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4.9 Resource MedicationPrescription - Content

An order for both supply of the medication and the instructions for administration of the medicine to a patient.

4.9.1 Scope and Usage

This resource covers all orders for medications for a patient. This includes in-patient 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. Aspirin) and dietary supplements. It may be used to support the order of medication-related devices. It is not intended for use in prescribing particular diets, or for ordering non-medication-related items (eye-glasses, supplies, etc.)

4.9.2 Boundaries and Relationships

The Medication domain includes a number of related resources

MedicationPrescription 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).
MedicationAdministration When a patient actually consumes a medicine, or it is otherwise administered to 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.

4.9.3 Resource Content

MedicationPrescription ( Resource ) External identifier - one that would be used by another non-FHIR system - for example a re-imbursement system might issue its own id for each prescription that is created. This is particularly important where FHIR only provides part of an erntire workflow process where records have to be tracked through an entire system (this element modifies the meaning of other elements) identifier : Identifier 0..* The date (and perhaps time) when the prescription was written dateWritten : dateTime 0..1 A code specifying the state of the order. Generally this will be active or completed state (this element modifies the meaning of other elements) status : code 0..1 << A code specifying the state of the prescribing event. Describes the lifecycle of the prescription. MedicationPrescriptionStatus >> A link to a resource representing the person to whom the medication will be given patient : Resource ( Patient ) 0..1 The healthcare professional responsible for authorizing the prescription prescriber : Resource ( Practitioner ) 0..1 A link to a resource that identifies the particular occurrence of contact between patient and health care provider encounter : Resource ( Encounter ) 0..1 Can be the reason or the indication for writing the prescription reason[x] : CodeableConcept | Resource ( Condition ) 0..1 Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications medication : Resource ( Medication ) 0..1 DosageInstruction Free text dosage instructions for cases where the instructions are too complex to code text : string 0..1 Additional instructions such as "Swallow with plenty of water" which may or may not be coded additionalInstructions : CodeableConcept 0..1 The timing schedule for giving the medication to the patient. The Schedule data type allows many different expressions, for example. "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013" timing[x] : dateTime | Period | Schedule 0..1 If set to true or if specified as a CodeableConcept, indicates that the medication is only taken when needed within the specified schedule rather than at every scheduled dose. If a CodeableConcept is present, it indicates the pre-condition for taking the Medication asNeeded[x] : boolean | CodeableConcept 0..1 A coded specification of the anatomic site where the medication first enters the body site : CodeableConcept 0..1 << A coded concept describing the site location the medicine enters into or onto the body MedicationAdministrationSite >> A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient route : CodeableConcept 0..1 << A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject. RouteOfAdministration >> A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. Examples: Slow Push; Deep IV. Terminologies used often pre-coordinate this term with the route and or form of administration method : CodeableConcept 0..1 << A coded concept describing the technique by which the medicine is administered MedicationAdministrationMethod >> The amount of therapeutic or other substance given at one administration event doseQuantity : Quantity 0..1 Identifies the speed with which the substance is introduced into the subject. Typically the rate for an infusion. 200ml in 2 hours rate : Ratio 0..1 The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. E.g. 1000mg in 24 hours maxDosePerPeriod : Ratio 0..1 Dispense Identifies the medication that is to be dispensed. This may be a more specifically defined than the medicationPrescription.medication . This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications medication : Resource ( Medication ) 0..1 Design Comments: This indicates the validity period of a prescription (stale dating the Prescription) It reflects the prescriber perspective for the validity of the prescription. Dispenses must not be made against the prescription outside of this period. The lower-bound of the Dispensing Window signifies the earliest date that the prescription can be filled for the first time. If an upper-bound is not specified then the Prescription is open-ended or will default to a stale-date based on regulations. Rationale: Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription validityPeriod : Period 0..1 An integer indicating the number of repeats of the Dispense. UsageNotes: For example, the number of times the prescribed quantity is to be supplied including the initial standard fill numberOfRepeatsAllowed : integer 0..1 The amount that is to be dispensed quantity : Quantity 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. In some situations, this attribute may be used instead of quantity to identify the amount supplied by how long it is expected to last, rather than the physical quantity issued, e.g. 90 days supply of medication (based on an ordered dosage) When possible, it is always better to specify quantity, as this tends to be more precise. expectedSupplyDuration will always be an estimate that can be influenced by external factors expectedSupplyDuration : Duration 0..1 Substitution A code signifying whether a different drug should be dispensed from what was prescribed type : CodeableConcept 1..1 << A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription MedicationIntendedSubstitutionType >> 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. MedicationIntendedSubstitutionReason >> Indicates how the medication is to be used by the patient dosageInstruction 0..* Deals with details of the dispense part of the order dispense 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, and in others it does not matter. This block explains the prescriber's intent. If nothing is specified substitution may be done substitution 0..1

This resource is referenced by CarePlan , MedicationAdministration , MedicationDispense and Procedure 

<MedicationPrescription xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: extension, modifierExtension, language, text, and contained -->
 <identifier><!-- 0..* Identifier External identifier --></identifier>
 <dateWritten value="[dateTime]"/><!-- 0..1 When prescription was authorized -->
 <status value="[code]"/><!-- 0..1 active | on hold | completed | entered in error | stopped | superceded -->
 <patient><!-- 0..1 Resource(Patient) Who prescription is for --></patient>
 <prescriber><!-- 0..1 Resource(Practitioner) Who ordered the medication(s) --></prescriber>
 <encounter><!-- 0..1 Resource(Encounter) Created during encounter / admission / stay --></encounter>
 <reason[x]><!-- 0..1 CodeableConcept|Resource(Condition) 
     Reason or indication for writing the prescription --></reason[x]>
 <medication><!-- 0..1 Resource(Medication) Medication to be taken --></medication>
 <dosageInstruction>  <!-- 0..* How medication should be taken -->
  <text value="[string]"/><!-- 0..1 Dosage instructions expressed as text -->
  <additionalInstructions><!-- 0..1 CodeableConcept 
      Supplemental instructions - e.g. "with meals" --></additionalInstructions>
  <timing[x]><!-- 0..1 dateTime|Period|Schedule When medication should be administered --></timing[x]>
  <asNeeded[x]><!-- 0..1 boolean|CodeableConcept Take "as needed" f(or x) --></asNeeded[x]>
  <site><!-- 0..1 CodeableConcept Body site to administer to --></site>
  <route><!-- 0..1 CodeableConcept How drug should enter body --></route>
  <method><!-- 0..1 CodeableConcept Technique for administering medication --></method>
  <doseQuantity><!-- 0..1 Quantity Amount of medication per dose --></doseQuantity>
  <rate><!-- 0..1 Ratio Amount of medication per unit of time --></rate>
  <maxDosePerPeriod><!-- 0..1 Ratio Upper limit on medication per unit of time --></maxDosePerPeriod>
 </dosageInstruction>
 <dispense>  <!-- 0..1 Medication supply authorization -->
  <medication><!-- 0..1 Resource(Medication) Product to be supplied --></medication>
  <validityPeriod><!-- 0..1 Period Time period supply is authorized for --></validityPeriod>
  <numberOfRepeatsAllowed value="[integer]"/><!-- 0..1 # of refills authorized -->
  <quantity><!-- 0..1 Quantity Amount of medication to supply per dispense --></quantity>
  <expectedSupplyDuration><!-- 0..1 Duration Days supply per dispense --></expectedSupplyDuration>
 </dispense>
 <substitution>  <!-- 0..1 Any restrictions on medication substitution? -->
  <type><!-- 1..1 CodeableConcept generic | formulary + --></type>
  <reason><!-- 0..1 CodeableConcept Why should substitution (not) be made --></reason>
 </substitution>
</MedicationPrescription>

Alternate definitions: Schema / Schematron , Resource Profile

4.9.3.1 Terminology Bindings

Path Definition Type Reference
MedicationPrescription.status A code specifying the state of the prescribing event. Describes the lifecycle of the prescription. Fixed http://hl7.org/fhir/medication-prescription-status
MedicationPrescription.dosageInstruction.asNeeded[x] A coded concept identifying the pre-condition that should hold prior to consuming a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up", etc. Unknown No details provided yet
MedicationPrescription.dosageInstruction.site A coded concept describing the site location the medicine enters into or onto the body Example http://hl7.org/fhir/vs/approach-site-codes
MedicationPrescription.dosageInstruction.route A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject. Example http://hl7.org/fhir/vs/route-codes
MedicationPrescription.dosageInstruction.method A coded concept describing the technique by which the medicine is administered Example http://hl7.org/fhir/vs/administration-method-codes
MedicationPrescription.substitution.type A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription Example http://hl7.org/fhir/v3/vs/ActSubstanceAdminSubstitutionCode
MedicationPrescription.substitution.reason A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed. Example http://hl7.org/fhir/v3/vs/SubstanceAdminSubstitutionReason

4.9.4 Search Parameters

Search parameters for this resource. The standard parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name Type Description Paths
_id token The logical resource id associated with the resource (must be supported by all servers)
_language token The language of the resource
datewritten date Return prescriptions written on this date MedicationPrescription.dateWritten
encounter reference Return prescriptions with this encounter identity MedicationPrescription.encounter
( Encounter )
identifier token Return prescriptions with this external identity MedicationPrescription.identifier
medication reference Code for medicine or text in medicine name MedicationPrescription.medication
( Medication )
patient reference The identity of a patient to list dispenses for MedicationPrescription.patient
( Patient )
status token Status of the prescription MedicationPrescription.status
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