FHIR Release 3 (STU) R4 Ballot #1 (Mixed Normative/Trial use)

This page is part of the FHIR Specification (v3.0.2: STU 3). (v3.3.0: R4 Ballot 2). 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 Work Group Maturity Level : 3   Trial Use Compartments : Not linked to any defined compartments

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

11.5.1 Scope and Usage

Representing medications in the majority of 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 patient-related resource or to other applications. Additional information about the medication is frequently provided for human verification, 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 medicine 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 be specified together with the amount contained, though the medication 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 how it is packaged. The medication will include the 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 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).

If 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 ActivityDefinition , AdverseEvent , CarePlan , EntryDefinition , Flag , Group , MedicationAdministration , MedicationDispense , MedicationRequest , MedicationStatement , MedicinalProductClinicals , Procedure , SupplyDelivery and SupplyRequest

11.5.2 Resource Content

Structure

container 0..1 CodeableConcept E.g. box, vial, blister-pack MedicationContainer ( Example ) content 0..* BackboneElement What is in the package item[x] 1..1 The item in the package itemCodeableConcept CodeableConcept itemReference Reference ( Medication ) amount 0..1 SimpleQuantity Quantity present in the package batch 0..* BackboneElement Identifies a single production run
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
. . . code Σ 0..1 CodeableConcept Codes that identify this medication
SNOMED CT Medication Codes ( Example )
. . . status Σ 0..1 code active | inactive | entered-in-error
MedicationStatus ( Required )
. . isBrand Σ 0..1 boolean True if a brand isOverTheCounter Σ 0..1 boolean True if medication does not require a prescription . manufacturer Σ 0..1 Reference ( Organization ) Manufacturer of the item
. . . form 0..1 CodeableConcept powder | tablets | capsule +
SNOMED CT Form Codes ( Example )
. . . amount ?! Σ 0..1 SimpleQuantity Amount of drug in package
. . . ingredient 0..* BackboneElement Active or inactive ingredient
. . . . item[x] 1..1 The product contained
. . . . . itemCodeableConcept CodeableConcept
. . . . . itemReference Reference ( Substance | Medication )
. . . . isActive 0..1 boolean Active ingredient indicator
. . . . amount 0..1 Ratio Quantity of ingredient present
. . . package batch 0..1 BackboneElement Details about packaged medications
. . . . lotNumber 0..1 string Identifier assigned to batch
. . . . expirationDate 0..1 dateTime When batch will expire
. . . image . serialNumber 0..* 0..1 Attachment string Picture of Identifier assigned to a drug at the medication time of manufacture

doco Documentation for this format

UML Diagram ( Legend )

Medication ( DomainResource ) 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 (Strength=Example) SNOMED CT Medication ?? » A code to indicate if the medication is in active use status : code [0..1] « A coded concept defining if the medication is in active use (Strength=Required) MedicationStatus ! » Set to true if the item is attributable to a specific manufacturer isBrand : boolean [0..1] Set to true if the medication can be obtained without an order from a prescriber isOverTheCounter : boolean [0..1] Describes the details of the manufacturer of the medication product. This is not intended to represent the distributor of a medication product manufacturer : Reference [0..1] « Organization » Describes the form of the item. Powder; tablets; capsule form : CodeableConcept [0..1] « A coded concept defining the form of a medication (Strength=Example) SNOMED CT Form ?? » Photo(s) or graphic representation(s) Specific amount of the medication 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.) (this element modifies the meaning of other elements) image amount : Attachment Quantity [0..*] ( SimpleQuantity ) [0..1] Ingredient The actual ingredient - either a substance (simple ingredient) or another medication item[x] : Type [1..1] « CodeableConcept | Reference ( Substance | Medication ) » Indication of whether thisingredient affectsthe 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 amount : Ratio [0..1] Package The kind of container that this package comes as container : CodeableConcept [0..1] A coded concept defining the kind of container a medication package is packaged in (Strength=Example) MedicationContainer ?? Content Identifies one of the items in the package item[x] : Type [1..1] CodeableConcept | Reference ( Medication ) The amount of the product that is in the package amount : Quantity ( SimpleQuantity ) [0..1] 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] An identifier assigned to a drug at the point of manufacturing and repackaging (at the package or pallet level), sufficient to facilitate the identification, validation, authentication, and tracking and tracking of drugs serialNumber : string [0..1] Identifies a particular constituent of interest in the product ingredient [0..*] A set of components that go to make up the described item content [0..*] Information about a group of medication produced or packaged from one production run batch [0..*] Information that only applies to packages (not products) package 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 -->
 <code><!-- 0..1 CodeableConcept Codes that identify this medication --></code>
 <
 <
 <

 <status value="[code]"/><!-- 0..1 active | inactive | entered-in-error -->

 <manufacturer><!-- 0..1 Reference(Organization) Manufacturer of the item --></manufacturer>
 <form><!-- 0..1 CodeableConcept powder | tablets | capsule + --></form>
 <amount><!-- 0..1 Quantity(SimpleQuantity) Amount of drug in package --></amount>

 <ingredient>  <!-- 0..* Active or inactive ingredient -->
  <item[x]><!-- 1..1 CodeableConcept|Reference(Substance|Medication) The product contained --></item[x]>
  <

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

  <amount><!-- 0..1 Ratio Quantity of ingredient present --></amount>
 </ingredient>
 <
  <</container>
  <
   <</item[x]>
   <</amount>
  </content>
  <
   <
   <
  </batch>
 </package>
 <</image>

 <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 -->
  <serialNumber value="[string]"/><!-- 0..1 Identifier assigned to a drug at the time of manufacture -->
 </batch>

</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:Medication.code [ CodeableConcept ]; # 0..1 Codes that identify this medication
  fhir:Medication.status [ code ]; # 0..1 active | inactive | entered-in-error
  fhir:
  fhir:

  fhir:Medication.manufacturer [ Reference(Organization) ]; # 0..1 Manufacturer of the item
  fhir:Medication.form [ CodeableConcept ]; # 0..1 powder | tablets | capsule +
  fhir:Medication.amount [ Quantity(SimpleQuantity) ]; # 0..1 Amount of drug in package

  fhir:Medication.ingredient [ # 0..* Active or inactive ingredient
    # Medication.ingredient.item[x] : 1..1 The product contained. One of these 2
      fhir:Medication.ingredient.itemCodeableConcept [ CodeableConcept ]
      fhir:Medication.ingredient.itemReference [ Reference(Substance|Medication) ]
    fhir:Medication.ingredient.isActive [ boolean ]; # 0..1 Active ingredient indicator
    fhir:Medication.ingredient.amount [ Ratio ]; # 0..1 Quantity of ingredient present
  ], ...;
  fhir:
    fhir:
    fhir:
      # . One of these 2
        fhir: ]
        fhir:) ]
      fhir:
    ], ...;
    fhir:
      fhir:
      fhir:
    ], ...;

  fhir:Medication.batch [ # 0..1 Details about packaged medications
    fhir:Medication.batch.lotNumber [ string ]; # 0..1 Identifier assigned to batch
    fhir:Medication.batch.expirationDate [ dateTime ]; # 0..1 When batch will expire
    fhir:Medication.batch.serialNumber [ string ]; # 0..1 Identifier assigned to a drug at the time of manufacture

  ];
  fhir:

]

Changes since DSTU2 R3

Medication.status Added Element Medication.isOverTheCounter Medication.package.content.item[x] Renamed from item to item[x] Add CodeableConcept
Medication Added Element
Medication.form Medication.amount
  • Added Element
Medication.ingredient Medication.ingredient.item[x]
  • Added Element Remove Reference(Substance|Medication), Add Reference(Substance|Medication)
Medication.ingredient.item[x] Medication.batch
  • Added Element
Medication.ingredient.isActive Medication.batch.lotNumber
  • Added Element
Medication.ingredient.amount Medication.batch.expirationDate
  • Added Element
Medication.package.batch Medication.batch.serialNumber
  • Added Element
Medication.package.batch.lotNumber Medication.isBrand
  • Added Element deleted
Medication.package.batch.expirationDate Medication.isOverTheCounter
  • Added Element deleted
Medication.image Medication.package
  • Added Element deleted
Medication.product Medication.image
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

See R2 <--> R3 Conversion Maps (status = 23 tests that all execute ok. 16 fail round-trip testing and 1 r3 resources are invalid (1 errors). ). Note: these have note yet been updated to be R3 to R4

Structure

container 0..1 CodeableConcept E.g. box, vial, blister-pack MedicationContainer ( Example ) content 0..* BackboneElement What is in the package item[x] 1..1 The item in the package itemCodeableConcept CodeableConcept itemReference Reference ( Medication ) amount 0..1 SimpleQuantity Quantity present in the package batch 0..* BackboneElement Identifies a single production run
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
. . . code Σ 0..1 CodeableConcept Codes that identify this medication
SNOMED CT Medication Codes ( Example )
. . . status Σ 0..1 code active | inactive | entered-in-error
MedicationStatus ( Required )
. . isBrand Σ 0..1 boolean True if a brand isOverTheCounter Σ 0..1 boolean True if medication does not require a prescription . manufacturer Σ 0..1 Reference ( Organization ) Manufacturer of the item
. . . form 0..1 CodeableConcept powder | tablets | capsule +
SNOMED CT Form Codes ( Example )
. . . amount ?! Σ 0..1 SimpleQuantity Amount of drug in package
. . . ingredient 0..* BackboneElement Active or inactive ingredient
. . . . item[x] 1..1 The product contained
. . . . . itemCodeableConcept CodeableConcept
. . . . . itemReference Reference ( Substance | Medication )
. . . . isActive 0..1 boolean Active ingredient indicator
. . . . amount 0..1 Ratio Quantity of ingredient present
. . . package batch 0..1 BackboneElement Details about packaged medications
. . . . lotNumber 0..1 string Identifier assigned to batch
. . . . expirationDate 0..1 dateTime When batch will expire
. . . image . serialNumber 0..* 0..1 Attachment string Picture of Identifier assigned to a drug at the medication time of manufacture

doco Documentation for this format

UML Diagram ( Legend )

Medication ( DomainResource ) 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 (Strength=Example) SNOMED CT Medication ?? » A code to indicate if the medication is in active use status : code [0..1] « A coded concept defining if the medication is in active use (Strength=Required) MedicationStatus ! » Set to true if the item is attributable to a specific manufacturer isBrand : boolean [0..1] Set to true if the medication can be obtained without an order from a prescriber isOverTheCounter : boolean [0..1] Describes the details of the manufacturer of the medication product. This is not intended to represent the distributor of a medication product manufacturer : Reference [0..1] « Organization » Describes the form of the item. Powder; tablets; capsule form : CodeableConcept [0..1] « A coded concept defining the form of a medication (Strength=Example) SNOMED CT Form ?? » Photo(s) or graphic representation(s) Specific amount of the medication 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.) (this element modifies the meaning of other elements) image amount : Attachment Quantity [0..*] ( SimpleQuantity ) [0..1] Ingredient The actual ingredient - either a substance (simple ingredient) or another medication item[x] : Type [1..1] « CodeableConcept | Reference ( Substance | Medication ) » Indication of whether thisingredient affectsthe 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 amount : Ratio [0..1] Package The kind of container that this package comes as container : CodeableConcept [0..1] A coded concept defining the kind of container a medication package is packaged in (Strength=Example) MedicationContainer ?? Content Identifies one of the items in the package item[x] : Type [1..1] CodeableConcept | Reference ( Medication ) The amount of the product that is in the package amount : Quantity ( SimpleQuantity ) [0..1] 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] An identifier assigned to a drug at the point of manufacturing and repackaging (at the package or pallet level), sufficient to facilitate the identification, validation, authentication, and tracking and tracking of drugs serialNumber : string [0..1] Identifies a particular constituent of interest in the product ingredient [0..*] A set of components that go to make up the described item content [0..*] Information about a group of medication produced or packaged from one production run batch [0..*] Information that only applies to packages (not products) package 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 -->
 <code><!-- 0..1 CodeableConcept Codes that identify this medication --></code>
 <
 <
 <

 <status value="[code]"/><!-- 0..1 active | inactive | entered-in-error -->

 <manufacturer><!-- 0..1 Reference(Organization) Manufacturer of the item --></manufacturer>
 <form><!-- 0..1 CodeableConcept powder | tablets | capsule + --></form>
 <amount><!-- 0..1 Quantity(SimpleQuantity) Amount of drug in package --></amount>

 <ingredient>  <!-- 0..* Active or inactive ingredient -->
  <item[x]><!-- 1..1 CodeableConcept|Reference(Substance|Medication) The product contained --></item[x]>
  <

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

  <amount><!-- 0..1 Ratio Quantity of ingredient present --></amount>
 </ingredient>
 <
  <</container>
  <
   <</item[x]>
   <</amount>
  </content>
  <
   <
   <
  </batch>
 </package>
 <</image>

 <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 -->
  <serialNumber value="[string]"/><!-- 0..1 Identifier assigned to a drug at the time of manufacture -->
 </batch>

</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:Medication.code [ CodeableConcept ]; # 0..1 Codes that identify this medication
  fhir:Medication.status [ code ]; # 0..1 active | inactive | entered-in-error
  fhir:
  fhir:

  fhir:Medication.manufacturer [ Reference(Organization) ]; # 0..1 Manufacturer of the item
  fhir:Medication.form [ CodeableConcept ]; # 0..1 powder | tablets | capsule +
  fhir:Medication.amount [ Quantity(SimpleQuantity) ]; # 0..1 Amount of drug in package

  fhir:Medication.ingredient [ # 0..* Active or inactive ingredient
    # Medication.ingredient.item[x] : 1..1 The product contained. One of these 2
      fhir:Medication.ingredient.itemCodeableConcept [ CodeableConcept ]
      fhir:Medication.ingredient.itemReference [ Reference(Substance|Medication) ]
    fhir:Medication.ingredient.isActive [ boolean ]; # 0..1 Active ingredient indicator
    fhir:Medication.ingredient.amount [ Ratio ]; # 0..1 Quantity of ingredient present
  ], ...;
  fhir:
    fhir:
    fhir:
      # . One of these 2
        fhir: ]
        fhir:) ]
      fhir:
    ], ...;
    fhir:
      fhir:
      fhir:
    ], ...;

  fhir:Medication.batch [ # 0..1 Details about packaged medications
    fhir:Medication.batch.lotNumber [ string ]; # 0..1 Identifier assigned to batch
    fhir:Medication.batch.expirationDate [ dateTime ]; # 0..1 When batch will expire
    fhir:Medication.batch.serialNumber [ string ]; # 0..1 Identifier assigned to a drug at the time of manufacture

  ];
  fhir:

]

Changes since DSTU2

Medication.status Medication.package.content.item[x] Renamed from item to item[x] Add CodeableConcept
Medication Added Element Medication.isOverTheCounter Added Element
Medication.form Medication.amount
  • Added Element
Medication.ingredient Medication.ingredient.item[x]
  • Added Element Remove Reference(Substance|Medication), Add Reference(Substance|Medication)
Medication.ingredient.item[x] Medication.batch
  • Added Element
Medication.ingredient.isActive Medication.batch.lotNumber
  • Added Element
Medication.ingredient.amount Medication.batch.expirationDate
  • Added Element
Medication.package.batch Medication.batch.serialNumber
  • Added Element
Medication.package.batch.lotNumber Medication.isBrand
  • Added Element deleted
Medication.package.batch.expirationDate Medication.isOverTheCounter
  • Added Element deleted
Medication.image Medication.package
  • Added Element deleted
Medication.product Medication.image
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

See R2 <--> R3 Conversion Maps (status = 23 tests that all execute ok. 16 fail round-trip testing and 1 r3 resources are invalid (1 errors). ). Note: these have note yet been updated to be R3 to R4

 

Alternate definitions: Master Definition ( XML , + JSON ), , XML Schema / Schematron (for ) + JSON Schema , ShEx (for Turtle ) + see the extensions & the dependency analysis

11.5.2.1 Terminology Bindings

Medication.package.container A coded concept defining the kind of container a medication package is packaged in Example MedicationContainer
Path Definition Type Reference
Medication.code A coded concept that defines the type of a medication Example SNOMED CT Medication Codes
Medication.status A coded concept defining if the medication is in active use Required MedicationStatus
Medication.form A coded concept defining the form of a medication Example SNOMED CT Form Codes

11.5.3 Best practices for using 'Medication'

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 committee. group.

11.5.4 Search Parameters

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

manufacturer reference
Name Type Description Expression In Common
code token Codes that identify this medication Medication.code 4 Resources
container expiration-date token date E.g. box, vial, blister-pack When batch will expire Medication.package.container Medication.batch.expirationDate
form token powder | tablets | capsule + Medication.form
ingredient reference The product contained Medication.ingredient.item.as(Reference)
( Medication , Substance )
ingredient-code token The product contained Medication.ingredient.item.as(CodeableConcept) Manufacturer of the item Medication.manufacturer ( Organization )
over-the-counter lot-number token True if medication does not require a prescription Identifier assigned to batch Medication.isOverTheCounter Medication.batch.lotNumber
package-item manufacturer reference The item in Manufacturer of the package item Medication.package.content.item.as(Reference) Medication.manufacturer
( Medication Organization )
package-item-code serial-number token The item in Identifier assigned to a drug at the package time of manufacture Medication.package.content.item.as(CodeableConcept) Medication.batch.serialNumber
status token active | inactive | entered-in-error Medication.status