HL7 FHIR Implementation Guide: minimal Common Oncology Data Elements (mCODE) Release 1 - US Realm | STU Ballot 1

HL7 FHIR Implementation Guide: minimal Common Oncology Data Elements (mCODE) Release 1 - US Realm | STU Ballot 1 - Local Development build (v0.9.1). See the Directory of published versions

MedicationStatement


<StructureDefinition xmlns="http://hl7.org/fhir">
  <id value="obf-MedicationStatement"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">
  <p><b>MedicationStatement Profile</b></p>
  <p>A record of the use of a medication (individual administration or entire course). The use may be reported by the patient or clinician and adminstration does not have to be directly observed.

Implementation note: Although FHIR supports the asserter (information source) and date asserted, it does not have a place for the author (who created and is responsible for the statement) and recorder (who entered the statement). Extensions are provided.

Conformance note: The treatment of 'not taken' has changed from DSTU2 and STU3 to R4. In R4, status and statusReason are used to indicate medications not taken. For upward compatibility, the 'not taken' attributes are profiled out.
ReasonCode is a choice of CodeableConcept or ref(Condition) in DSTU2, and limited to one reason (pick a type). In STU3 and R4, there can be multiple reason codes, and multiple reason references, simultaneously.

Implementation note: Preference is given to using the National Library of Medicine (NLM) RxNorm terminology for medications. RxNorm is a coding standard established by the Office of the National Coordinator (ONC). However, RxNorm is restricted to FDA-approved drugs and does not include clinical trial drugs. MedicationStatement allows for the inclusion of other coding systems like the NCI Thesaurus (NCIT) to represent clinical trial oncology drugs.</p>
  <p><b>Mapping Summary</b></p>
  <p><pre>obf.MedicationStatement maps to http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationstatement:
  Language maps to language
  ImplicitRules maps to implicitRules
  Metadata.VersionId maps to meta.versionId
  Metadata.SourceSystem maps to meta.source
  Metadata.Profile maps to meta.profile
  Metadata.LastUpdated maps to meta.lastUpdated
  Metadata.SecurityLabel maps to meta.security
  Metadata.Tag maps to meta.tag
  Narrative maps to text
  Identifier maps to identifier
  MedicationBasedOn maps to basedOn
  MedicationStatementPartOf maps to partOf
  Status maps to status
  StatusReason maps to statusReason
  Category maps to category
  MedicationCodeOrReference maps to medication[x]
  SubjectOfRecord maps to subject
  CareContext maps to context
  OccurrenceTimeOrPeriod maps to effective[x]
  StatementDateTime maps to dateAsserted
  MedicationInformationSource maps to informationSource
  SupportingInformation maps to derivedFrom  //erroneous attribute name in FHIR STU3, R4
  ReasonCode maps to reasonCode
  MedicationReasonReference maps to reasonReference
  Annotation maps to note
  Dosage maps to dosage
</pre></p>
</div>
  </text>
  <url
       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-MedicationStatement"/>
  <version value="0.9.1"/>
  <name value="MedicationStatement"/>
  <title value="obf-MedicationStatement"/>
  <status value="active"/>
  <experimental value="false"/>
  <date value="2019-08-01T00:00:00-04:00"/>
  <publisher value="HL7 International Clinical Interoperability Council"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/cic"/>
    </telecom>
  </contact>
  <description
               value="A record of the use of a medication (individual administration or entire course). The use may be reported by the patient or clinician and adminstration does not have to be directly observed.

Implementation note: Although FHIR supports the asserter (information source) and date asserted, it does not have a place for the author (who created and is responsible for the statement) and recorder (who entered the statement). Extensions are provided.

Conformance note: The treatment of &#39;not taken&#39; has changed from DSTU2 and STU3 to R4. In R4, status and statusReason are used to indicate medications not taken. For upward compatibility, the &#39;not taken&#39; attributes are profiled out.
ReasonCode is a choice of CodeableConcept or ref(Condition) in DSTU2, and limited to one reason (pick a type). In STU3 and R4, there can be multiple reason codes, and multiple reason references, simultaneously.

Implementation note: Preference is given to using the National Library of Medicine (NLM) RxNorm terminology for medications. RxNorm is a coding standard established by the Office of the National Coordinator (ONC). However, RxNorm is restricted to FDA-approved drugs and does not include clinical trial drugs. MedicationStatement allows for the inclusion of other coding systems like the NCI Thesaurus (NCIT) to represent clinical trial oncology drugs."/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
      <display value="United States of America"/>
    </coding>
  </jurisdiction>
  <fhirVersion value="4.0.0"/>
  <mapping>
    <identity value="argonaut-dq-dstu2"/>
    <uri value="http://unknown.org/Argonaut-DQ-DSTU2"/>
    <name value="Argonaut-DQ-DSTU2"/>
  </mapping>
  <mapping>
    <identity value="workflow"/>
    <uri value="http://hl7.org/fhir/workflow"/>
    <name value="Workflow Pattern"/>
  </mapping>
  <mapping>
    <identity value="rim"/>
    <uri value="http://hl7.org/v3"/>
    <name value="RIM Mapping"/>
  </mapping>
  <mapping>
    <identity value="w5"/>
    <uri value="http://hl7.org/fhir/fivews"/>
    <name value="FiveWs Pattern Mapping"/>
  </mapping>
  <mapping>
    <identity value="v2"/>
    <uri value="http://hl7.org/v2"/>
    <name value="HL7 v2 Mapping"/>
  </mapping>
  <kind value="resource"/>
  <abstract value="false"/>
  <type value="MedicationStatement"/>
  <baseDefinition
                  value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationstatement"/>
  <derivation value="constraint"/>
  <snapshot>
    <element id="MedicationStatement">
      <path value="MedicationStatement"/>
      <short value="obf-MedicationStatement"/>
      <definition
                  value="A record of the use of a medication (individual administration or entire course). The use may be reported by the patient or clinician and adminstration does not have to be directly observed.

Implementation note: Although FHIR supports the asserter (information source) and date asserted, it does not have a place for the author (who created and is responsible for the statement) and recorder (who entered the statement). Extensions are provided.

Conformance note: The treatment of &#39;not taken&#39; has changed from DSTU2 and STU3 to R4. In R4, status and statusReason are used to indicate medications not taken. For upward compatibility, the &#39;not taken&#39; attributes are profiled out.
ReasonCode is a choice of CodeableConcept or ref(Condition) in DSTU2, and limited to one reason (pick a type). In STU3 and R4, there can be multiple reason codes, and multiple reason references, simultaneously.

Implementation note: Preference is given to using the National Library of Medicine (NLM) RxNorm terminology for medications. RxNorm is a coding standard established by the Office of the National Coordinator (ONC). However, RxNorm is restricted to FDA-approved drugs and does not include clinical trial drugs. MedicationStatement allows for the inclusion of other coding systems like the NCI Thesaurus (NCIT) to represent clinical trial oncology drugs."/>
      <comment
               value="When interpreting a medicationStatement, the value of the status and NotTaken needed to be considered:
MedicationStatement.status + MedicationStatement.wasNotTaken
Status=Active + NotTaken=T = Not currently taking
Status=Completed + NotTaken=T = Not taken in the past
Status=Intended + NotTaken=T = No intention of taking
Status=Active + NotTaken=F = Taking, but not as prescribed
Status=Active + NotTaken=F = Taking
Status=Intended +NotTaken= F = Will be taking (not started)
Status=Completed + NotTaken=F = Taken in past
Status=In Error + NotTaken=N/A = In Error."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="MedicationStatement"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <constraint>
        <key value="dom-2"/>
        <severity value="error"/>
        <human
               value="If the resource is contained in another resource, it SHALL NOT contain nested Resources"/>
        <expression value="contained.contained.empty()"/>
        <xpath value="not(parent::f:contained and f:contained)"/>
        <source value="DomainResource"/>
      </constraint>
      <constraint>
        <key value="dom-4"/>
        <severity value="error"/>
        <human
               value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated"/>
        <expression
                    value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()"/>
        <xpath
               value="not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))"/>
        <source value="DomainResource"/>
      </constraint>
      <constraint>
        <key value="dom-3"/>
        <severity value="error"/>
        <human
               value="If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource"/>
        <expression
                    value="contained.where(((&#39;#&#39;+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = &#39;#&#39;).exists() or descendants().where(as(canonical) = &#39;#&#39;).exists() or descendants().where(as(canonical) = &#39;#&#39;).exists()).not()).trace(&#39;unmatched&#39;, id).empty()"/>
        <xpath
               value="not(exists(for $contained in f:contained return $contained[not(parent::*/descendant::f:reference/@value=concat(&#39;#&#39;, $contained/*/id/@value) or descendant::f:reference[@value=&#39;#&#39;])]))"/>
        <source value="DomainResource"/>
      </constraint>
      <constraint>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice">
          <valueBoolean value="true"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation">
          <valueMarkdown
                         value="When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."/>
        </extension>
        <key value="dom-6"/>
        <severity value="warning"/>
        <human value="A resource should have narrative for robust management"/>
        <expression value="text.div.exists()"/>
        <xpath value="exists(f:text/h:div)"/>
        <source value="DomainResource"/>
      </constraint>
      <constraint>
        <key value="dom-5"/>
        <severity value="error"/>
        <human
               value="If a resource is contained in another resource, it SHALL NOT have a security label"/>
        <expression value="contained.meta.security.empty()"/>
        <xpath value="not(exists(f:contained/*/f:meta/f:security))"/>
        <source value="DomainResource"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="Entity. Role, or Act"/>
      </mapping>
      <mapping>
        <identity value="workflow"/>
        <map value="Event"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="SubstanceAdministration"/>
      </mapping>
      <mapping>
        <identity value="argonaut-dq-dstu2"/>
        <map value="MedicationStatement"/>
      </mapping>
    </element>
    <element id="MedicationStatement.id">
      <path value="MedicationStatement.id"/>
      <short value="Logical id of this artifact"/>
      <definition
                  value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes."/>
      <comment
               value="The only time that a resource does not have an id is when it is being submitted to the server using a create operation."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Resource.id"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="id"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
    </element>
    <element id="MedicationStatement.meta">
      <path value="MedicationStatement.meta"/>
      <short value="Metadata about the resource"/>
      <definition
                  value="The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Resource.meta"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Meta"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
    </element>
    <element id="MedicationStatement.implicitRules">
      <path value="MedicationStatement.implicitRules"/>
      <short value="A set of rules under which this content was created"/>
      <definition
                  value="A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc."/>
      <comment
               value="Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it&#39;s narrative along with other profiles, value sets, etc."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Resource.implicitRules"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="uri"/>
      </type>
      <isModifier value="true"/>
      <isModifierReason
                        value="This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it&#39;s meaning or interpretation"/>
      <isSummary value="true"/>
    </element>
    <element id="MedicationStatement.language">
      <path value="MedicationStatement.language"/>
      <short value="Language of the resource content"/>
      <definition value="The base language in which the resource is written."/>
      <comment
               value="Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies  to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Resource.language"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="code"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet">
          <valueCanonical value="http://hl7.org/fhir/ValueSet/all-languages"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="Language"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding">
          <valueBoolean value="true"/>
        </extension>
        <strength value="preferred"/>
        <description value="A human language."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/languages"/>
      </binding>
    </element>
    <element id="MedicationStatement.text">
      <path value="MedicationStatement.text"/>
      <short value="Text summary of the resource, for human interpretation"/>
      <definition
                  value="A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it &quot;clinically safe&quot; for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety."/>
      <comment
               value="Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied).  This may be necessary for data from legacy systems where information is captured as a &quot;text blob&quot; or where text is additionally entered raw or narrated and encoded information is added later."/>
      <alias value="narrative"/>
      <alias value="html"/>
      <alias value="xhtml"/>
      <alias value="display"/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="DomainResource.text"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Narrative"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="Act.text?"/>
      </mapping>
    </element>
    <element id="MedicationStatement.contained">
      <path value="MedicationStatement.contained"/>
      <short value="Contained, inline Resources"/>
      <definition
                  value="These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope."/>
      <comment
               value="This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels."/>
      <alias value="inline resources"/>
      <alias value="anonymous resources"/>
      <alias value="contained resources"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="DomainResource.contained"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Resource"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="MedicationStatement.extension">
      <path value="MedicationStatement.extension"/>
      <slicing id="1">
        <discriminator>
          <type value="value"/>
          <path value="url"/>
        </discriminator>
        <ordered value="false"/>
        <rules value="open"/>
      </slicing>
      <short value="Additional content defined by implementations"/>
      <definition
                  value="May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
      <comment
               value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="DomainResource.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="MedicationStatement.extension:treatmentintent">
      <path value="MedicationStatement.extension"/>
      <sliceName value="treatmentintent"/>
      <definition value="The purpose of a treatment."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="DomainResource.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile
                 value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-TreatmentIntent-extension"/>
      </type>
      <mustSupport value="true"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="MedicationStatement.extension:terminationreason">
      <path value="MedicationStatement.extension"/>
      <sliceName value="terminationreason"/>
      <definition
                  value="A code explaining unplanned or premature termination of a plan of treatment, course of medication, or research study."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="DomainResource.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile
                 value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-TerminationReason-extension"/>
      </type>
      <mustSupport value="true"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="MedicationStatement.extension:terminationreason.id">
      <path value="MedicationStatement.extension.id"/>
      <representation value="xmlAttr"/>
      <short value="Unique id for inter-element referencing"/>
      <definition
                  value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Element.id"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="string"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="MedicationStatement.extension:terminationreason.extension">
      <path value="MedicationStatement.extension.extension"/>
      <slicing>
        <discriminator>
          <type value="value"/>
          <path value="url"/>
        </discriminator>
        <description value="Extensions are always sliced by (at least) url"/>
        <rules value="open"/>
      </slicing>
      <short value="Additional content defined by implementations"/>
      <definition
                  value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
      <comment
               value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <min value="0"/>
      <max value="0"/>
      <base>
        <path value="Element.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="MedicationStatement.extension:terminationreason.url">
      <path value="MedicationStatement.extension.url"/>
      <representation value="xmlAttr"/>
      <short value="identifies the meaning of the extension"/>
      <definition
                  value="Source of the definition for the extension code - a logical name or a URL."/>
      <comment
               value="The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="Extension.url"/>
        <min value="1"/>
        <max value="1"/>
      </base>
      <type>
        <code value="uri"/>
      </type>
      <fixedUri
                value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-TerminationReason-extension"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element
             id="MedicationStatement.extension:terminationreason.valueCodeableConcept">
      <path value="MedicationStatement.extension.valueCodeableConcept"/>
      <short value="Value of extension"/>
      <definition
                  value="Value of extension - must be one of a constrained set of the data types (see [Extensibility](extensibility.html) for a list)."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="Extension.value[x]"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <strength value="required"/>
        <valueSet
                  value="http://hl7.org/fhir/us/mcode/ValueSet/obf-TreatmentTerminationReasonVS"/>
      </binding>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="MedicationStatement.modifierExtension">
      <path value="MedicationStatement.modifierExtension"/>
      <short value="Extensions that cannot be ignored"/>
      <definition
                  value="May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element&#39;s descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
      <comment
               value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
      <requirements
                    value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored.  This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="DomainResource.modifierExtension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <isModifier value="true"/>
      <isModifierReason
                        value="Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="MedicationStatement.identifier">
      <path value="MedicationStatement.identifier"/>
      <short value="External identifier"/>
      <definition
                  value="Identifiers associated with this Medication Statement 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."/>
      <comment value="This is a business identifier, not a resource identifier."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="MedicationStatement.identifier"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Identifier"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.identifier"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.identifier"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".id"/>
      </mapping>
    </element>
    <element id="MedicationStatement.basedOn">
      <path value="MedicationStatement.basedOn"/>
      <short value="Fulfils plan, proposal or order"/>
      <definition
                  value="A plan, proposal or order that is fulfilled in whole or in part by this event."/>
      <requirements
                    value="Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="MedicationStatement.basedOn"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/StructureDefinition/ServiceRequest"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.basedOn"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map
             value=".outboundRelationship[typeCode=FLFS].target[classCode=SBADM or PROC or PCPR or OBS, moodCode=RQO orPLAN or PRP]"/>
      </mapping>
    </element>
    <element id="MedicationStatement.partOf">
      <path value="MedicationStatement.partOf"/>
      <short value="Part of referenced event"/>
      <definition
                  value="A larger event of which this particular event is a component or step."/>
      <requirements
                    value="This should not be used when indicating which resource a MedicationStatement has been derived from.  If that is the use case, then MedicationStatement.derivedFrom should be used."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="MedicationStatement.partOf"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/StructureDefinition/MedicationAdministration"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-MedicationStatement"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Procedure"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Observation"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.partOf"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map
             value=".outboundRelationship[typeCode=COMP]/target[classCode=SPLY or SBADM or PROC or OBS,moodCode=EVN]"/>
      </mapping>
    </element>
    <element id="MedicationStatement.status">
      <path value="MedicationStatement.status"/>
      <short
             value="active | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken"/>
      <definition
                  value="A code representing the patient or other source&#39;s judgment about the state of the medication used that this statement is about.  Generally, this will be active or completed."/>
      <comment
               value="MedicationStatement is a statement at a point in time.  The status is only representative at the point when it was asserted.  The value set for MedicationStatement.status contains codes that assert the status of the use of the medication by the patient (for example, stopped or on hold) as well as codes that assert the status of the medication statement itself (for example, entered in error).

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="MedicationStatement.status"/>
        <min value="1"/>
        <max value="1"/>
      </base>
      <type>
        <code value="code"/>
      </type>
      <mustSupport value="true"/>
      <isModifier value="true"/>
      <isModifierReason
                        value="This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid"/>
      <isSummary value="true"/>
      <binding>
        <strength value="required"/>
        <description
                     value="A set of codes indicating the current status of a MedicationStatement."/>
        <valueSet
                  value="http://hl7.org/fhir/ValueSet/medication-statement-status"/>
      </binding>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.status"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.status"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".statusCode"/>
      </mapping>
      <mapping>
        <identity value="argonaut-dq-dstu2"/>
        <map value="MedicationStatement.status"/>
      </mapping>
    </element>
    <element id="MedicationStatement.statusReason">
      <path value="MedicationStatement.statusReason"/>
      <short value="Reason for current status"/>
      <definition
                  value="Captures the reason for the current state of the MedicationStatement."/>
      <comment
               value="This is generally only used for &quot;exception&quot; statuses such as &quot;not-taken&quot;, &quot;on-hold&quot;, &quot;cancelled&quot; or &quot;entered-in-error&quot;. The reason for performing the event at all is captured in reasonCode, not here."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="MedicationStatement.statusReason"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="MedicationStatementStatusReason"/>
        </extension>
        <strength value="example"/>
        <description
                     value="A coded concept indicating the reason for the status of the statement."/>
        <valueSet
                  value="http://hl7.org/fhir/ValueSet/reason-medication-status-codes"/>
      </binding>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.statusReason"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map
             value=".inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde"/>
      </mapping>
    </element>
    <element id="MedicationStatement.category">
      <path value="MedicationStatement.category"/>
      <short value="Type of medication usage"/>
      <definition
                  value="Indicates where the medication is expected to be consumed or administered."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="MedicationStatement.category"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <binding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="MedicationStatementCategory"/>
        </extension>
        <strength value="preferred"/>
        <description
                     value="A coded concept identifying where the medication included in the MedicationStatement is expected to be consumed or administered."/>
        <valueSet
                  value="http://hl7.org/fhir/ValueSet/medication-statement-category"/>
      </binding>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.class"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map
             value=".inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code=&quot;type of medication usage&quot;].value"/>
      </mapping>
    </element>
    <element id="MedicationStatement.medication[x]">
      <path value="MedicationStatement.medication[x]"/>
      <short value="What medication was taken"/>
      <definition
                  value="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."/>
      <comment
               value="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, then you must reference the Medication resource."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="MedicationStatement.medication[x]"/>
        <min value="1"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication"/>
      </type>
      <mustSupport value="true"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <binding>
        <strength value="extensible"/>
        <description value="Prescribable medications"/>
        <valueSet
                  value="http://hl7.org/fhir/us/core/ValueSet/us-core-medication-codes"/>
      </binding>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.code"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.what[x]"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".participation[typeCode=CSM].role[classCode=ADMM or MANU]"/>
      </mapping>
      <mapping>
        <identity value="argonaut-dq-dstu2"/>
        <map value="MedicationStatement.medication[x]"/>
      </mapping>
    </element>
    <element id="MedicationStatement.subject">
      <path value="MedicationStatement.subject"/>
      <short value="Who is/was taking  the medication"/>
      <definition
                  value="The person, animal or group who is/was taking the medication."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="MedicationStatement.subject"/>
        <min value="1"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Patient"/>
      </type>
      <mustSupport value="true"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.subject"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.subject[x]"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="PID-3-Patient ID List"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".participation[typeCode=SBJ].role[classCode=PAT]"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.subject"/>
      </mapping>
      <mapping>
        <identity value="argonaut-dq-dstu2"/>
        <map value="MedicationStatement.patient"/>
      </mapping>
    </element>
    <element id="MedicationStatement.context">
      <path value="MedicationStatement.context"/>
      <short value="Encounter / Episode associated with MedicationStatement"/>
      <definition
                  value="The encounter or episode of care that establishes the context for this MedicationStatement."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="MedicationStatement.context"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter"/>
        <targetProfile
                       value="http://hl7.org/fhir/StructureDefinition/EpisodeOfCare"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.context"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map
             value=".inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code=&quot;type of encounter or episode&quot;]"/>
      </mapping>
    </element>
    <element id="MedicationStatement.effective[x]">
      <path value="MedicationStatement.effective[x]"/>
      <short
             value="The date/time or interval when the medication is/was/will be taken"/>
      <definition
                  value="The interval of time during which it is being asserted that the patient is/was/will be taking the medication (or was not taking, when the MedicationStatement.taken element is No)."/>
      <comment
               value="This attribute reflects the period over which the patient consumed the medication and is expected to be populated on the majority of Medication Statements. If the medication is still being taken at the time the statement is recorded, the &quot;end&quot; date will be omitted.  The date/time attribute supports a variety of dates - year, year/month and exact date.  If something more than this is required, this should be conveyed as text."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="MedicationStatement.effective[x]"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="dateTime"/>
      </type>
      <type>
        <code value="Period"/>
      </type>
      <mustSupport value="true"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.occurrence[x]"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.done[x]"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".effectiveTime"/>
      </mapping>
      <mapping>
        <identity value="argonaut-dq-dstu2"/>
        <map value="MedicationStatement.effective[x]"/>
      </mapping>
    </element>
    <element id="MedicationStatement.dateAsserted">
      <path value="MedicationStatement.dateAsserted"/>
      <short value="When the statement was asserted?"/>
      <definition
                  value="The date when the medication statement was asserted by the information source."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="MedicationStatement.dateAsserted"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="dateTime"/>
      </type>
      <mustSupport value="true"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.recorded"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".participation[typeCode=AUT].time"/>
      </mapping>
      <mapping>
        <identity value="argonaut-dq-dstu2"/>
        <map value="MedicationStatement.dateAsserted"/>
      </mapping>
    </element>
    <element id="MedicationStatement.informationSource">
      <path value="MedicationStatement.informationSource"/>
      <short
             value="Person or organization that provided the information about the taking of this medication"/>
      <definition
                  value="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. Claim or MedicationRequest."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="MedicationStatement.informationSource"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Patient"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner"/>
        <targetProfile
                       value="http://hl7.org/fhir/StructureDefinition/RelatedPerson"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.source"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map
             value=".participation[typeCode=INF].role[classCode=PAT, or codes for Practioner or Related Person (if PAT is the informer, then syntax for self-reported =true)"/>
      </mapping>
    </element>
    <element id="MedicationStatement.derivedFrom">
      <path value="MedicationStatement.derivedFrom"/>
      <short value="Additional supporting information"/>
      <definition
                  value="Allows linking the MedicationStatement to the underlying MedicationRequest, or to other information that supports or is used to derive the MedicationStatement."/>
      <comment
               value="Likely references would be to [US Core MedicationRequest Profile](http://hl7.org/fhir/us/core/StructureDefinition-us-core-medicationrequest.html), MedicationDispense, Claim, Observation or QuestionnaireAnswers.  The most common use cases for deriving a MedicationStatement comes from creating a MedicationStatement from a MedicationRequest or from a lab observation or a claim.  it should be noted that the amount of information that is available varies from the type resource that you derive the MedicationStatement from."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="MedicationStatement.derivedFrom"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Resource"/>
      </type>
      <mustSupport value="true"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map
             value=".outboundRelationship[typeCode=SPRT]/target[classCode=ACT,moodCode=EVN]"/>
      </mapping>
      <mapping>
        <identity value="argonaut-dq-dstu2"/>
        <map value="NA (new element in STU3)"/>
      </mapping>
    </element>
    <element id="MedicationStatement.reasonCode">
      <path value="MedicationStatement.reasonCode"/>
      <short value="Reason for why the medication is being/was taken"/>
      <definition value="A reason for why the medication is being/was taken."/>
      <comment
               value="This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonForUseReference."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="MedicationStatement.reasonCode"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="MedicationReason"/>
        </extension>
        <strength value="example"/>
        <description
                     value="A coded concept identifying why the medication is being taken."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/condition-code"/>
      </binding>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.reasonCode"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.why[x]"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".reasonCode"/>
      </mapping>
    </element>
    <element id="MedicationStatement.reasonReference">
      <path value="MedicationStatement.reasonReference"/>
      <short
             value="Condition or observation that supports why the medication is being/was taken"/>
      <definition
                  value="Condition or observation that supports why the medication is being/was taken"/>
      <comment
               value="This is a reference to a condition that is the reason why the medication is being/was taken.  If only a code exists, use reasonForUseCode."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="MedicationStatement.reasonReference"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Condition"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Observation"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-DiagnosticReport"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.reasonReference"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.why[x]"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map
             value=".outboundRelationship[typeCode=RSON]/target[classCode=OBS,moodCode=EVN, code=&quot;reason for use&quot;].value"/>
      </mapping>
    </element>
    <element id="MedicationStatement.note">
      <path value="MedicationStatement.note"/>
      <short value="Further information about the statement"/>
      <definition
                  value="Provides extra information about the medication statement that is not conveyed by the other attributes."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="MedicationStatement.note"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Annotation"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.note"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map
             value=".inboundRelationship[typeCode=SUBJ]/source[classCode=OBS,moodCode=EVN,code=&quot;annotation&quot;].value"/>
      </mapping>
    </element>
    <element id="MedicationStatement.dosage">
      <path value="MedicationStatement.dosage"/>
      <short value="Details of how medication is/was taken or should be taken"/>
      <definition
                  value="Indicates how the medication is/was or should be taken by the patient."/>
      <comment
               value="The dates included in the dosage on a Medication Statement reflect the dates for a given dose.  For example, &quot;from November 1, 2016 to November 3, 2016, take one tablet daily and from November 4, 2016 to November 7, 2016, take two tablets daily.&quot;  It is expected that this specificity may only be populated where the patient brings in their labeled container or where the Medication Statement is derived from a MedicationRequest."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="MedicationStatement.dosage"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Dosage"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="refer dosageInstruction mapping"/>
      </mapping>
    </element>
  </snapshot>
  <differential>
    <element id="MedicationStatement">
      <path value="MedicationStatement"/>
      <short value="obf-MedicationStatement"/>
      <definition
                  value="A record of the use of a medication (individual administration or entire course). The use may be reported by the patient or clinician and adminstration does not have to be directly observed.

Implementation note: Although FHIR supports the asserter (information source) and date asserted, it does not have a place for the author (who created and is responsible for the statement) and recorder (who entered the statement). Extensions are provided.

Conformance note: The treatment of &#39;not taken&#39; has changed from DSTU2 and STU3 to R4. In R4, status and statusReason are used to indicate medications not taken. For upward compatibility, the &#39;not taken&#39; attributes are profiled out.
ReasonCode is a choice of CodeableConcept or ref(Condition) in DSTU2, and limited to one reason (pick a type). In STU3 and R4, there can be multiple reason codes, and multiple reason references, simultaneously.

Implementation note: Preference is given to using the National Library of Medicine (NLM) RxNorm terminology for medications. RxNorm is a coding standard established by the Office of the National Coordinator (ONC). However, RxNorm is restricted to FDA-approved drugs and does not include clinical trial drugs. MedicationStatement allows for the inclusion of other coding systems like the NCI Thesaurus (NCIT) to represent clinical trial oncology drugs."/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="MedicationStatement.extension">
      <path value="MedicationStatement.extension"/>
      <slicing id="1">
        <discriminator>
          <type value="value"/>
          <path value="url"/>
        </discriminator>
        <ordered value="false"/>
        <rules value="open"/>
      </slicing>
    </element>
    <element id="MedicationStatement.extension:treatmentintent">
      <path value="MedicationStatement.extension"/>
      <sliceName value="treatmentintent"/>
      <definition value="The purpose of a treatment."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="DomainResource.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile
                 value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-TreatmentIntent-extension"/>
      </type>
      <mustSupport value="true"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="MedicationStatement.extension:terminationreason">
      <path value="MedicationStatement.extension"/>
      <sliceName value="terminationreason"/>
      <definition
                  value="A code explaining unplanned or premature termination of a plan of treatment, course of medication, or research study."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="DomainResource.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile
                 value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-TerminationReason-extension"/>
      </type>
      <mustSupport value="true"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element
             id="MedicationStatement.extension:terminationreason.valueCodeableConcept">
      <path value="MedicationStatement.extension.valueCodeableConcept"/>
      <binding>
        <strength value="required"/>
        <valueSet
                  value="http://hl7.org/fhir/us/mcode/ValueSet/obf-TreatmentTerminationReasonVS"/>
      </binding>
    </element>
    <element id="MedicationStatement.basedOn">
      <path value="MedicationStatement.basedOn"/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/StructureDefinition/ServiceRequest"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest"/>
      </type>
    </element>
    <element id="MedicationStatement.partOf">
      <path value="MedicationStatement.partOf"/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/StructureDefinition/MedicationAdministration"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-MedicationStatement"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Procedure"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Observation"/>
      </type>
    </element>
    <element id="MedicationStatement.subject">
      <path value="MedicationStatement.subject"/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Patient"/>
      </type>
    </element>
    <element id="MedicationStatement.context">
      <path value="MedicationStatement.context"/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter"/>
        <targetProfile
                       value="http://hl7.org/fhir/StructureDefinition/EpisodeOfCare"/>
      </type>
    </element>
    <element id="MedicationStatement.effective[x]">
      <path value="MedicationStatement.effective[x]"/>
      <min value="1"/>
      <max value="1"/>
    </element>
    <element id="MedicationStatement.informationSource">
      <path value="MedicationStatement.informationSource"/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Patient"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner"/>
        <targetProfile
                       value="http://hl7.org/fhir/StructureDefinition/RelatedPerson"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization"/>
      </type>
    </element>
    <element id="MedicationStatement.reasonCode">
      <path value="MedicationStatement.reasonCode"/>
      <min value="0"/>
      <max value="1"/>
    </element>
    <element id="MedicationStatement.reasonReference">
      <path value="MedicationStatement.reasonReference"/>
      <definition
                  value="Condition or observation that supports why the medication is being/was taken"/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Condition"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Observation"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-DiagnosticReport"/>
      </type>
    </element>
    <element id="MedicationStatement.dosage">
      <path value="MedicationStatement.dosage"/>
      <min value="0"/>
      <max value="1"/>
    </element>
  </differential>
</StructureDefinition>