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

11.4 Resource MedicationStatement - Content

Pharmacy Work Group Maturity Level : 3   Trial Use Compartments : Patient , Practitioner , RelatedPerson

A record of a medication that is being consumed by a patient. A MedicationStatement may indicate that the patient may be taking the medication now, or has taken the medication in the past or will be taking the medication in the future. The source of this information can be the patient, significant other (such as a family member or spouse), or a clinician. A common scenario where this information is captured is during the history taking process during a patient visit or stay. The medication information may come from sources such as the patient's memory, from a prescription bottle, or from a list of medications the patient, clinician or other party maintains maintains. The primary difference between a medication statement and a medication administration is that the medication administration has complete administration information and is based on actual administration information from the person who administered the medication. A medication statement is often, if not always, less specific. There is no required date/time when the medication was administered, in fact we only know that a source has reported the patient is taking this medication, where details such as time, quantity, or rate or even medication product may be incomplete or missing or less precise. As stated earlier, the medication statement information may come from the patient's memory, from a prescription bottle or from a list of medications the patient, clinician or other party maintains. Medication administration is more formal and is not missing detailed information.

Common usage includes:

  • the recording of non-prescription and/or recreational drugs
  • the recording of an intake medication list upon admission to hospital
  • the summarization of a patient's "active medications" "active medications" in a patient profile

A MedicationStatement may be used to record substance abuse or the use of other agents such as tobacco or alcohol. This would typically be done if these substances are intended to be inluded included in clinical decision support checking (for example, interaction checking) and as part of an active medication list. If the intent is to populate social history and/or to include additional information (for example, desire to quit, amount per day, negative health effects), then it is better to record as an Observation that could then be used to populate Social History.

This resource does not produce a medication list, but it does produce individual medication statements that may be used in the List resource to construct various types of medication lists. Note that other medication lists can also be constructed from the other Pharmacy resources (e.g., MedicationRequest, MedicationAdministration).

A medication statement is not a part of the prescribe -> dispense -> administer sequence, but is a report by a patient, significant other or a clinician that one or more of the prescribe, dispense or administer actions has occurred, resulting is a belief that the patient is, has, or will be using a particular medication.

MedicationStatement is an event resource from a FHIR workflow perspective - see Workflow Event

The MedicationStatement resource is used to record a medications or substances that the patient reports as being taken, not taking, have taken in the past or may take in the future. It can also be used to record medication use that is derived from other records such as a MedicationRequest. The statement is not used to request or order a medication, supply or device. When requesting medicaation, medication, supplies or devices when there is a patient focus or instructions regarding their use, a MedicationRequest , SupplyRequest or DeviceRequest DeviceRequest should be used instead

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).
MedicationAdministration When a patient actually consumes a medicine, or it is otherwise administered to them
MedicationStatement This is a record of a medication being taken by a patient or that a medication has been given to a patient, where the record is the result of a report from the patient or another clinician, or derived from supporting information (for example, Claim, Observation or MedicationRequest). 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 resource is distinct from MedicationRequest , MedicationDispense and MedicationAdministration . Each of those resources refer refers to specific events - an individual order, an individual provisioning of medication or an individual dosing. MedicationStatement is a broader assertion covering a wider timespan and is independent of specific events. The existence of resource instances of any of the preceding three types may be used to infer a medication statement. However, medication statements can also be captured on the basis of other information, including an assertion by the patient or a care-giver, the results of a lab test, etc.

This resource is referenced by AdverseEvent and , Goal and Observation

Structure

Name Flags Card. Type Description & Constraints doco
. . MedicationStatement I TU DomainResource Record of medication being taken by a patient
+ Reason not taken is only permitted if Taken is No Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier Σ 0..* Identifier External identifier
. . . basedOn Σ 0..* Reference ( MedicationRequest | CarePlan | ProcedureRequest | ReferralRequest ServiceRequest ) Fulfils plan, proposal or order
. . . partOf Σ 0..* Reference ( MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Observation ) Part of referenced event
. . context . status ?! Σ 0..1 1..1 Reference ( Encounter | EpisodeOfCare code ) Encounter / Episode associated with MedicationStatement active | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken
MedicationStatementStatus ( Required )
. . status . statusReason ?! Σ 1..1 0..* code CodeableConcept active | completed | entered-in-error | intended | stopped | on-hold Reason for current status
MedicationStatementStatus SNOMED CT Drug Therapy Status codes ( Required Example )
. . . category Σ 0..1 CodeableConcept Type of medication usage
MedicationStatementCategory ( Preferred )
. . . medication[x] Σ 1..1 What medication was taken
SNOMED CT Medication Codes ( Example )
. . . . medicationCodeableConcept CodeableConcept
. . . . medicationReference Reference ( Medication )
. . . subject Σ 1..1 Reference ( Patient | Group ) Who is/was taking the medication
... context Σ 0..1 Reference ( Encounter | EpisodeOfCare ) Encounter / Episode associated with MedicationStatement
. . . effective[x] Σ 0..1 The date/time or interval when the medication was is/was/will taken
. . . . effectiveDateTime dateTime
. . . . effectivePeriod Period
. . . dateAsserted Σ 0..1 dateTime When the statement was asserted?
. . . informationSource 0..1 Reference ( Patient | Practitioner | RelatedPerson | Organization ) Person or organization that provided the information about the taking of this medication
. . . subject Σ 1..1 Reference ( Patient | Group ) Who is/was taking the medication derivedFrom 0..* Reference ( Any ) Additional supporting information
. . taken ?! Σ 1..1 code y | n | unk | na MedicationStatementTaken ( Required ) reasonNotTaken I 0..* CodeableConcept True if asserting medication was not given SNOMED CT Drugs not taken/completed Codes ( Example ) . reasonCode 0..* CodeableConcept Reason for why the medication is being/was taken
Condition/Problem/Diagnosis Codes ( Example )
. . . reasonReference 0..* Reference ( Condition | Observation | DiagnosticReport ) Condition or observation that supports why the medication is being/was taken
. . . note 0..* Annotation Further information about the statement
. . . dosage 0..* Dosage Details of how medication is/was taken or should be taken

doco Documentation for this format

UML Diagram ( Legend )

MedicationStatement ( DomainResource ) External identifier - FHIR will generate its own internal identifiers (probably URLs) which do not need to be explicitly managed by the resource. The identifier here is one that would be used by another non-FHIR system - for example an automated medication pump would provide a record each time it operated; an administration while the patient was off the ward might be made with a different system and entered after the event. Particularly important if these records have to be updated identifier : Identifier [0..*] A plan, proposal or order that is fulfilled in whole or in part by this event basedOn : Reference [0..*] « MedicationRequest | CarePlan | ProcedureRequest | ReferralRequest ServiceRequest » A larger event of which this particular event is a component or step partOf : Reference [0..*] « MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Observation » The encounter or episode of care that establishes the context for this MedicationStatement context : Reference [0..1] Encounter | EpisodeOfCare A code representing the patient or other source's judgment about the state of the medication used that this statement is about. Generally this will be active or completed (this element modifies the meaning of other elements) status : code [1..1] « A coded concept indicating the current status of a MedicationStatement. (Strength=Required) MedicationStatementStatus ! » Captures the reason for the current state of the MedicationStatement statusReason : CodeableConcept [0..*] « A coded concept indicating the reason for the status of the statement (Strength=Example) SNOMED CT Drug Therapy Status... ?? » Indicates where type of medication statement and where the medication is expected to be consumed or administered category : CodeableConcept [0..1] « A coded concept identifying where the medication included in the medicationstatement MedicationStatement is expected to be consumed or administered (Strength=Preferred) MedicationStatementCategory ? » 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[x] : Type [1..1] « CodeableConcept | Reference ( Medication ); A coded concept identifying the substance or product being taken. (Strength=Example) SNOMED CT Medication ?? » The person, animal or group who is/was taking the medication subject : Reference [1..1] « Patient | Group » The encounter or episode of care that establishes the context for this MedicationStatement context : Reference [0..1] « Encounter | EpisodeOfCare » The interval of time during which it is being asserted that the patient was is/was/will be taking the medication (or ( or was not taking, when the wasNotGiven MedicationStatement.taken element is true) No) effective[x] : Type [0..1] « dateTime | Period » The date when the medication statement was asserted by the information source dateAsserted : dateTime [0..1] The person or organization that provided the information about the taking of this medication. Note: Use derivedFrom when a MedicationStatement is derived from other resources, e.g e.g. Claim or MedicationRequest informationSource : Reference [0..1] « Patient | Practitioner | RelatedPerson | Organization » The person, animal or group who is/was taking the medication subject : Reference [1..1] Patient | Group Allows linking the MedicationStatement to the underlying MedicationRequest, or to other information that supports or is used to derive the MedicationStatement derivedFrom : Reference [0..*] « Any » Indicator of the certainty of whether the medication was taken by the patient (this element modifies the meaning of other elements) taken : code [1..1] A coded concept identifying level of certainty if patient has taken or has not taken the medication (Strength=Required) MedicationStatementTaken ! A code indicating why the medication was not taken reasonNotTaken : CodeableConcept [0..*] A coded concept indicating the reason why the medication was not taken (Strength=Example) SNOMED CT Drugs not taken/com... ?? A reason for why the medication is being/was taken reasonCode : CodeableConcept [0..*] « A coded concept identifying why the medication is being taken. (Strength=Example) Condition/Problem/Diagnosis ?? » Condition or observation that supports why the medication is being/was taken reasonReference : Reference [0..*] « Condition | Observation | DiagnosticReport » Provides extra information about the medication statement that is not conveyed by the other attributes note : Annotation [0..*] Indicates how the medication is/was or should be taken by the patient dosage : Dosage [0..*]

XML Template

<

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

 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier External identifier --></identifier>
 <|
   </basedOn>

 <basedOn><!-- 0..* Reference(MedicationRequest|CarePlan|ServiceRequest) Fulfils plan, proposal or order --></basedOn>

 <partOf><!-- 0..* Reference(MedicationAdministration|MedicationDispense|
   MedicationStatement|Procedure|Observation) Part of referenced event --></partOf>
 <</context>
 <
 <</category>

 <status value="[code]"/><!-- 1..1 active | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken -->
 <statusReason><!-- 0..* CodeableConcept Reason for current status --></statusReason>
 <category><!-- 0..1 CodeableConcept Type of medication usage --></category>

 <medication[x]><!-- 1..1 CodeableConcept|Reference(Medication) What medication was taken --></medication[x]>
 <</effective[x]>
 <
 <|
   </informationSource>

 <subject><!-- 1..1 Reference(Patient|Group) Who is/was taking  the medication --></subject>
 <context><!-- 0..1 Reference(Encounter|EpisodeOfCare) Encounter / Episode associated with MedicationStatement --></context>
 <effective[x]><!-- 0..1 dateTime|Period The date/time or interval when the medication is/was/will taken --></effective[x]>
 <dateAsserted value="[dateTime]"/><!-- 0..1 When the statement was asserted? -->
 <informationSource><!-- 0..1 Reference(Patient|Practitioner|RelatedPerson|
   Organization) Person or organization that provided the information about the taking of this medication --></informationSource>
 <derivedFrom><!-- 0..* Reference(Any) Additional supporting information --></derivedFrom>
 <
 <</reasonNotTaken>

 <reasonCode><!-- 0..* CodeableConcept Reason for why the medication is being/was taken --></reasonCode>
 <</reasonReference>

 <reasonReference><!-- 0..* Reference(Condition|Observation|DiagnosticReport) Condition or observation that supports why the medication is being/was taken --></reasonReference>

 <note><!-- 0..* Annotation Further information about the statement --></note>
 <dosage><!-- 0..* Dosage Details of how medication is/was taken or should be taken --></dosage>
</MedicationStatement>

JSON Template

{doco
  "resourceType" : "",

  "resourceType" : "MedicationStatement",

  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "
  "|
   
  "|

  "identifier" : [{ Identifier }], // External identifier
  "basedOn" : [{ Reference(MedicationRequest|CarePlan|ServiceRequest) }], // Fulfils plan, proposal or order
  "partOf" : [{ Reference(MedicationAdministration|MedicationDispense|

   MedicationStatement|Procedure|Observation) }], // Part of referenced event
  "
  "
  "

  "status" : "<code>", // R!  active | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken
  "statusReason" : [{ CodeableConcept }], // Reason for current status
  "category" : { CodeableConcept }, // Type of medication usage

  // medication[x]: What medication was taken. One of these 2:
  " },
  " },
  
  ">",
  " },
  "
  "|

  "medicationCodeableConcept" : { CodeableConcept },
  "medicationReference" : { Reference(Medication) },
  "subject" : { Reference(Patient|Group) }, // R!  Who is/was taking  the medication
  "context" : { Reference(Encounter|EpisodeOfCare) }, // Encounter / Episode associated with MedicationStatement
  // effective[x]: The date/time or interval when the medication is/was/will taken. One of these 2:

  "effectiveDateTime" : "<dateTime>",
  "effectivePeriod" : { Period },
  "dateAsserted" : "<dateTime>", // When the statement was asserted?
  "informationSource" : { Reference(Patient|Practitioner|RelatedPerson|

   Organization) }, // Person or organization that provided the information about the taking of this medication
  "
  "
  "
  "
  "
  "
  "
  "

  "derivedFrom" : [{ Reference(Any) }], // Additional supporting information
  "reasonCode" : [{ CodeableConcept }], // Reason for why the medication is being/was taken
  "reasonReference" : [{ Reference(Condition|Observation|DiagnosticReport) }], // Condition or observation that supports why the medication is being/was taken
  "note" : [{ Annotation }], // Further information about the statement
  "dosage" : [{ Dosage }] // Details of how medication is/was taken or should be taken

}

Turtle Template

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


[ a fhir:;

[ a fhir:MedicationStatement;

  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:MedicationStatement.identifier [ Identifier ], ... ; # 0..* External identifier
  fhir:

  fhir:MedicationStatement.basedOn [ Reference(MedicationRequest|CarePlan|ServiceRequest) ], ... ; # 0..* Fulfils plan, proposal or order

  fhir:MedicationStatement.partOf [ Reference(MedicationAdministration|MedicationDispense|MedicationStatement|Procedure|
  Observation) ], ... ; # 0..* Part of referenced event
  fhir:
  fhir:
  fhir:

  fhir:MedicationStatement.status [ code ]; # 1..1 active | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken
  fhir:MedicationStatement.statusReason [ CodeableConcept ], ... ; # 0..* Reason for current status
  fhir:MedicationStatement.category [ CodeableConcept ]; # 0..1 Type of medication usage

  # MedicationStatement.medication[x] : 1..1 What medication was taken. One of these 2
    fhir:MedicationStatement.medicationCodeableConcept [ CodeableConcept ]
    fhir:MedicationStatement.medicationReference [ Reference(Medication) ]
  # . One of these 2
    fhir: ]
    fhir: ]
  fhir:
  fhir:

  fhir:MedicationStatement.subject [ Reference(Patient|Group) ]; # 1..1 Who is/was taking  the medication
  fhir:MedicationStatement.context [ Reference(Encounter|EpisodeOfCare) ]; # 0..1 Encounter / Episode associated with MedicationStatement
  # MedicationStatement.effective[x] : 0..1 The date/time or interval when the medication is/was/will taken. One of these 2
    fhir:MedicationStatement.effectiveDateTime [ dateTime ]
    fhir:MedicationStatement.effectivePeriod [ Period ]
  fhir:MedicationStatement.dateAsserted [ dateTime ]; # 0..1 When the statement was asserted?
  fhir:MedicationStatement.informationSource [ Reference(Patient|Practitioner|RelatedPerson|Organization) ]; # 0..1 Person or organization that provided the information about the taking of this medication

  fhir:MedicationStatement.derivedFrom [ Reference(Any) ], ... ; # 0..* Additional supporting information
  fhir:
  fhir:

  fhir:MedicationStatement.reasonCode [ CodeableConcept ], ... ; # 0..* Reason for why the medication is being/was taken
  fhir:

  fhir:MedicationStatement.reasonReference [ Reference(Condition|Observation|DiagnosticReport) ], ... ; # 0..* Condition or observation that supports why the medication is being/was taken

  fhir:MedicationStatement.note [ Annotation ], ... ; # 0..* Further information about the statement
  fhir:MedicationStatement.dosage [ Dosage ], ... ; # 0..* Details of how medication is/was taken or should be taken
]

Changes since DSTU2 R3

MedicationStatement.basedOn Added Element MedicationStatement.partOf
MedicationStatement Added Element MedicationStatement.context Added Element MedicationStatement.category Added Element MedicationStatement.informationSource Add Reference(Organization) MedicationStatement.subject Renamed from patient to subject Add Reference(Group)
MedicationStatement.derivedFrom MedicationStatement.basedOn
  • Renamed Type changed from supportingInformation Reference(MedicationRequest|CarePlan|ProcedureRequest|ReferralRequest) to derivedFrom MedicationStatement.taken Added Element MedicationStatement.reasonCode Added Element Reference(MedicationRequest|CarePlan|ServiceRequest)
MedicationStatement.reasonReference MedicationStatement.statusReason
  • Added Element
MedicationStatement.note MedicationStatement.medication[x]
  • Max Cardinality changed from 1 to * Type changed from string to Annotation Remove Reference(Medication), Add Reference(Medication)
MedicationStatement.dosage MedicationStatement.reasonReference
  • Type changed from BackboneElement Reference(Condition|Observation) to Dosage MedicationStatement.wasNotTaken deleted MedicationStatement.reasonForUse[x] deleted MedicationStatement.dosage.text deleted MedicationStatement.dosage.timing deleted MedicationStatement.dosage.asNeeded[x] deleted MedicationStatement.dosage.site[x] deleted MedicationStatement.dosage.route deleted MedicationStatement.dosage.method deleted MedicationStatement.dosage.quantity[x] deleted Reference(Condition|Observation|DiagnosticReport)
MedicationStatement.dosage.rate[x] MedicationStatement.taken
  • deleted
MedicationStatement.dosage.maxDosePerPeriod MedicationStatement.reasonNotTaken
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

See R2 <--> R3 Conversion Maps (status = 7 tests that all execute ok. All tests pass round-trip testing and 1 r3 resources are invalid (1 errors). ). Note: these have note yet been updated to be R3 to R4

Structure

Name Flags Card. Type Description & Constraints doco
. . MedicationStatement I TU DomainResource Record of medication being taken by a patient
+ Reason not taken is only permitted if Taken is No Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier Σ 0..* Identifier External identifier
. . . basedOn Σ 0..* Reference ( MedicationRequest | CarePlan | ProcedureRequest | ReferralRequest ServiceRequest ) Fulfils plan, proposal or order
. . . partOf Σ 0..* Reference ( MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Observation ) Part of referenced event
. . context . status ?! Σ 0..1 1..1 Reference ( Encounter | EpisodeOfCare code ) Encounter / Episode associated with MedicationStatement active | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken
MedicationStatementStatus ( Required )
. . status . statusReason ?! Σ 1..1 0..* code CodeableConcept active | completed | entered-in-error | intended | stopped | on-hold Reason for current status
MedicationStatementStatus SNOMED CT Drug Therapy Status codes ( Required Example )
. . . category Σ 0..1 CodeableConcept Type of medication usage
MedicationStatementCategory ( Preferred )
. . . medication[x] Σ 1..1 What medication was taken
SNOMED CT Medication Codes ( Example )
. . . . medicationCodeableConcept CodeableConcept
. . . . medicationReference Reference ( Medication )
. . . subject Σ 1..1 Reference ( Patient | Group ) Who is/was taking the medication
... context Σ 0..1 Reference ( Encounter | EpisodeOfCare ) Encounter / Episode associated with MedicationStatement
. . . effective[x] Σ 0..1 The date/time or interval when the medication was is/was/will taken
. . . . effectiveDateTime dateTime
. . . . effectivePeriod Period
. . . dateAsserted Σ 0..1 dateTime When the statement was asserted?
. . . informationSource 0..1 Reference ( Patient | Practitioner | RelatedPerson | Organization ) Person or organization that provided the information about the taking of this medication
. . . subject Σ 1..1 Reference ( Patient | Group ) Who is/was taking the medication derivedFrom 0..* Reference ( Any ) Additional supporting information
. . taken ?! Σ 1..1 code y | n | unk | na MedicationStatementTaken ( Required ) reasonNotTaken I 0..* CodeableConcept True if asserting medication was not given SNOMED CT Drugs not taken/completed Codes ( Example ) . reasonCode 0..* CodeableConcept Reason for why the medication is being/was taken
Condition/Problem/Diagnosis Codes ( Example )
. . . reasonReference 0..* Reference ( Condition | Observation | DiagnosticReport ) Condition or observation that supports why the medication is being/was taken
. . . note 0..* Annotation Further information about the statement
. . . dosage 0..* Dosage Details of how medication is/was taken or should be taken

doco Documentation for this format

UML Diagram ( Legend )

MedicationStatement ( DomainResource ) External identifier - FHIR will generate its own internal identifiers (probably URLs) which do not need to be explicitly managed by the resource. The identifier here is one that would be used by another non-FHIR system - for example an automated medication pump would provide a record each time it operated; an administration while the patient was off the ward might be made with a different system and entered after the event. Particularly important if these records have to be updated identifier : Identifier [0..*] A plan, proposal or order that is fulfilled in whole or in part by this event basedOn : Reference [0..*] « MedicationRequest | CarePlan | ProcedureRequest | ReferralRequest ServiceRequest » A larger event of which this particular event is a component or step partOf : Reference [0..*] « MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Observation » The encounter or episode of care that establishes the context for this MedicationStatement context : Reference [0..1] Encounter | EpisodeOfCare A code representing the patient or other source's judgment about the state of the medication used that this statement is about. Generally this will be active or completed (this element modifies the meaning of other elements) status : code [1..1] « A coded concept indicating the current status of a MedicationStatement. (Strength=Required) MedicationStatementStatus ! » Captures the reason for the current state of the MedicationStatement statusReason : CodeableConcept [0..*] « A coded concept indicating the reason for the status of the statement (Strength=Example) SNOMED CT Drug Therapy Status... ?? » Indicates where type of medication statement and where the medication is expected to be consumed or administered category : CodeableConcept [0..1] « A coded concept identifying where the medication included in the medicationstatement MedicationStatement is expected to be consumed or administered (Strength=Preferred) MedicationStatementCategory ? » 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[x] : Type [1..1] « CodeableConcept | Reference ( Medication ); A coded concept identifying the substance or product being taken. (Strength=Example) SNOMED CT Medication ?? » The person, animal or group who is/was taking the medication subject : Reference [1..1] « Patient | Group » The encounter or episode of care that establishes the context for this MedicationStatement context : Reference [0..1] « Encounter | EpisodeOfCare » The interval of time during which it is being asserted that the patient was is/was/will be taking the medication (or ( or was not taking, when the wasNotGiven MedicationStatement.taken element is true) No) effective[x] : Type [0..1] « dateTime | Period » The date when the medication statement was asserted by the information source dateAsserted : dateTime [0..1] The person or organization that provided the information about the taking of this medication. Note: Use derivedFrom when a MedicationStatement is derived from other resources, e.g e.g. Claim or MedicationRequest informationSource : Reference [0..1] « Patient | Practitioner | RelatedPerson | Organization » The person, animal or group who is/was taking the medication subject : Reference [1..1] Patient | Group Allows linking the MedicationStatement to the underlying MedicationRequest, or to other information that supports or is used to derive the MedicationStatement derivedFrom : Reference [0..*] « Any » Indicator of the certainty of whether the medication was taken by the patient (this element modifies the meaning of other elements) taken : code [1..1] A coded concept identifying level of certainty if patient has taken or has not taken the medication (Strength=Required) MedicationStatementTaken ! A code indicating why the medication was not taken reasonNotTaken : CodeableConcept [0..*] A coded concept indicating the reason why the medication was not taken (Strength=Example) SNOMED CT Drugs not taken/com... ?? A reason for why the medication is being/was taken reasonCode : CodeableConcept [0..*] « A coded concept identifying why the medication is being taken. (Strength=Example) Condition/Problem/Diagnosis ?? » Condition or observation that supports why the medication is being/was taken reasonReference : Reference [0..*] « Condition | Observation | DiagnosticReport » Provides extra information about the medication statement that is not conveyed by the other attributes note : Annotation [0..*] Indicates how the medication is/was or should be taken by the patient dosage : Dosage [0..*]

XML Template

<

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

 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier External identifier --></identifier>
 <|
   </basedOn>

 <basedOn><!-- 0..* Reference(MedicationRequest|CarePlan|ServiceRequest) Fulfils plan, proposal or order --></basedOn>

 <partOf><!-- 0..* Reference(MedicationAdministration|MedicationDispense|
   MedicationStatement|Procedure|Observation) Part of referenced event --></partOf>
 <</context>
 <
 <</category>

 <status value="[code]"/><!-- 1..1 active | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken -->
 <statusReason><!-- 0..* CodeableConcept Reason for current status --></statusReason>
 <category><!-- 0..1 CodeableConcept Type of medication usage --></category>

 <medication[x]><!-- 1..1 CodeableConcept|Reference(Medication) What medication was taken --></medication[x]>
 <</effective[x]>
 <
 <|
   </informationSource>

 <subject><!-- 1..1 Reference(Patient|Group) Who is/was taking  the medication --></subject>
 <context><!-- 0..1 Reference(Encounter|EpisodeOfCare) Encounter / Episode associated with MedicationStatement --></context>
 <effective[x]><!-- 0..1 dateTime|Period The date/time or interval when the medication is/was/will taken --></effective[x]>
 <dateAsserted value="[dateTime]"/><!-- 0..1 When the statement was asserted? -->
 <informationSource><!-- 0..1 Reference(Patient|Practitioner|RelatedPerson|
   Organization) Person or organization that provided the information about the taking of this medication --></informationSource>
 <derivedFrom><!-- 0..* Reference(Any) Additional supporting information --></derivedFrom>
 <
 <</reasonNotTaken>

 <reasonCode><!-- 0..* CodeableConcept Reason for why the medication is being/was taken --></reasonCode>
 <</reasonReference>

 <reasonReference><!-- 0..* Reference(Condition|Observation|DiagnosticReport) Condition or observation that supports why the medication is being/was taken --></reasonReference>

 <note><!-- 0..* Annotation Further information about the statement --></note>
 <dosage><!-- 0..* Dosage Details of how medication is/was taken or should be taken --></dosage>
</MedicationStatement>

JSON Template

{doco
  "resourceType" : "",

  "resourceType" : "MedicationStatement",

  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "
  "|
   
  "|

  "identifier" : [{ Identifier }], // External identifier
  "basedOn" : [{ Reference(MedicationRequest|CarePlan|ServiceRequest) }], // Fulfils plan, proposal or order
  "partOf" : [{ Reference(MedicationAdministration|MedicationDispense|

   MedicationStatement|Procedure|Observation) }], // Part of referenced event
  "
  "
  "

  "status" : "<code>", // R!  active | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken
  "statusReason" : [{ CodeableConcept }], // Reason for current status
  "category" : { CodeableConcept }, // Type of medication usage

  // medication[x]: What medication was taken. One of these 2:
  " },
  " },
  
  ">",
  " },
  "
  "|

  "medicationCodeableConcept" : { CodeableConcept },
  "medicationReference" : { Reference(Medication) },
  "subject" : { Reference(Patient|Group) }, // R!  Who is/was taking  the medication
  "context" : { Reference(Encounter|EpisodeOfCare) }, // Encounter / Episode associated with MedicationStatement
  // effective[x]: The date/time or interval when the medication is/was/will taken. One of these 2:

  "effectiveDateTime" : "<dateTime>",
  "effectivePeriod" : { Period },
  "dateAsserted" : "<dateTime>", // When the statement was asserted?
  "informationSource" : { Reference(Patient|Practitioner|RelatedPerson|

   Organization) }, // Person or organization that provided the information about the taking of this medication
  "
  "
  "
  "
  "
  "
  "
  "

  "derivedFrom" : [{ Reference(Any) }], // Additional supporting information
  "reasonCode" : [{ CodeableConcept }], // Reason for why the medication is being/was taken
  "reasonReference" : [{ Reference(Condition|Observation|DiagnosticReport) }], // Condition or observation that supports why the medication is being/was taken
  "note" : [{ Annotation }], // Further information about the statement
  "dosage" : [{ Dosage }] // Details of how medication is/was taken or should be taken

}

Turtle Template

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


[ a fhir:;

[ a fhir:MedicationStatement;

  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:MedicationStatement.identifier [ Identifier ], ... ; # 0..* External identifier
  fhir:

  fhir:MedicationStatement.basedOn [ Reference(MedicationRequest|CarePlan|ServiceRequest) ], ... ; # 0..* Fulfils plan, proposal or order

  fhir:MedicationStatement.partOf [ Reference(MedicationAdministration|MedicationDispense|MedicationStatement|Procedure|
  Observation) ], ... ; # 0..* Part of referenced event
  fhir:
  fhir:
  fhir:

  fhir:MedicationStatement.status [ code ]; # 1..1 active | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken
  fhir:MedicationStatement.statusReason [ CodeableConcept ], ... ; # 0..* Reason for current status
  fhir:MedicationStatement.category [ CodeableConcept ]; # 0..1 Type of medication usage

  # MedicationStatement.medication[x] : 1..1 What medication was taken. One of these 2
    fhir:MedicationStatement.medicationCodeableConcept [ CodeableConcept ]
    fhir:MedicationStatement.medicationReference [ Reference(Medication) ]
  # . One of these 2
    fhir: ]
    fhir: ]
  fhir:
  fhir:

  fhir:MedicationStatement.subject [ Reference(Patient|Group) ]; # 1..1 Who is/was taking  the medication
  fhir:MedicationStatement.context [ Reference(Encounter|EpisodeOfCare) ]; # 0..1 Encounter / Episode associated with MedicationStatement
  # MedicationStatement.effective[x] : 0..1 The date/time or interval when the medication is/was/will taken. One of these 2
    fhir:MedicationStatement.effectiveDateTime [ dateTime ]
    fhir:MedicationStatement.effectivePeriod [ Period ]
  fhir:MedicationStatement.dateAsserted [ dateTime ]; # 0..1 When the statement was asserted?
  fhir:MedicationStatement.informationSource [ Reference(Patient|Practitioner|RelatedPerson|Organization) ]; # 0..1 Person or organization that provided the information about the taking of this medication

  fhir:MedicationStatement.derivedFrom [ Reference(Any) ], ... ; # 0..* Additional supporting information
  fhir:
  fhir:

  fhir:MedicationStatement.reasonCode [ CodeableConcept ], ... ; # 0..* Reason for why the medication is being/was taken
  fhir:

  fhir:MedicationStatement.reasonReference [ Reference(Condition|Observation|DiagnosticReport) ], ... ; # 0..* Condition or observation that supports why the medication is being/was taken

  fhir:MedicationStatement.note [ Annotation ], ... ; # 0..* Further information about the statement
  fhir:MedicationStatement.dosage [ Dosage ], ... ; # 0..* Details of how medication is/was taken or should be taken
]

Changes since DSTU2

MedicationStatement.basedOn Added Element MedicationStatement.partOf Added Element MedicationStatement.context
MedicationStatement Added Element MedicationStatement.category Added Element MedicationStatement.informationSource Add Reference(Organization) MedicationStatement.subject Renamed from patient to subject Add Reference(Group)
MedicationStatement.derivedFrom MedicationStatement.basedOn
  • Renamed Type changed from supportingInformation Reference(MedicationRequest|CarePlan|ProcedureRequest|ReferralRequest) to derivedFrom MedicationStatement.taken Added Element MedicationStatement.reasonCode Added Element Reference(MedicationRequest|CarePlan|ServiceRequest)
MedicationStatement.reasonReference MedicationStatement.statusReason
  • Added Element
MedicationStatement.note MedicationStatement.medication[x]
  • Max Cardinality changed from 1 to * Type changed from string to Annotation Remove Reference(Medication), Add Reference(Medication)
MedicationStatement.dosage MedicationStatement.reasonReference
  • Type changed from BackboneElement Reference(Condition|Observation) to Dosage MedicationStatement.wasNotTaken deleted MedicationStatement.reasonForUse[x] deleted MedicationStatement.dosage.text deleted MedicationStatement.dosage.timing deleted MedicationStatement.dosage.asNeeded[x] deleted MedicationStatement.dosage.site[x] deleted MedicationStatement.dosage.route deleted MedicationStatement.dosage.method deleted MedicationStatement.dosage.quantity[x] deleted Reference(Condition|Observation|DiagnosticReport)
MedicationStatement.dosage.rate[x] MedicationStatement.taken
  • deleted
MedicationStatement.dosage.maxDosePerPeriod MedicationStatement.reasonNotTaken
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

See R2 <--> R3 Conversion Maps (status = 7 tests that all execute ok. All tests pass 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

MedicationStatement.category MedicationStatement.taken MedicationStatement.reasonNotTaken
Path Definition Type Reference
MedicationStatement.status A coded concept indicating the current status of a MedicationStatement. Required MedicationStatementStatus
MedicationStatement.statusReason A coded concept identifying where indicating the medication included in reason for the medicationstatement is expected to be consumed or administered Preferred MedicationStatementCategory MedicationStatement.medication[x] A coded concept identifying status of the substance or product being taken. statement Example SNOMED CT Medication Codes Drug Therapy Status codes
MedicationStatement.category A coded concept identifying level of certainty if patient has taken or has not taken where the medication included in the MedicationStatement is expected to be consumed or administered Required Preferred MedicationStatementTaken MedicationStatementCategory
MedicationStatement.medication[x] A coded concept indicating the reason why identifying the medication was not taken substance or product being taken. Example SNOMED CT Drugs not taken/completed Medication Codes
MedicationStatement.reasonCode A coded concept identifying why the medication is being taken. Example Condition/Problem/Diagnosis Codes

11.4.3.2 Constraints mst-1 : Reason not taken is only permitted if Taken is No ( expression : reasonNotTaken.exists().not() or (taken = 'n') ) 11.4.3.3 How to determine if the patient has taken the medication The MedicationStatement resource includes both a status and a taken code. The taken code conveys whether the medication was taken by the patient from the perspective of the information source. The status code reflects the current state of the practitioner’s instructions to the patient whether the consumption of the medication should continue or not. Note: Medication statements can be made about prescribed medications as well as non-prescribed (i.e. over the counter) medications. If you desire to perform a query for all medication statements that “imply” that a medication has been taken, you will need to use both MedicationStatement.status and MedicationStatement.taken in your query. The following table is intended to provide guidance on the interpretation of these two attributes with respect to the MedicationStatement. In the table below the “X” represents a valid status that can be present in combination with the Taken value. Taken Information Source Active Completed Stopped On Hold Entered in Error Intended Interpretation or Meaning N Exists (e.g. Patient or RelatedPerson) X X X Patient or related person states the medication is not currently being taken. Taken must = N. When status = Active, it means that although a statement was made that the patient isn’t taking the medication, the practitioner still expects and instructs the patient to take the medication. When status = On Hold, it means that although a statement was made that the patient isn’t taking the medication, the practitioner has suspended the medication, but intends for the patient to take the medication in the future. When status = Intended, it means that although a statement was made that the patient isn’t taking the medication, the practitioner intends for the patient to take the medication in the future. Y Exists (e.g. Patient or RelatedPerson) X X X Patient or related person states the medication is or will be taken. Taken must = Y. The status values can be any of the following: active, on hold, or intended. UNK No information source exists X X X No assertion by patient or related person of whether the medication is being consumed. The MedicationStatement still exists because it can be derived from a MedicationRequest, but it is unknown whether the Patient is taking the medication as prescribed in the MedicationRequest. NA No information source exists X X X X X X Patient reporting does not apply. For example, this can occur when MedicationStatements are derived from MedicationRequests that are administered by a practitioner. In this example, there is no need to ask for input from the patient or related person since the practitioner was responsible for the administration. Another example might be a MedicationStatement derived from an end-stated (stopped, completed, entered in error) MedicationRequest. In this example, there is no need to ask for input from the patient or related person since the MedicationRequest is no longer applicable.

Search parameters for 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
category token Returns statements of this category of medicationstatement MedicationStatement.category
code token Return statements of this medication code MedicationStatement.medication.as(CodeableConcept) 4 Resources
context reference Returns statements for a specific context (episode or episode of Care). MedicationStatement.context
( EpisodeOfCare , Encounter )
effective date Date when patient was taking (or not taking) the medication MedicationStatement.effective
identifier token Return statements with this external identifier MedicationStatement.identifier 3 Resources
medication reference Return statements of this medication reference MedicationStatement.medication.as(Reference)
( Medication )
3 Resources
part-of reference Returns statements that are part of another event. MedicationStatement.partOf
( MedicationDispense , Observation , MedicationAdministration , Procedure , MedicationStatement )
patient reference Returns statements for a specific patient. MedicationStatement.subject
( Patient )
3 Resources
source reference Who or where the information in the statement came from MedicationStatement.informationSource
( Practitioner , Organization , Patient , RelatedPerson )
status token Return statements that match the given status MedicationStatement.status 3 Resources
subject reference The identity of a patient, animal or group to list statements for MedicationStatement.subject
( Group , Patient )