . . statusChanged 0..1 dateTime When the status was changed
. . . intent ?! Σ 1..1 code proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option (immutable)
Medication request intent Binding: medicationRequest Intent ( Required )
. . . category 0..* CodeableConcept Grouping or category of medication usage Medication request category codes
Binding: MedicationRequest Category Codes ( Example )

. . . priority Σ 0..1 code routine | urgent | asap | stat
Request priority Binding: RequestPriority ( Required )
. . . doNotPerform ?! Σ 0..1 boolean If true, indicates the provider is prohibiting action ordering a patient should not take the specified medication
. . reported[x] . medication Σ 1..1 Reference CodeableReference ( Patient | Practitioner | PractitionerRole | RelatedPerson | Organization Medication ) Medication to be taken
Binding: SNOMED CT Medication Codes ( Example )
. . medicationCodeableConcept CodeableConcept . subject medicationReference Σ 1..1 Reference ( Medication Patient | Group ) Individual or group for whom the medication has been requested
. . . subject informationSource 0..* Reference ( Patient | Practitioner | PractitionerRole | RelatedPerson | Organization | Group ) The person or group medication request organization who provided the information about this request, if the source is for someone other than the requestor

. . . encounter 0..1 Reference ( Encounter ) Encounter created as part of encounter/admission/stay
. . . supportingInformation 0..* Reference ( Any ) Information to support ordering fulfilling of the medication

. . . authoredOn Σ 0..1 dateTime When request was initially authored
. . . requester Σ 0..1 Reference ( Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device ) Who/What requested the Request
. . performer . isRecordOfRequest Σ 0..1 Reference ( Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam boolean ) Intended performer Whether this is record of administration a Medication Request or the actual request itself
. . . performerType Σ 0..1 CodeableConcept Desired kind of performer of the medication administration
Procedure Binding: Medication Intended Performer Role Codes ( Example Extensible )
. . . recorder performer 0..* Reference ( Practitioner | PractitionerRole | Organization | Patient | DeviceDefinition | RelatedPerson | CareTeam | HealthcareService | Group ) Intended performer of administration

Person who entered the request
. . reasonCode . device 0..* CodeableConcept CodeableReference ( DeviceDefinition ) Intended type of device for ordering or not ordering the medication administration
Condition/Problem/Diagnosis Codes ( Example )
. . . reasonReference recorder 0..1 Reference ( Condition Practitioner | Observation PractitionerRole ) Person who entered the prescription is being written request
. . . instantiatesCanonical reason 0..* canonical CodeableReference () ( Condition | Observation | DiagnosticReport | Procedure | AllergyIntolerance ) Reason or definition indication for ordering or not ordering the medication
Binding: Condition/Problem/Diagnosis Codes ( Example )

. . instantiatesUri . courseOfTherapyType 0..1 uri CodeableConcept Overall pattern of medication administration
Binding: medicationRequest Course of Therapy Codes ( Extensible )
. . . basedOn insurance 0..* Reference ( CarePlan | MedicationRequest | ServiceRequest Coverage | ImmunizationRecommendation ClaimResponse ) Associated insurance coverage
What request fulfills
. . . groupIdentifier note 0..* Identifier Annotation Information about the prescription

Composite request this is part of
. . courseOfTherapyType . effectiveTiming[x] 0..1 Period over which the medication administration is to be taken, can be specified as a duration or a range
Medication request course of therapy codes ( Example )
. . insurance . . effectiveTimingDuration 0..* Reference ( Coverage | ClaimResponse Duration ) Associated insurance coverage
. . . . note effectiveTimingRange Range
. . . . effectiveTimingPeriod 0..* Annotation Period
. . . dosageInstruction 0..1 Dosage DosageDetails Specific instructions for how the medication should be taken
. . . dispenseRequest 0..1 BackboneElement Medication supply authorization
. . . . initialFill 0..1 BackboneElement First fill details
. . . . . 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 0..1 unsignedInt Number of refills authorized
. . . . quantity 0..1 SimpleQuantity Amount of medication to supply per dispense
. . . . expectedSupplyDuration 0..1 Duration Number of days supply per dispense
. . . performer . dispenser 0..1 Reference ( Organization ) Intended performer of dispense
.... dispenserInstruction 0..* CodeableConcept Additional information for the dispenser
Binding: medicationrequest dispenser-instructions ( Example )

. . . substitution . doseAdministrationAid 0..1 CodeableConcept Type of adherence packaging to use for the dispense
Binding: Medication Dose Aids ( Example )
. . . . destination 0..1 Reference ( Location ) Where the medication is expected to be delivered
BackboneElement
. . . substitution 0..1 BackboneElement Any restrictions on medication substitution
. . . . allowed[x] 1..1 Whether substitution is allowed or not
Binding: ActSubstanceAdminSubstitutionCode icon V3 Value SetActSubstanceAdminSubstitutionCode ( Example Preferred )
. . . . . allowedBoolean boolean
. . . . . allowedCodeableConcept CodeableConcept
. . . . reason 0..1 CodeableConcept Why should (not) substitution be made
Binding: SubstanceAdminSubstitutionReason icon V3 Value SetSubstanceAdminSubstitutionReason ( Example ) 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 icon

See the Extensions for this resource

UML Diagram ( Legend )

MedicationRequest ( DomainResource ) 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 identifier : Identifier [0..*] Whenever the medication request is being issued because of another request, eg. a procedure that is being planned (ServiceRequest) and MedicationRequests are known to be needed, this element documents those requests basedOn : Reference [0..*] « CarePlan | MedicationRequest | ServiceRequest | RequestOrchestration » Reference to an order/prescription that is being replaced by this MedicationRequest priorPrescription : Reference [0..1] « MedicationRequest » A shared identifier common to multiple independent Request instances that were activated/authorized more or less simultaneously by a single author. The presence of the same identifier on each request ties those requests together and may have business ramifications in terms of reporting of results, billing, etc. E.g. a requisition number shared by a set of lab tests ordered together, or a prescription number shared by all meds ordered at one time groupIdentifier : Identifier [0..1] A code specifying the current state of the order. Generally, this will be active or completed state (this element modifies the meaning of other elements) status : code [1..1] « A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription. null (Strength=Required) medicationrequest Status MedicationrequestStatus ! » Captures the reason for the current state of the MedicationRequest statusReason : CodeableConcept [0..1] « Identifies the reasons for a given status. null (Strength=Example) medicationRequest Status Reas... MedicationRequestStatusReason... ?? » The date (and perhaps time) when the status was changed statusChanged : dateTime [0..1] Whether the request is a proposal, plan, or an original order (this element modifies the meaning of other elements) intent : code [1..1] « The kind of medication order. null (Strength=Required) medicationRequest Intent MedicationRequestIntent ! » Indicates the type An arbitrary categorization or grouping of medication request (for example, where the medication is expected request. It could be used for indicating where meds are intended to be consumed or administered (i.e. administered, eg. in an inpatient setting or outpatient)) in a patient's home, or a legal category of the medication category : CodeableConcept [0..*] « 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. null (Strength=Example) medicationRequest Category MedicationRequestCategoryCodes ?? » Indicates how quickly the Medication Request should be addressed with respect to other requests priority : code [0..1] « Identifies the level of importance to be assigned to actioning the request. null (Strength=Required) RequestPriority ! » If true true, indicates that the provider is asking ordering a patient should not take the specified medication. The reason for this order can be provided in the medication .reason element. A MedicationRequest with .doNotPerform = true will not result in any dispense or administration. A request not to occur take or administer medication is a standalone request, and does not update any other medication request. When true, active orders that may exist for the same medication are expected to be canceled/ended, and new orders for the same medication are not expected (this element modifies the meaning of other elements) doNotPerform : boolean [0..1] 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 reported[x] : Type [0..1] « boolean | Reference ( Patient | Practitioner | PractitionerRole | RelatedPerson | Organization ) » 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 medication[x] medication : Type CodeableReference [1..1] « CodeableConcept | Reference ( Medication ); ; A coded concept identifying substance or product that can be ordered. null (Strength=Example) SNOMEDCTMedicationCodes ?? » A link to a resource representing the person The individual or set of individuals to group for whom the medication will be given has been requested subject : Reference [1..1] « Patient | Group » The person or organization who provided the information about this request, if the source is someone other than the requestor. The informationSource element is generally used when details of a prescription are being reported by someone who is not the requestor, e.g., I indicate that I received a prescription for a med out of my jurisdiction and the details are recorded in the system as a MedicationRequest. Normally when this element is populated, the .isRecordOfRequest element would be set to "true" informationSource : Reference [0..*] « Patient | Practitioner | PractitionerRole | RelatedPerson | Organization | Group » The Encounter during which this [x] was created or to which the creation of this record is tightly associated encounter : Reference [0..1] « Encounter » Include additional information (for Information to support fulfilling (i.e. dispensing or administering) of the medication, for example, patient height and weight) that supports the ordering of weight, a MedicationStatement for the medication patient) supportingInformation : Reference [0..*] « Any » The date (and perhaps time) when the prescription was initially written or authored on authoredOn : dateTime [0..1] The individual, organization, or device that initiated the request and has responsibility for its activation requester : Reference [0..1] « Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device » The information in this instance is a record of the Medication Request and is not request or order itself and should not be considered as such, i.e. the information should not be used for medication dispense | supply and administration isRecordOfRequest : boolean [0..1] Indicates the type of performer of the administration of the medication performerType : CodeableConcept [0..1] « null (Strength=Extensible) MedicationIntendedPerformerRo... + » The specified desired performer of the medication treatment (e.g. the performer of the medication administration) administration). For devices, this is the device that is intended to perform the administration of the medication. An IV Pump would be an example of a device that is performing the administration. Both the IV Pump and the practitioner that set the rate or bolus on the pump can be listed as performers performer : Reference [0..1] [0..*] « Practitioner | PractitionerRole | Organization | Patient | Device DeviceDefinition | RelatedPerson | CareTeam | HealthcareService | Group » Indicates the The intended type of performer of device that is to be used for the administration of the medication (for example, PCA Pump) performerType device : CodeableConcept CodeableReference [0..1] [0..*] « Identifies the type of individual that is desired to administer the medication. (Strength=Example) ProcedurePerformerRoleCodes DeviceDefinition ?? » The person who entered the order on behalf of another individual for example in the case of a verbal or a telephone order recorder : Reference [0..1] « Practitioner | PractitionerRole » The reason or the indication for ordering or not ordering the medication reasonCode : CodeableConcept [0..*] « A coded concept indicating why When the medication request was ordered. (Strength=Example) Condition/Problem/DiagnosisCo... ?? » Condition or observation issued as a result of something that supports why the medication was ordered occurred, i.e. a lab test or a performed procedure, this documents those reasons reasonReference reason : Reference CodeableReference [0..*] « Condition | Observation » | The URL pointing to a protocol, guideline, orderset, or other definition that is adhered to in whole or in part by this MedicationRequest instantiatesCanonical : canonical DiagnosticReport [0..*] « » 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 instantiatesUri | Procedure : uri | AllergyIntolerance [0..*] ; A plan or request that is fulfilled in whole or in part by this medication request null (Strength=Example) basedOn : Reference [0..*] « CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation » 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 groupIdentifier : Identifier ConditionProblemDiagnosisCodes [0..1] ?? » The description of the overall patte3rn pattern of the administration of the medication to the patient courseOfTherapyType : CodeableConcept [0..1] « Identifies the overall pattern of medication administratio. (Strength=Example) null (Strength=Extensible) medicationRequest Course of T... MedicationRequestCourseOfTher... ?? + » Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be required for delivering the requested service insurance : Reference [0..*] « Coverage | ClaimResponse » Extra information about the prescription that could not be conveyed by the other attributes note : Annotation [0..*] Indicates how The period over which the medication is to be used by the patient dosageInstruction : Dosage [0..*] A link to taken. Can be specified as a resource representing an earlier order related order duration or prescription a range. Where there are multiple dosageInstruction lines (for example, tapering doses), this is the earliest date and the latest end date of the dosageInstructions priorPrescription effectiveTiming[x] : Reference DataType [0..1] « MedicationRequest Duration | Range | Period » Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions Specific instructions for a patient; e.g. Drug-drug interaction, duplicate therapy, dosage alert etc how the medication is to be used by the patient detectedIssue dosageInstruction : Reference [0..*] « DetectedIssue DosageDetails » [0..1] 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 eventHistory : Reference [0..*] « Provenance » DispenseRequest The minimum period of time that must occur between dispenses of the medication dispenseInterval : Duration [0..1] This indicates the validity period of a prescription (stale dating the Prescription) validityPeriod : Period [0..1] 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 numberOfRepeatsAllowed : unsignedInt [0..1] The amount that is to be dispensed for one fill quantity : Quantity ( SimpleQuantity ) [0..1] 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 expectedSupplyDuration : Duration [0..1] Indicates the intended dispensing performing Organization that will dispense the medication as specified by the prescriber performer dispenser : Reference [0..1] « Organization » Provides additional information to the dispenser, for example, counselling to be provided to the patient dispenserInstruction : CodeableConcept [0..*] « null (Strength=Example) Medicationrequestdispenser-in... ?? » Provides information about the type of adherence packaging to be supplied for the medication dispense doseAdministrationAid : CodeableConcept [0..1] « null (Strength=Example) MedicationDoseAids ?? » Identification of the facility/location where the medication is expected to be delivered destination : Reference [0..1] « Location » InitialFill The amount or quantity to provide as part of the first dispense quantity : Quantity ( SimpleQuantity ) [0..1] The length of time that the first dispense is expected to last duration : Duration [0..1] Substitution True if the prescriber allows a different drug to be dispensed from what was prescribed allowed[x] : Type DataType [1..1] « boolean | CodeableConcept ; Identifies the type of substitution allowed. (Strength=Example) null (Strength=Preferred) v3.ActSubstanceAdminSubstitut... ActSubstanceAdminSubstitution... ?? ? » Indicates the reason for the substitution, or why substitution must or must not be performed reason : CodeableConcept [0..1] « A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed. (Strength=Example) v3.SubstanceAdminSubstitution... SubstanceAdminSubstitutionRea... ?? » Indicates the quantity or duration for the first dispense of the medication initialFill [0..1] 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 dispenseRequest [0..1] 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 substitution [0..1]

XML Template 

<MedicationRequest xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier External ids for this request --></identifier>
 <

 <basedOn><!-- 0..* Reference(CarePlan|MedicationRequest|RequestOrchestration|
   ServiceRequest) A plan or request that is fulfilled in whole or in part by this medication request --></basedOn>

 <priorPrescription><!-- 0..1 Reference(MedicationRequest) Reference to an order/prescription that is being replaced by this MedicationRequest --></priorPrescription>
 <groupIdentifier><!-- 0..1 Identifier Composite request this is part of --></groupIdentifier>
 <status value="[code]"/><!-- 1..1 active | on-hold | ended | stopped | completed | cancelled | entered-in-error | draft | unknown -->

 <statusReason><!-- 0..1 CodeableConcept Reason for current status --></statusReason>
 <
 <</category>

 <statusChanged value="[dateTime]"/><!-- 0..1 When the status was changed -->
 <intent value="[code]"/><!-- 1..1 proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option (immutable) -->
 <category><!-- 0..* CodeableConcept Grouping or category of medication request --></category>

 <priority value="[code]"/><!-- 0..1 routine | urgent | asap | stat -->
 <
 <|
   </reported[x]>
 <</medication[x]>
 <</subject>

 <doNotPerform value="[boolean]"/><!-- 0..1 If true, indicates the provider is ordering a patient should not take the specified medication -->
 <medication><!-- 1..1 CodeableReference(Medication) Medication to be taken --></medication>
 <subject><!-- 1..1 Reference(Group|Patient) Individual or group for whom the medication has been requested --></subject>
 <informationSource><!-- 0..* Reference(Group|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) The person or organization who provided the information about this request, if the source is someone other than the requestor --></informationSource>
 <encounter><!-- 0..1 Reference(Encounter) Encounter created as part of encounter/admission/stay --></encounter>
 <</supportingInformation>

 <supportingInformation><!-- 0..* Reference(Any) Information to support fulfilling of the medication --></supportingInformation>

 <authoredOn value="[dateTime]"/><!-- 0..1 When request was initially authored -->
 <|
   </requester>
 <|
   </performer>
 <</performerType>

 <requester><!-- 0..1 Reference(Device|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) Who/What requested the Request --></requester>

 <isRecordOfRequest value="[boolean]"/><!-- 0..1 Whether this is record of a Medication Request or the actual request itself -->
 <performerType><!-- 0..1 CodeableConcept Desired kind of performer of the medication administration --></performerType>
 <performer><!-- 0..* Reference(CareTeam|DeviceDefinition|Group|HealthcareService|
   Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) Intended performer of administration --></performer>

 <device><!-- 0..* CodeableReference(DeviceDefinition) Intended type of device for the administration --></device>

 <recorder><!-- 0..1 Reference(Practitioner|PractitionerRole) Person who entered the request --></recorder>
 <</reasonCode>
 <</reasonReference>
 <
 <
 <|
   </basedOn>
 <</groupIdentifier>
 <</courseOfTherapyType>
 <</insurance>

 <reason><!-- 0..* CodeableReference(AllergyIntolerance|Condition|
   DiagnosticReport|Observation|Procedure) Reason or indication for ordering or not ordering the medication --></reason>

 <courseOfTherapyType><!-- 0..1 CodeableConcept Overall pattern of medication administration --></courseOfTherapyType>
 <insurance><!-- 0..* Reference(ClaimResponse|Coverage) Associated insurance coverage --></insurance>

 <note><!-- 0..* Annotation Information about the prescription --></note>
 <</dosageInstruction>

 <effectiveTiming[x]><!-- 0..1 Duration|Range|Period Period over which the medication is to be taken, can be specified as a duration or a range --></effectiveTiming[x]>
 <dosageInstruction><!-- 0..1 DosageDetails Specific instructions for how the medication should be taken --></dosageInstruction>

 <dispenseRequest>  <!-- 0..1 Medication supply authorization -->
  <initialFill>  <!-- 0..1 First fill details -->
   <quantity><!-- 0..1 Quantity(SimpleQuantity) First fill quantity --></quantity>
   <duration><!-- 0..1 Duration First fill duration --></duration>
  </initialFill>
  <dispenseInterval><!-- 0..1 Duration Minimum period of time between dispenses --></dispenseInterval>
  <validityPeriod><!-- 0..1 Period Time period supply is authorized for --></validityPeriod>
  <numberOfRepeatsAllowed value="[unsignedInt]"/><!-- 0..1 Number of refills authorized -->
  <quantity><!-- 0..1 Quantity(SimpleQuantity) Amount of medication to supply per dispense --></quantity>
  <expectedSupplyDuration><!-- 0..1 Duration Number of days supply per dispense --></expectedSupplyDuration>
  <</performer>

  <dispenser><!-- 0..1 Reference(Organization) Intended performer of dispense --></dispenser>
  <dispenserInstruction><!-- 0..* CodeableConcept Additional information for the dispenser --></dispenserInstruction>
  <doseAdministrationAid><!-- 0..1 CodeableConcept Type of adherence packaging to use for the dispense --></doseAdministrationAid>
  <destination><!-- 0..1 Reference(Location) Where the medication is expected to be delivered --></destination>

 </dispenseRequest>
 <substitution>  <!-- 0..1 Any restrictions on medication substitution -->
  <</allowed[x]>
  <</reason>

  <allowed[x]><!-- 1..1 boolean|CodeableConcept Whether substitution is allowed or not icon --></allowed[x]>
  <reason><!-- 0..1 CodeableConcept Why should (not) substitution be made icon --></reason>

 </substitution>
 <</priorPrescription>
 <</detectedIssue>

 <eventHistory><!-- 0..* Reference(Provenance) A list of events of interest in the lifecycle --></eventHistory>
</MedicationRequest>

JSON Template 

{doco
  "resourceType" : "MedicationRequest",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External ids for this request
  "

  "basedOn" : [{ Reference(CarePlan|MedicationRequest|RequestOrchestration|
   ServiceRequest) }], // A plan or request that is fulfilled in whole or in part by this medication request

  "priorPrescription" : { Reference(MedicationRequest) }, // Reference to an order/prescription that is being replaced by this MedicationRequest
  "groupIdentifier" : { Identifier }, // Composite request this is part of
  "status" : "<code>", // R!  active | on-hold | ended | stopped | completed | cancelled | entered-in-error | draft | unknown

  "statusReason" : { CodeableConcept }, // Reason for current status
  "
  "

  "statusChanged" : "<dateTime>", // When the status was changed
  "intent" : "<code>", // R!  proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option (immutable)
  "category" : [{ CodeableConcept }], // Grouping or category of medication request

  "priority" : "<code>", // routine | urgent | asap | stat
  "
  
  ">,
  "|
    },
  
  " },
  " },
  "

  "doNotPerform" : <boolean>, // If true, indicates the provider is ordering a patient should not take the specified medication
  "medication" : { CodeableReference(Medication) }, // R!  Medication to be taken
  "subject" : { Reference(Group|Patient) }, // R!  Individual or group for whom the medication has been requested
  "informationSource" : [{ Reference(Group|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) }], // The person or organization who provided the information about this request, if the source is someone other than the requestor
  "encounter" : { Reference(Encounter) }, // Encounter created as part of encounter/admission/stay
  "

  "supportingInformation" : [{ Reference(Any) }], // Information to support fulfilling of the medication

  "authoredOn" : "<dateTime>", // When request was initially authored
  "|
   
  "|
   
  "

  "requester" : { Reference(Device|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) }, // Who/What requested the Request

  "isRecordOfRequest" : <boolean>, // Whether this is record of a Medication Request or the actual request itself
  "performerType" : { CodeableConcept }, // Desired kind of performer of the medication administration
  "performer" : [{ Reference(CareTeam|DeviceDefinition|Group|HealthcareService|
   Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) }], // Intended performer of administration

  "device" : [{ CodeableReference(DeviceDefinition) }], // Intended type of device for the administration

  "recorder" : { Reference(Practitioner|PractitionerRole) }, // Person who entered the request
  "
  "
  "
  "
  "|
   
  "
  "
  "

  "reason" : [{ CodeableReference(AllergyIntolerance|Condition|
   DiagnosticReport|Observation|Procedure) }], // Reason or indication for ordering or not ordering the medication

  "courseOfTherapyType" : { CodeableConcept }, // Overall pattern of medication administration
  "insurance" : [{ Reference(ClaimResponse|Coverage) }], // Associated insurance coverage

  "note" : [{ Annotation }], // Information about the prescription
  "

  // effectiveTiming[x]: 
     Period over which the medication is to be taken, can be specified as a duration or a range. One of these 3:
  "effectiveTimingDuration" : { Duration },
  "effectiveTimingRange" : { Range },
  "effectiveTimingPeriod" : { Period },
  "dosageInstruction" : { DosageDetails }, // Specific instructions for how the medication should be taken

  "dispenseRequest" : { // Medication supply authorization
    "initialFill" : { // First fill details
      "quantity" : { Quantity(SimpleQuantity) }, // First fill quantity
      "duration" : { Duration } // First fill duration
    },
    "dispenseInterval" : { Duration }, // Minimum period of time between dispenses
    "validityPeriod" : { Period }, // Time period supply is authorized for
    "numberOfRepeatsAllowed" : "<unsignedInt>", // Number of refills authorized
    "quantity" : { Quantity(SimpleQuantity) }, // Amount of medication to supply per dispense
    "expectedSupplyDuration" : { Duration }, // Number of days supply per dispense
    "

    "dispenser" : { Reference(Organization) }, // Intended performer of dispense
    "dispenserInstruction" : [{ CodeableConcept }], // Additional information for the dispenser
    "doseAdministrationAid" : { CodeableConcept }, // Type of adherence packaging to use for the dispense
    "destination" : { Reference(Location) } // Where the medication is expected to be delivered

  },
  "substitution" : { // Any restrictions on medication substitution
    // allowed[x]: Whether substitution is allowed or not. One of these 2:
    "allowedBoolean" : <boolean>,
    "allowedCodeableConcept" : { CodeableConcept },
    "

    "reason" : { CodeableConcept } // Why should (not) substitution be made icon

  },
  "
  "

  "eventHistory" : [{ Reference(Provenance) }] // A list of events of interest in the lifecycle
}

Turtle Template 

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:MedicationRequest;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from 
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    ];
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  ];
  fhir:
    # . One of these 2
      fhir: ]
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  ];
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  # from Resource: fhir:id, fhir:meta, fhir:implicitRules, and fhir:language
  # from DomainResource: fhir:text, fhir:contained, fhir:extension, and fhir:modifierExtension
  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* External ids for this request
  fhir:basedOn  ( [ Reference(CarePlan|MedicationRequest|RequestOrchestration|ServiceRequest) ] ... ) ; # 0..* A plan or request that is fulfilled in whole or in part by this medication request
  fhir:priorPrescription [ Reference(MedicationRequest) ] ; # 0..1 Reference to an order/prescription that is being replaced by this MedicationRequest
  fhir:groupIdentifier [ Identifier ] ; # 0..1 Composite request this is part of
  fhir:status [ code ] ; # 1..1 active | on-hold | ended | stopped | completed | cancelled | entered-in-error | draft | unknown
  fhir:statusReason [ CodeableConcept ] ; # 0..1 Reason for current status
  fhir:statusChanged [ dateTime ] ; # 0..1 When the status was changed
  fhir:intent [ code ] ; # 1..1 proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option (immutable)
  fhir:category  ( [ CodeableConcept ] ... ) ; # 0..* Grouping or category of medication request
  fhir:priority [ code ] ; # 0..1 routine | urgent | asap | stat
  fhir:doNotPerform [ boolean ] ; # 0..1 If true, indicates the provider is ordering a patient should not take the specified medication
  fhir:medication [ CodeableReference(Medication) ] ; # 1..1 Medication to be taken
  fhir:subject [ Reference(Group|Patient) ] ; # 1..1 Individual or group for whom the medication has been requested
  fhir:informationSource  ( [ Reference(Group|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ... ) ; # 0..* The person or organization who provided the information about this request, if the source is someone other than the requestor
  fhir:encounter [ Reference(Encounter) ] ; # 0..1 Encounter created as part of encounter/admission/stay
  fhir:supportingInformation  ( [ Reference(Any) ] ... ) ; # 0..* Information to support fulfilling of the medication
  fhir:authoredOn [ dateTime ] ; # 0..1 When request was initially authored
  fhir:requester [ Reference(Device|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ; # 0..1 Who/What requested the Request
  fhir:isRecordOfRequest [ boolean ] ; # 0..1 Whether this is record of a Medication Request or the actual request itself
  fhir:performerType [ CodeableConcept ] ; # 0..1 Desired kind of performer of the medication administration
  fhir:performer  ( [ Reference(CareTeam|DeviceDefinition|Group|HealthcareService|Organization|Patient|
  Practitioner|PractitionerRole|RelatedPerson) ] ... ) ; # 0..* Intended performer of administration

  fhir:device  ( [ CodeableReference(DeviceDefinition) ] ... ) ; # 0..* Intended type of device for the administration
  fhir:recorder [ Reference(Practitioner|PractitionerRole) ] ; # 0..1 Person who entered the request
  fhir:reason  ( [ CodeableReference(AllergyIntolerance|Condition|DiagnosticReport|Observation|Procedure) ] ... ) ; # 0..* Reason or indication for ordering or not ordering the medication
  fhir:courseOfTherapyType [ CodeableConcept ] ; # 0..1 Overall pattern of medication administration
  fhir:insurance  ( [ Reference(ClaimResponse|Coverage) ] ... ) ; # 0..* Associated insurance coverage
  fhir:note  ( [ Annotation ] ... ) ; # 0..* Information about the prescription
  # effectiveTiming[x] : 0..1 Period over which the medication is to be taken, can be specified as a duration or a range. One of these 3
    fhir:effectiveTiming [  a fhir:Duration ; Duration ]
    fhir:effectiveTiming [  a fhir:Range ; Range ]
    fhir:effectiveTiming [  a fhir:Period ; Period ]
  fhir:dosageInstruction [ DosageDetails ] ; # 0..1 Specific instructions for how the medication should be taken
  fhir:dispenseRequest [ # 0..1 Medication supply authorization
    fhir:initialFill [ # 0..1 First fill details
      fhir:quantity [ Quantity(SimpleQuantity) ] ; # 0..1 First fill quantity
      fhir:duration [ Duration ] ; # 0..1 First fill duration
    ] ;
    fhir:dispenseInterval [ Duration ] ; # 0..1 Minimum period of time between dispenses
    fhir:validityPeriod [ Period ] ; # 0..1 Time period supply is authorized for
    fhir:numberOfRepeatsAllowed [ unsignedInt ] ; # 0..1 Number of refills authorized
    fhir:quantity [ Quantity(SimpleQuantity) ] ; # 0..1 Amount of medication to supply per dispense
    fhir:expectedSupplyDuration [ Duration ] ; # 0..1 Number of days supply per dispense
    fhir:dispenser [ Reference(Organization) ] ; # 0..1 Intended performer of dispense
    fhir:dispenserInstruction  ( [ CodeableConcept ] ... ) ; # 0..* Additional information for the dispenser
    fhir:doseAdministrationAid [ CodeableConcept ] ; # 0..1 Type of adherence packaging to use for the dispense
    fhir:destination [ Reference(Location) ] ; # 0..1 Where the medication is expected to be delivered
  ] ;
  fhir:substitution [ # 0..1 Any restrictions on medication substitution
    # allowed[x] : 1..1 Whether substitution is allowed or not. One of these 2
      fhir:allowed [  a fhir:Boolean ; boolean ]
      fhir:allowed [  a fhir:CodeableConcept ; CodeableConcept ]
    fhir:reason [ CodeableConcept ] ; # 0..1 Why should (not) substitution be made
  ] ;
  fhir:eventHistory  ( [ Reference(Provenance) ] ... ) ; # 0..* A list of events of interest in the lifecycle

]

Changes since Release 3 from R5 to R6

MedicationRequest
MedicationRequest.basedOn
  • Type Reference: Added Target Type RequestOrchestration
  • Type Reference: Removed Target Type ImmunizationRecommendation
MedicationRequest.status
  • Min Cardinality changed from 0 to 1 Remove codes stopped , completed , cancelled
MedicationRequest.intent
  • Change value set Remove codes original-order , reflex-order , filler-order , instance-order
MedicationRequest.informationSource
  • Type Reference: Added Target Type Group
MedicationRequest.isRecordOfRequest
  • Renamed from http://hl7.org/fhir/ValueSet/medication-request-status reported to http://hl7.org/fhir/ValueSet/medicationrequest-status|4.0.1 isRecordOfRequest
MedicationRequest.statusReason MedicationRequest.performer
  • Type Reference: Added Element Target Type Group
MedicationRequest.intent MedicationRequest.effectiveTiming[x]
  • Change value set Renamed from http://hl7.org/fhir/ValueSet/medication-request-intent effectiveDosePeriod to http://hl7.org/fhir/ValueSet/medicationrequest-intent|4.0.1 effectiveTiming[x]
  • Add Types Duration, Range
MedicationRequest.category MedicationRequest.dosageInstruction
  • Max Cardinality changed from * to 1
  • Type changed from Dosage to * DosageDetails
MedicationRequest.priority MedicationRequest.dispenseRequest.dispenserInstruction
  • Change value set Type changed from http://hl7.org/fhir/ValueSet/medication-request-priority Annotation to http://hl7.org/fhir/ValueSet/request-priority|4.0.1 CodeableConcept
MedicationRequest.doNotPerform MedicationRequest.dispenseRequest.destination
  • Added Element
MedicationRequest.reported[x] MedicationRequest.renderedDosageInstruction
  • Added Element Deleted

Changes from R4 and R4B to R6

MedicationRequest.encounter MedicationRequest
MedicationRequest.basedOn
  • Type Reference: Added Element Target Type RequestOrchestration
  • Type Reference: Removed Target Type ImmunizationRecommendation
MedicationRequest.requester MedicationRequest.status
  • Type changed from BackboneElement to Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device) Remove codes cancelled , completed , stopped
  • Add code ended
MedicationRequest.performer MedicationRequest.statusChanged
  • Added Element
MedicationRequest.performerType MedicationRequest.intent
  • Added Element Remove codes original-order , reflex-order , filler-order , instance-order
MedicationRequest.recorder MedicationRequest.medication
  • Renamed from medication[x] to medication
  • Add Type Reference: Added Target Type PractitionerRole CodeableReference
  • Remove Types CodeableConcept, Reference(Medication)
MedicationRequest.instantiatesCanonical MedicationRequest.informationSource
  • Added Element
MedicationRequest.instantiatesUri MedicationRequest.isRecordOfRequest
  • Added Element Renamed from reported[x] to isRecordOfRequest
  • Remove Type Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | Organization)
MedicationRequest.basedOn MedicationRequest.performerType
  • Add Binding `http://hl7.org/fhir/ValueSet/medication-intended-performer-role` (extensible)
MedicationRequest.performer
  • Max Cardinality changed from 1 to *
  • Type Reference: Added Target Types ServiceRequest, ImmunizationRecommendation DeviceDefinition, HealthcareService, Group
  • Type Reference: Removed Target Types ProcedureRequest, ReferralRequest Type Device
MedicationRequest.courseOfTherapyType MedicationRequest.device
  • Added Element
MedicationRequest.insurance MedicationRequest.reason
  • Added Element
  • Merged both reasonCode and reasonReference into reason
MedicationRequest.courseOfTherapyType
  • Add Binding `http://hl7.org/fhir/ValueSet/medicationrequest-course-of-therapy` (extensible)
MedicationRequest.dispenseRequest.initialFill MedicationRequest.effectiveTiming[x]
  • Added Element
MedicationRequest.dispenseRequest.initialFill.quantity MedicationRequest.dosageInstruction
  • Added Element Max Cardinality changed from * to 1
  • Type changed from Dosage to DosageDetails
MedicationRequest.dispenseRequest.dispenser
  • Renamed from performer to dispenser
MedicationRequest.dispenseRequest.initialFill.duration MedicationRequest.dispenseRequest.dispenserInstruction
  • Added Element
MedicationRequest.dispenseRequest.dispenseInterval MedicationRequest.dispenseRequest.doseAdministrationAid
  • Added Element
MedicationRequest.dispenseRequest.numberOfRepeatsAllowed MedicationRequest.dispenseRequest.destination
  • Type changed from positiveInt to unsignedInt Added Element
MedicationRequest.substitution.allowed[x] MedicationRequest.reasonCode
  • Renamed from allowed to allowed[x] Add Type CodeableConcept No longer marked as Modifier Deleted (-> reason.concept)
MedicationRequest.definition MedicationRequest.reasonReference
  • deleted Deleted (-> reason.reference)
MedicationRequest.context MedicationRequest.instantiatesCanonical
  • deleted Deleted
MedicationRequest.requester.agent MedicationRequest.instantiatesUri
  • deleted Deleted
MedicationRequest.requester.onBehalfOf MedicationRequest.detectedIssue
  • deleted Deleted

See the Full Difference for further information

This analysis is available for R4 as XML or JSON . See R3 <--> R4 Conversion Maps (status = 36 tests that all execute ok. 8 fail round-trip testing and 36 r3 resources are invalid (0 errors). ) for R4B as XML or JSON .

 

See the Profiles & Extensions and the alternate Additional definitions: Master Definition XML + JSON , XML Schema / Schematron + JSON Schema , ShEx (for Turtle ) + see the extensions , the spreadsheet version & the dependency analysis

11.1.3.1 14.1.4.1 Terminology Bindings

MedicationRequest.substitution.allowed[x]
Path Definition ValueSet Type Reference Documentation
MedicationRequest.status A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription. MedicationrequestStatus (a valid code from MedicationRequest Status Codes ) Required medicationrequest

MedicationRequest Status Codes

MedicationRequest.statusReason Identifies the reasons for a given status. MedicationRequestStatusReasonCodes Example medicationRequest

MedicationRequest Status Reason Codes

MedicationRequest.intent The kind of medication order. MedicationRequestIntent (a valid code from MedicationRequest Intent Codes ) Required medicationRequest

MedicationRequest Intent Codes

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. MedicationRequestCategoryCodes Example medicationRequest

MedicationRequest Category Codes

MedicationRequest.priority RequestPriority Required

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

MedicationRequest.medication[x] MedicationRequest.medication A coded concept identifying substance or product that can be ordered. SNOMEDCTMedicationCodes Example SNOMEDCTMedicationCodes

This value set includes all drug or medicament substance codes and all pharmaceutical/biologic products from SNOMED CT - provided as an exemplar value set.

MedicationRequest.performerType Identifies the type of individual that is desired to administer the medication. MedicationIntendedPerformerRole Example Extensible ProcedurePerformerRoleCodes

Medication Intended Performer Role

MedicationRequest.reasonCode MedicationRequest.reason A coded concept indicating why the medication was ordered. ConditionProblemDiagnosisCodes Example Condition/Problem/DiagnosisCodes

Example value set for Condition/Problem/Diagnosis codes.

MedicationRequest.courseOfTherapyType Identifies the overall pattern of medication administratio. MedicationRequestCourseOfTherapyCodes Example Extensible medicationRequest

MedicationRequest Course of Therapy Codes

MedicationRequest.dispenseRequest.dispenserInstruction Medicationrequestdispenser-instructions (a valid code from MedicationRequest dispenser instructions ) Example Identifies the type of substitution allowed.

MedicationRequest Dispenser Insruction Codes

MedicationRequest.dispenseRequest.doseAdministrationAid MedicationDoseAids (a valid code from Medication dose aid ) Example

Medication Dose Aids

MedicationRequest.substitution.allowed[x] v3.ActSubstanceAdminSubstitutionCode ActSubstanceAdminSubstitutionCode icon Preferred

No description

MedicationRequest.substitution.reason A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed. SubstanceAdminSubstitutionReason icon Example v3.SubstanceAdminSubstitutionReason

No description

11.1.3.2 14.1.4.2 Dosage Instructions

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.

14.1.4.2.1 Grouping Medication Requests

In general, each prescribed drug will be a separate Medication Request.

When drug orders are grouped together at the time of order entry, but each of the drugs can be manipulated independently e.g. changing the status of one order to "completed" or "cancelled", changing another order status to "on-hold", the method to "group" all of the medication requests together is to use MedicationRequest.groupIdentifier element. All of the orders grouped together in this manner will have the same groupIdentifier, and separately, each order in the group may have a unique identifier.

There are cases that require grouping of Medication orders together when it is necessary to specify optionality e.g. order two drugs at one time, but stating either of these drugs may be used to treat the patient. The use of a RequestOrchestration should be used as a parent for the Medication orders that require this type of grouping. An example when it may be necessary to group medication orders together is when you specify:

  • timing relationships e.g. order drug "xyz" with dose 123, then taper the same drug to a different dose after some interval of time precedence. For example:
    • give drug "abc" followed by drug "def"
    • give drug 30 minutes before some procedure was performed.
  • more generically this supports - hierarchical groups of actions, where each specific action references the action to be performed (in terms of a Request resource), and each group describes additional behavior, relationships, and applicable conditions between the actions in the overall group.

Note that one should NOT use the List or Composition resource to accomplish the above requirements. You may use List or Composition for other business requirements, but not to address the specific requirements of grouping medication orders.

11.1.4 14.1.5 Search Parameters

Search parameters for this resource. See also the full list of search parameters for this resource , and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name Type Description Expression In Common
authoredon date Return prescriptions written on this date MedicationRequest.authoredOn
category token Returns prescriptions with different categories MedicationRequest.category
code token Return prescriptions of this medication code (MedicationRequest.medication as CodeableConcept) MedicationRequest.medication.concept 13 19 Resources
date encounter date reference Returns medication request to be administered on a specific date Return prescriptions with this encounter identifier MedicationRequest.dosageInstruction.timing.event MedicationRequest.encounter
( Encounter ) 		3 2 Resources
group-identifier encounter reference token Return prescriptions with Composite request this encounter identifier is part of MedicationRequest.encounter ( Encounter ) MedicationRequest.groupIdentifier
group-or-identifier 1 Resources token Group ID or other identifier MedicationRequest.groupIdentifier | MedicationRequest.identifier
identifier token Return prescriptions with this external identifier MedicationRequest.identifier 30 58 Resources
intended-dispenser reference Returns prescriptions intended to be dispensed by this Organization MedicationRequest.dispenseRequest.performer MedicationRequest.dispenseRequest.dispenser
( Organization )
intended-performer reference Returns the intended performer of the administration of the medication request MedicationRequest.performer
( Practitioner , Group , Organization , CareTeam , Device DeviceDefinition , Patient , HealthcareService , PractitionerRole , RelatedPerson )
intended-performertype token Returns requests for a specific type of performer MedicationRequest.performerType
intent token Returns prescriptions with different intents MedicationRequest.intent
medication reference Return prescriptions for this medication reference (MedicationRequest.medication as Reference) ( Medication ) MedicationRequest.medication.reference 3 4 Resources
patient reference Returns prescriptions for a specific patient MedicationRequest.subject.where(resolve() is Patient)
( Patient ) 		33 60 Resources
priority token Returns prescriptions with different priorities MedicationRequest.priority
requester reference Returns prescriptions prescribed by this prescriber MedicationRequest.requester
( Practitioner , Organization , Device , Patient , PractitionerRole , RelatedPerson )
status token Status of the prescription MedicationRequest.status 3 4 Resources
subject reference The identity of a patient to list orders for MedicationRequest.subject
( Group , Patient )