Release 4 5

This page is part of the FHIR Specification (v4.0.1: R4 (v5.0.0: R5 - Mixed Normative and STU ) ). This is the current published version 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 . Page versions: R5 R4B R4 R3 R2

11.5 Resource Medication - Content

Pharmacy icon Work Group Maturity Level : 3 4   Trial Use Security Category : Business Compartments : Not linked to any No defined compartments

This resource is primarily used for the identification and definition of a medication medication, including ingredients, for the purposes of prescribing, dispensing, and administering a medication as well as for making statements about medication use.

11.5.1 Scope and Usage

Representing medications in the majority of most healthcare settings is a matter of identifying an item from a list and then conveying a reference for the item selected either into a patient-related resource or to other applications. Additional information about the medication is frequently provided for human verification, verification (e.g., the product name), but a full representation of the details of composition and efficacy of the medicine is conveyed by referring to drug dictionaries by means of the codes they define. There are some occasions where it is necessary to identify slightly more detail, such as when dispensing a package containing a particular medication requires identification both of the medicine and the package at once. There are also some occasions (e.g. custom formulations) where the composition of a medicine must be represented. In these cases, the ingredients of the medicine have to must be specified together with the amount contained, though the Medication resource does not provide full details.

The Medication resource allows for medications to be characterized by the form of the drug and the ingredient (or ingredients), as well as and how it is packaged. The medication will include the ingredient(s) ingredient(s), and their strength(s) and the package can include the amount (for example, number of tablets, volume, etc.) that is contained in a particular container (for example, 100 capsules of Amoxicillin 500mg per bottle).

The Medication resource can be used to describe a compounded (aka extemporaneous or magistral) product that is manufactured by the pharmacy at the time of dispensing. In this case there will be multiple ingredients which are typically base chemicals (for example, hydrocortisone powder) and there may be other ingredients that are manufactured products (for example, Glaxal Base).

When a medication includes a package, further details about the composition can be provided. A package has a container (vacuum packed box, jar, etc.) and a list of the products or other packages that are in the package.

This resource is referenced by

11.5.2 References to this Resource

11.5.2 11.5.3 Resource Content

Structure

Active ingredient indicator
Name Flags Card. Type Description & Constraints doco
. . Medication TU DomainResource Definition of a Medication

Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier Σ 0..* Identifier Business identifier for this medication

. . . code Σ 0..1 CodeableConcept Codes that identify this medication
Binding: SNOMED CT Medication Codes ( Example )
. . . status ?! Σ 0..1 code active | inactive | entered-in-error
Binding: Medication status codes Status Codes ( Required )
. . . form doseForm 0..1 CodeableConcept powder | tablets | capsule +
Binding: SNOMED CT Form Codes ( Example )
. . . amount totalVolume Σ 0..1 Ratio Quantity Amount When the specified product code does not infer a package size, this is the specific amount of drug in package the product
. . . ingredient 0..* BackboneElement Active or inactive ingredient

. . . item[x] . item 1..1 CodeableReference ( Substance | Medication ) The actual ingredient (substance or content medication) that the ingredient.strength relates to
Binding: SNOMED CT Medication Codes ( Example )
. . . itemCodeableConcept . isActive 0..1 CodeableConcept boolean Active ingredient indicator
. . . . strength[x] itemReference 0..1 Reference Quantity of ingredient present
Binding: Medication Ingredient Strength Codes ( Substance | Medication Preferred )
. . . isActive . . strengthRatio 0..1 boolean Ratio
. . . strength . . strengthCodeableConcept 0..1 CodeableConcept Ratio
. . . . . strengthQuantity Quantity of ingredient present
. . . batch 0..1 BackboneElement Details about packaged medications
. . . . lotNumber 0..1 string Identifier assigned to batch
. . . . expirationDate 0..1 dateTime When batch will expire
. . . definition 0..1 Reference ( MedicationKnowledge ) Knowledge about this medication

doco Documentation for this format icon

See the Extensions for this resource

UML Diagram ( Legend )

Medication ( DomainResource ) Business identifier for this medication identifier : Identifier [0..*] A code (or set of codes) that specify this medication, or a textual description if no code is available. Usage note: This could be a standard medication code such as a code from RxNorm, SNOMED CT, IDMP etc. It could also be a national or local formulary code, optionally with translations to other code systems code : CodeableConcept [0..1] « A coded concept that defines the type of a medication. null (Strength=Example) SNOMEDCTMedicationCodes ?? » A code to indicate if the medication is in active use (this element modifies the meaning of other elements) status : code [0..1] « A coded concept defining if the medication is in active use. null (Strength=Required) Medication Status MedicationStatusCodes ! » Describes the details of the manufacturer of The company or other legal entity that has authorization, from the medication product. This is not intended appropriate drug regulatory authority, to represent market a medicine in one or more jurisdictions. Typically abbreviated MAH.Note: The MAH may manufacture the distributor product and may also contract the manufacturing of a medication the product to one or more companies (organizations) manufacturer marketingAuthorizationHolder : Reference [0..1] « Organization » Describes the form of the item. Powder; tablets; capsule form doseForm : CodeableConcept [0..1] « A coded concept defining the form of a medication. null (Strength=Example) SNOMEDCTFormCodes ?? » Specific When the specified product code does not infer a package size, this is the specific amount of the drug in the packaged product. For example, when specifying a product that has the same strength (For example, Insulin glargine 100 unit per mL solution for injection), this attribute provides additional clarification of the package amount (For example, 3 mL, 10mL, etc.) amount totalVolume : Ratio Quantity [0..1] A reference to a knowledge resource that provides more information about this medication definition : Reference [0..1] « MedicationKnowledge » Ingredient The actual ingredient - either (substance or medication) that the ingredient.strength relates to. This is represented as a substance (simple ingredient) concept from a code system or described in another medication of a medication resource (Substance or Medication) item[x] item : Type CodeableReference [1..1] « CodeableConcept Substance | Reference Medication ( Substance ; null (Strength=Example) | Medication SNOMEDCTMedicationCodes ) ?? » Indication of whether this ingredient affects the therapeutic action of the drug isActive : boolean [0..1] Specifies how many (or how much) of the items there are in this Medication. For example, 250 mg per tablet. This is expressed as a ratio where the numerator is 250mg and the denominator is 1 tablet but can also be expressed a quantity when the denominator is assumed to be 1 tablet strength strength[x] : Ratio DataType [0..1] « Ratio | CodeableConcept | Quantity ; null (Strength=Preferred) MedicationIngredientStrengthC... ? » Batch The assigned lot number of a batch of the specified product lotNumber : string [0..1] When this specific batch of product will expire expirationDate : dateTime [0..1] Identifies a particular constituent of interest in the product ingredient [0..*] Information that only applies to packages (not products) batch [0..1]

XML Template 

<

<Medication xmlns="http://hl7.org/fhir"> doco

 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business identifier for this medication --></identifier>
 <code><!-- 0..1 CodeableConcept Codes that identify this medication --></code>
 <status value="[code]"/><!-- 0..1 active | inactive | entered-in-error -->
 <</manufacturer>
 <</form>
 <</amount>

 <marketingAuthorizationHolder><!-- 0..1 Reference(Organization) Organization that has authorization to market medication --></marketingAuthorizationHolder>
 <doseForm><!-- 0..1 CodeableConcept powder | tablets | capsule + --></doseForm>
 <totalVolume><!-- 0..1 Quantity When the specified product code does not infer a package size, this is the specific amount of drug in the product --></totalVolume>

 <ingredient>  <!-- 0..* Active or inactive ingredient -->
  <</item[x]>

  <item><!-- 1..1 CodeableReference(Medication|Substance) The ingredient (substance or medication) that the ingredient.strength relates to --></item>

  <isActive value="[boolean]"/><!-- 0..1 Active ingredient indicator -->
  <</strength>

  <strength[x]><!-- 0..1 Ratio|CodeableConcept|Quantity Quantity of ingredient present --></strength[x]>

 </ingredient>
 <batch>  <!-- 0..1 Details about packaged medications -->
  <lotNumber value="[string]"/><!-- 0..1 Identifier assigned to batch -->
  <expirationDate value="[dateTime]"/><!-- 0..1 When batch will expire -->
 </batch>
 <definition><!-- 0..1 Reference(MedicationKnowledge) Knowledge about this medication --></definition>

</Medication>

Turtle Template 

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


[ a fhir:;

[ a fhir:Medication;

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

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
    # . One of these 2
      fhir: ]
      fhir:) ]
    fhir:
    fhir:
  ], ...;
  fhir:
    fhir:
    fhir:
  ];

  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* Business identifier for this medication
  fhir:code [ CodeableConcept ] ; # 0..1 Codes that identify this medication
  fhir:status [ code ] ; # 0..1 active | inactive | entered-in-error
  fhir:marketingAuthorizationHolder [ Reference(Organization) ] ; # 0..1 Organization that has authorization to market medication
  fhir:doseForm [ CodeableConcept ] ; # 0..1 powder | tablets | capsule +
  fhir:totalVolume [ Quantity ] ; # 0..1 When the specified product code does not infer a package size, this is the specific amount of drug in the product
  fhir:ingredient ( [ # 0..* Active or inactive ingredient
    fhir:item [ CodeableReference(Medication|Substance) ] ; # 1..1 The ingredient (substance or medication) that the ingredient.strength relates to
    fhir:isActive [ boolean ] ; # 0..1 Active ingredient indicator
    # strength[x] : 0..1 Quantity of ingredient present. One of these 3
      fhir:strength [  a fhir:Ratio ; Ratio ]
      fhir:strength [  a fhir:CodeableConcept ; CodeableConcept ]
      fhir:strength [  a fhir:Quantity ; Quantity ]
  ] ... ) ;
  fhir:batch [ # 0..1 Details about packaged medications
    fhir:lotNumber [ string ] ; # 0..1 Identifier assigned to batch
    fhir:expirationDate [ dateTime ] ; # 0..1 When batch will expire
  ] ;
  fhir:definition [ Reference(MedicationKnowledge) ] ; # 0..1 Knowledge about this medication

]

Changes since R3 from both R4 and R4B

Medication.status Change value set from http://hl7.org/fhir/ValueSet/medication-status to http://hl7.org/fhir/ValueSet/medication-status|4.0.1 Now marked as Modifier
Medication
Medication.identifier Medication.marketingAuthorizationHolder
  • Added Element
Medication.amount Medication.doseForm
  • Added Element
Medication.ingredient.strength Medication.totalVolume
  • Added Element
Medication.batch Medication.ingredient.item
  • Added Element Renamed from item[x] to item
    • Medication.batch.lotNumber
  • Added Element Add Type CodeableReference
    • Medication.batch.expirationDate
  • Added Element Remove Types CodeableConcept, Reference(Substance | Medication)
Medication.isBrand Medication.ingredient.strength[x]
  • deleted Renamed from strength to strength[x]
  • Add Types CodeableConcept, Quantity
Medication.isOverTheCounter Medication.definition
  • deleted Added Element
Medication.ingredient.amount Medication.manufacturer
  • deleted Deleted
Medication.package Medication.form
  • deleted Deleted
Medication.image Medication.amount
  • deleted Deleted

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON .

See R3 <--> R4 <--> R5 Conversion Maps (status = 23 tests that all execute ok. 22 fail round-trip testing and 22 r3 resources are invalid (0 errors). ) See Conversions Summary .)

Structure

Active ingredient indicator
Name Flags Card. Type Description & Constraints doco
. . Medication TU DomainResource Definition of a Medication

Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier Σ 0..* Identifier Business identifier for this medication

. . . code Σ 0..1 CodeableConcept Codes that identify this medication
Binding: SNOMED CT Medication Codes ( Example )
. . . status ?! Σ 0..1 code active | inactive | entered-in-error
Binding: Medication status codes Status Codes ( Required )
. . . form doseForm 0..1 CodeableConcept powder | tablets | capsule +
Binding: SNOMED CT Form Codes ( Example )
. . . amount totalVolume Σ 0..1 Ratio Quantity Amount When the specified product code does not infer a package size, this is the specific amount of drug in package the product
. . . ingredient 0..* BackboneElement Active or inactive ingredient

. . . item[x] . item 1..1 CodeableReference ( Substance | Medication ) The actual ingredient (substance or content medication) that the ingredient.strength relates to
Binding: SNOMED CT Medication Codes ( Example )
. . . itemCodeableConcept . isActive 0..1 CodeableConcept boolean Active ingredient indicator
. . . . strength[x] itemReference 0..1 Reference Quantity of ingredient present
Binding: Medication Ingredient Strength Codes ( Substance | Medication Preferred )
. . . isActive . . strengthRatio 0..1 boolean Ratio
. . . strength . . strengthCodeableConcept 0..1 CodeableConcept Ratio
. . . . . strengthQuantity Quantity of ingredient present
. . . batch 0..1 BackboneElement Details about packaged medications
. . . . lotNumber 0..1 string Identifier assigned to batch
. . . . expirationDate 0..1 dateTime When batch will expire
. . . definition 0..1 Reference ( MedicationKnowledge ) Knowledge about this medication

doco Documentation for this format icon

See the Extensions for this resource

UML Diagram ( Legend )

Medication ( DomainResource ) Business identifier for this medication identifier : Identifier [0..*] A code (or set of codes) that specify this medication, or a textual description if no code is available. Usage note: This could be a standard medication code such as a code from RxNorm, SNOMED CT, IDMP etc. It could also be a national or local formulary code, optionally with translations to other code systems code : CodeableConcept [0..1] « A coded concept that defines the type of a medication. null (Strength=Example) SNOMEDCTMedicationCodes ?? » A code to indicate if the medication is in active use (this element modifies the meaning of other elements) status : code [0..1] « A coded concept defining if the medication is in active use. null (Strength=Required) Medication Status MedicationStatusCodes ! » Describes the details of the manufacturer of The company or other legal entity that has authorization, from the medication product. This is not intended appropriate drug regulatory authority, to represent market a medicine in one or more jurisdictions. Typically abbreviated MAH.Note: The MAH may manufacture the distributor product and may also contract the manufacturing of a medication the product to one or more companies (organizations) manufacturer marketingAuthorizationHolder : Reference [0..1] « Organization » Describes the form of the item. Powder; tablets; capsule form doseForm : CodeableConcept [0..1] « A coded concept defining the form of a medication. null (Strength=Example) SNOMEDCTFormCodes ?? » Specific When the specified product code does not infer a package size, this is the specific amount of the drug in the packaged product. For example, when specifying a product that has the same strength (For example, Insulin glargine 100 unit per mL solution for injection), this attribute provides additional clarification of the package amount (For example, 3 mL, 10mL, etc.) amount totalVolume : Ratio Quantity [0..1] A reference to a knowledge resource that provides more information about this medication definition : Reference [0..1] « MedicationKnowledge » Ingredient The actual ingredient - either (substance or medication) that the ingredient.strength relates to. This is represented as a substance (simple ingredient) concept from a code system or described in another medication of a medication resource (Substance or Medication) item[x] item : Type CodeableReference [1..1] « CodeableConcept Substance | Reference Medication ( Substance ; null (Strength=Example) | Medication SNOMEDCTMedicationCodes ) ?? » Indication of whether this ingredient affects the therapeutic action of the drug isActive : boolean [0..1] Specifies how many (or how much) of the items there are in this Medication. For example, 250 mg per tablet. This is expressed as a ratio where the numerator is 250mg and the denominator is 1 tablet but can also be expressed a quantity when the denominator is assumed to be 1 tablet strength strength[x] : Ratio DataType [0..1] « Ratio | CodeableConcept | Quantity ; null (Strength=Preferred) MedicationIngredientStrengthC... ? » Batch The assigned lot number of a batch of the specified product lotNumber : string [0..1] When this specific batch of product will expire expirationDate : dateTime [0..1] Identifies a particular constituent of interest in the product ingredient [0..*] Information that only applies to packages (not products) batch [0..1]

XML Template 

<

<Medication xmlns="http://hl7.org/fhir"> doco

 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business identifier for this medication --></identifier>
 <code><!-- 0..1 CodeableConcept Codes that identify this medication --></code>
 <status value="[code]"/><!-- 0..1 active | inactive | entered-in-error -->
 <</manufacturer>
 <</form>
 <</amount>

 <marketingAuthorizationHolder><!-- 0..1 Reference(Organization) Organization that has authorization to market medication --></marketingAuthorizationHolder>
 <doseForm><!-- 0..1 CodeableConcept powder | tablets | capsule + --></doseForm>
 <totalVolume><!-- 0..1 Quantity When the specified product code does not infer a package size, this is the specific amount of drug in the product --></totalVolume>

 <ingredient>  <!-- 0..* Active or inactive ingredient -->
  <</item[x]>

  <item><!-- 1..1 CodeableReference(Medication|Substance) The ingredient (substance or medication) that the ingredient.strength relates to --></item>

  <isActive value="[boolean]"/><!-- 0..1 Active ingredient indicator -->
  <</strength>

  <strength[x]><!-- 0..1 Ratio|CodeableConcept|Quantity Quantity of ingredient present --></strength[x]>

 </ingredient>
 <batch>  <!-- 0..1 Details about packaged medications -->
  <lotNumber value="[string]"/><!-- 0..1 Identifier assigned to batch -->
  <expirationDate value="[dateTime]"/><!-- 0..1 When batch will expire -->
 </batch>
 <definition><!-- 0..1 Reference(MedicationKnowledge) Knowledge about this medication --></definition>

</Medication>

Turtle Template 

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


[ a fhir:;

[ a fhir:Medication;

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

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
    # . One of these 2
      fhir: ]
      fhir:) ]
    fhir:
    fhir:
  ], ...;
  fhir:
    fhir:
    fhir:
  ];

  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* Business identifier for this medication
  fhir:code [ CodeableConcept ] ; # 0..1 Codes that identify this medication
  fhir:status [ code ] ; # 0..1 active | inactive | entered-in-error
  fhir:marketingAuthorizationHolder [ Reference(Organization) ] ; # 0..1 Organization that has authorization to market medication
  fhir:doseForm [ CodeableConcept ] ; # 0..1 powder | tablets | capsule +
  fhir:totalVolume [ Quantity ] ; # 0..1 When the specified product code does not infer a package size, this is the specific amount of drug in the product
  fhir:ingredient ( [ # 0..* Active or inactive ingredient
    fhir:item [ CodeableReference(Medication|Substance) ] ; # 1..1 The ingredient (substance or medication) that the ingredient.strength relates to
    fhir:isActive [ boolean ] ; # 0..1 Active ingredient indicator
    # strength[x] : 0..1 Quantity of ingredient present. One of these 3
      fhir:strength [  a fhir:Ratio ; Ratio ]
      fhir:strength [  a fhir:CodeableConcept ; CodeableConcept ]
      fhir:strength [  a fhir:Quantity ; Quantity ]
  ] ... ) ;
  fhir:batch [ # 0..1 Details about packaged medications
    fhir:lotNumber [ string ] ; # 0..1 Identifier assigned to batch
    fhir:expirationDate [ dateTime ] ; # 0..1 When batch will expire
  ] ;
  fhir:definition [ Reference(MedicationKnowledge) ] ; # 0..1 Knowledge about this medication

]

Changes since Release 3 from both R4 and R4B

Medication.status Change value set from http://hl7.org/fhir/ValueSet/medication-status to http://hl7.org/fhir/ValueSet/medication-status|4.0.1 Now marked as Modifier
Medication
Medication.identifier Medication.marketingAuthorizationHolder
  • Added Element
Medication.amount Medication.doseForm
  • Added Element
Medication.ingredient.strength Medication.totalVolume
  • Added Element
Medication.batch Medication.ingredient.item
  • Added Element Renamed from item[x] to item
    • Medication.batch.lotNumber
  • Added Element Add Type CodeableReference
    • Medication.batch.expirationDate
  • Added Element Remove Types CodeableConcept, Reference(Substance | Medication)
Medication.isBrand Medication.ingredient.strength[x]
  • deleted Renamed from strength to strength[x]
  • Add Types CodeableConcept, Quantity
Medication.isOverTheCounter Medication.definition
  • deleted Added Element
Medication.ingredient.amount Medication.manufacturer
  • deleted Deleted
Medication.package Medication.form
  • deleted Deleted
Medication.image Medication.amount
  • deleted Deleted

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON .

See R3 <--> R4 <--> R5 Conversion Maps (status = 23 tests that all execute ok. 22 fail round-trip testing and 22 r3 resources are invalid (0 errors). ) See Conversions Summary .)

 

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

11.5.2.1 11.5.3.1 Terminology Bindings

11.5.3 Best practices for using 'Medication'
Path Definition ValueSet Type Reference Documentation
Medication.code A coded concept that defines the type of a medication. 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.

Medication.status A coded concept defining if the medication is in active use. MedicationStatusCodes Required

Medication Status Codes

Medication.form Medication.doseForm A coded concept defining the form of a medication. SNOMEDCTFormCodes Example SNOMEDCTFormCodes

This value set includes all dose form codes from SNOMED CT - provided as an exemplar.

Medication.ingredient.item SNOMEDCTMedicationCodes Example

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

Medication.ingredient.strength[x] MedicationIngredientStrengthCodes Preferred

Medication does not have a status. If Medication was used to support a formulary use case, then an extension can be used to convey formulary statuses, such as active (e.g. the medication can be ordered) or inactive (e.g. the medication can be documented, but not ordered). Pharmacy is evaluating formulary use cases. Feedback is encouraged to the Pharmacy working group. Ingredient Strength Codes

11.5.4 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
code token Returns medications for a specific code Medication.code 13 22 Resources
expiration-date date Returns medications in a batch with this expiration date Medication.batch.expirationDate
form token Returns medications for a specific dose form Medication.form
identifier token Returns medications with this external identifier Medication.identifier 65 Resources
ingredient reference Returns medications for this ingredient reference (Medication.ingredient.item as Reference) ( Medication , Substance ) Medication.ingredient.item.reference
ingredient-code token Returns medications for this ingredient code (Medication.ingredient.item as CodeableConcept) Medication.ingredient.item.concept
lot-number token Returns medications in a batch with this lot number Medication.batch.lotNumber
manufacturer marketingauthorizationholder reference Returns medications made or sold for this manufacturer marketing authorization holder Medication.manufacturer Medication.marketingAuthorizationHolder
( Organization )
serial-number token Returns medications in a batch with this lot number Medication.identifier
status token Returns medications for this status Medication.status