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.

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.

This is a business identifier, not a resource identifier.

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

Reference to an order/prescription that is being replaced by this 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.

Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.

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

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Clinical decision support systems should take the status into account when determining which medications to include in their algorithms.

Captures the reason for the current state of the MedicationRequest.

This is generally only used for "exception" statuses such as "suspended" or "cancelled". The reason why the MedicationRequest was created at all is captured in reasonCode, not here.

The date (and perhaps time) when the status was changed.

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

It is expected that the type of requester will be restricted for different stages of a MedicationRequest. For example, Proposals can be created by a patient, relatedPerson, Practitioner or Device. Plans can be created by Practitioners, Patients, RelatedPersons and Devices. Original orders can be created by a Practitioner only.

An instance-order is an instantiation of a request or order and may be used to populate Medication Administration Record.

This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.

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.

The category can be used to include where the medication is expected to be consumed or other types of requests. The examplar value set represents where the meds are intended to be administered and is just one example of request categorization.

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

If true true, indicates that the provider is asking for the medication request patient to either stop taking or to not start taking the specified medication. For example, the patient is taking an existing medication and the provider is changing their medication. They want to occur. create two seperate requests: one to stop using the current medication and another to start the new medication.

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

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.

If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the Medication resource is recommended. For example, if you require form or lot number or if the medication is compounded or extemporaneously prepared, then you must reference the Medication resource.

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.

The subject on a medication request is mandatory. For the secondary use case where the actual subject is not provided, there still must be an anonymized subject specified.

The person or organization who provided the information about this request, if the source is someone other than the requestor. This is often used when the MedicationRequest is reported by another person.

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

This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter." If there is a need to link to episodes of care they will be handled with an extension.

Include additional information (for Information to support fulfilling (i.e. dispensing or administering) of the medication, for example, patient height and weight) that supports weight, a MedicationStatement for the ordering patient).

This attribute can be used to reference a MedicationStatement about the patients' medication use.

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

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

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

If not populated, then assume that this is the original record and not reported

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

If specified without indicating a performer, this indicates that the performer must be of the specified type. If specified with a performer then it indicates the requirements of the performer if the designated performer is not available.

The person who entered specified desired performer of the order on behalf medication treatment (e.g. the performer of another individual for example in the case medication 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 verbal device that is performing the administration. Both the IV Pump and the practitioner that set the rate or a telephone order. bolus on the pump can be listed as performers.

The reason or the indication intended type of device that is to be used for ordering or not ordering the medication. administration of the medication (for example, PCA Pump).

Condition or observation that supports why The person who entered the medication was ordered. order on behalf of another individual for example in the case of a verbal or a telephone order.

The URL pointing to a protocol, guideline, orderset, reason or other definition that is adhered to in whole the indication for ordering or in part by this MedicationRequest. not ordering the medication.

This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonReference.

The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered description of the overall pattern of the administration of the medication to in whole or in part by this MedicationRequest. the patient.

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

A plan or request Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that is fulfilled in whole or in part by this medication request. may be required for delivering the requested service.

A shared identifier common to all requests Extra information about the prescription that were authorized more or less simultaneously could not be conveyed by a single author, representing the identifier of the requisition or prescription. other attributes.

The description of the overall patte3rn full representation of the administration dose of the medication included in all dosage instructions. To be used when multiple dosage instructions are included to the patient. represent complex dosing such as increasing or tapering doses.

This attribute should The content of the renderedDosageInstructions must not be confused with different than the protocol of dose represented in the medication. dosageInstruction content.

Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may The period over which the medication is to be required for delivering taken. Where there are multiple dosageInstruction lines (for example, tapering doses), this is the requested service. earliest date and the latest end date of the dosageInstructions.

Indicates Specific instructions for how the medication is to be used by the patient.

There are examples where a medication request may include the option of an oral dose or an Intravenous or Intramuscular dose. For example, "Ondansetron 8mg orally or IV twice a day as needed for nausea" or "Compazine® (prochlorperazine) 5-10mg PO or 25mg PR bid prn nausea or vomiting". In these cases, two medication requests would be created that could be grouped together. The decision on which dose and route of administration to use is based on the patient's condition at the time the dose is needed. 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.

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.

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

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

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

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

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

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

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

It reflects the prescribers' perspective for the validity of the prescription. Dispenses must not be made against the prescription outside of this period. The lower-bound of the Dispensing Window signifies the earliest date that the prescription can be filled for the first time. If an upper-bound is not specified then the Prescription is open-ended or will default to a stale-date based on regulations.

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.

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

The amount that is to be dispensed for one fill.

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.

Indicates the intended dispensing performing Organization that will dispense the medication as specified by the prescriber.

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 Provides additional information to the prescriber's intent. If nothing is specified substitution may dispenser, for example, counselling to be done. provided to the patient.

True if Provides information about the prescriber allows a different drug type of adherence packaging to be dispensed from what was prescribed. supplied for the medication dispense.

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

A link to True if the prescriber allows a resource representing an earlier order related order or prescription. different drug to be dispensed from what was prescribed.

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

Indicates an actual or potential clinical issue with or between one the reason for the substitution, or more active why substitution must or proposed clinical actions for a patient; e.g. Drug-drug interaction, duplicate therapy, dosage alert etc. must not be performed.

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.

This might not include provenances for all versions of the request – only those deemed “relevant” "relevant" or important. This SHALL NOT include the provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” "relevant" change, it will need to be added as part of a later update. Until then, it can be queried directly as the provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.).