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Medication

The SHR Medication domain contains definitions related to medications taken, or not taken, by the person of record, both currently and in the past.

AdditionalDoseInstruction

Supplemental instructions - e.g. 'with meals'. C1644714

Value:  CodeableConcept A set of codes drawn from different coding systems, representing the same concept.

Adherence [Entry]

The degree (frequency) that the stated treatment plan, prescription, or protocol was followed. A statement of the ability and cooperation of the patient in taking medicine or supplement as recommended or prescribed. This includes correct timing, dosage, and frequency. C2364172

Based On BehavioralFinding

Value:  CodeableConcept must be from QualitativeFrequencyVS A set of codes drawn from different coding systems, representing the same concept.
ObservationCode is C2364172 required A code that represents what the finding concerns, for example, the subject's height, blood pressure, disease status, wound dimensions, diabetes risk, etc. Although named ObservationCode, in different contexts the same attribute might be more naturally referred to as a property, observable, or test code. In assertions (observations without an explicit question), the observation code is defaulted to a value representing 'assertion'.
ReasonForBehavior must be from MedicationNonAdherenceReasonVS 0 or more Why the behavior has taken or is taking place.
Category includes Behavior (54511-1) 0 or more A class or division of people or things having particular shared characteristics
ReadinessToChange optional How motivated the subject is to change the behavior, if the behavior is ongoing, and change would be beneficial.
Outcome 0 or more The result of performing an action or behavior, for example, an adverse reaction or new finding.
Specimen not used Sample for analysis
Device not used A specific durable physical device used in diagnosis or treatment. The value is the coding for a type of device, for example, a CPAP machine. The same device might be used on multiple patients.
ReferenceRange not used The usual or acceptable range for a test result.
ValueAbsentReason optional Provides a reason why the value of the observation is missing, if it is expected (some observations are not expected to have a value).
ClinicallyRelevantTime optional The time or time period that the finding addresses. The clinically relevant time is not necessarily when the information is gathered or when a test is carried out, but for example, when a specimen was collected, or the time period referred to by the question. Use a TimePeriod for a measurement or specimen collection continued over a significant period of time (e.g. 24 hour Urine Sodium).
FindingStatus required Indicates whether the finding is preliminary, amended, final, etc..
BodySite optional A location or structure in the body, including tissues, regions, cavities, and spaces, for example, right elbow, or left ventricle of the heart.
ChangeFlag optional Indicator of significant change (delta) from the last or previous measurement.
Details optional An text note containing additional details, explanation, description, comment, or summarization. Details can discuss, support, explain changes to, or dispute information.
Interpretation optional A clinical interpretation of a finding.
ObservationQualifier 0 or more A description of the conditions or context of an observation, for example, under sedation, fasting or post-exercise. Body position and body site are also qualifiers, but handled separately. A qualifier cannot modify the measurement type; for example, a fasting blood sugar is still a blood sugar.
Components optional Components are parts of the parent observation. Component observations share the same attributes (such as Specimen) as the primary observation and are not separable. However, the reference range may be different for each component observation.
Subject optional The person or thing that this entry relates to, usually the Person of Record. However, not all entries have health information specifically about the patient, but in different contexts, could refer to a fetus, family member (living or dead), device, location, organization, finding, condition, or intervention.
FocalSubject optional For use when FHIR's subject does not allow the desired type of Subject in the Finding.Subject field.
FindingMethod optional The technique used to create the finding, for example, the specific imaging technical or assessment vehicle.
Evidence 0 or more A symptom, observation, or other item, for example, a radiology report, that serves as evidence for the current assessment.
RelatedEncounter optional If content was generated during a patient encounter, related encounter is the encounter where the information was gained.
Author optional The person or organization who created the entry and is responsible for (and may certify) the content.
Informant optional The person or entity that provided the information in the entry, as distinct from who created the entry, e.g. the subject (patient), medical professional, family member, device or software program.

AdministrationBodySite

The anatomic site at which medical intervention is applied. C0229986

Value:  BodySite A location or structure in the body, including tissues, regions, cavities, and spaces, for example, right elbow, or left ventricle of the heart.

AdministrationMethod

Technique for administering medication. C1547585

Value:  CodeableConcept A set of codes drawn from different coding systems, representing the same concept.

AmountOfMedication

A standardized measure or discrete amount of medication serving as a reference for dosing or strength, for example, 1 tablet.

Value:  Quantity A quantity with units, whose value may be bounded from above or below, as defined in FHIR

AmountPerDose

The amount of medication taken at each dose, as a quantity or range.

Value:  Choice
         |  SimpleQuantity required A quantity where the comparator is not used, as defined in FHIR
         |  Range required An interval defined by a quantitative upper and/or lower bound. One of the two bounds must be specified, and the lower bound must be less than the upper bound. When Quantities are specified, the units of measure must be the same.

AsNeededIndicator

Indicates the pre-condition under which the drug or intervention should be used. C1883728

Value:  Choice
         |  boolean required
         |  CodeableConcept could be from http://hl7.org/fhir/ValueSet/medication-as-needed-reason required A set of codes drawn from different coding systems, representing the same concept.

Dosage

The dosage of the medication as prescribed. Do not include if dosage was not known. C0178602

AmountPerDose required The amount of medication taken at each dose, as a quantity or range.
TimingOfDoses required When doses of medication should be administered.
AsNeededIndicator required Indicates the pre-condition under which the drug or intervention should be used.
DoseInstructionsText optional The directions (signetur) on the drug prescription or dispensing record.
AdditionalDoseInstruction must be from http://hl7.org/fhir/ValueSet/additional-instruction-codes 0 or more Supplemental instructions - e.g. 'with meals'.
RouteIntoBody optional The way a substance enters an organism after contact, particularly, the route of drug administration.
AdministrationMethod must be from http://hl7.org/fhir/ValueSet/administration-method-codes optional Technique for administering medication.
AdministrationBodySite optional The anatomic site at which medical intervention is applied.
MaximumDosePerTimePeriod optional The maximum amount of a medication to be taken in a given period of time (e.g., no more than x in any 24-hour period)

DoseInstructionsText

The directions (signetur) on the drug prescription or dispensing record.

Value:  string

MaximumDosePerTimePeriod

The maximum amount of a medication to be taken in a given period of time (e.g., no more than x in any 24-hour period)

Value:  Ratio A unit of measurement for the quotient of the amount of one entity to another.

MedicationAfterChange

The medication taken, prior to the change.

Value:  Choice
         |  MedicationRequested required An order for a medication to be dispensed and instructions for use.
         |  MedicationUsed required A record of the use of a medication.

MedicationBeforeChange

The medication taken, prior to the change.

Value:  Choice
         |  MedicationRequested required An order for a medication to be dispensed and instructions for use.
         |  MedicationUsed required A record of the use of a medication.

MedicationChangeTopic [Entry]

Description of a modification or change of a medication or dosage. C0554834

Based On ActionTopic

ActionContext must be a PerformedContext must be from MedicationChangeReasonVS required The ontological status of the intervention, e.g., performed/not performed, requested/not requested.
         where  Reason must be from http://hl7.org/fhir/ValueSet/no-immunization-reason must be from MedicationChangeReasonVS The justification for an action or non-action, conclusion, opinion, etc.
Type must be from MedicationChangeTypeVS required The most specific code (lowest level term) describing the kind or sort of thing being represented.
MedicationBeforeChange 0 or more The medication taken, prior to the change.
MedicationAfterChange 0 or more The medication taken, prior to the change.
Category 0 or more A class or division of people or things having particular shared characteristics
RelatedEncounter optional If content was generated during a patient encounter, related encounter is the encounter where the information was gained.
Author optional The person or organization who created the entry and is responsible for (and may certify) the content.
Informant optional The person or entity that provided the information in the entry, as distinct from who created the entry, e.g. the subject (patient), medical professional, family member, device or software program.

MedicationDispensed

Indicates that a medication product has been dispensed for a named person/patient. This includes a description of the medication product (supply) provided and the instructions for administering the medication. The medication dispense is the result of a pharmacy system responding to a medication order.

Based On MedicationDispenseTopic

ActionContext must be a PerformedContext required The ontological status of the intervention, e.g., performed/not performed, requested/not requested.
NumberOfRefillsAllowed optional The maximum number of times the dispense can be repeated. For medication dispense, this integer does NOT include the original order dispense. This means that if an order indicates dispense 30 tablets plus 3 repeats, then the order can be dispensed a total of 4 times and the patient can receive a total of 120 tablets.
QuantityPerDispense optional The amount that is to be dispensed for one fill.
SupplyDuration optional Identifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last.
MedicationOrCode required A medication entity or a medication code.
Dosage optional The dosage of the medication as prescribed. Do not include if dosage was not known.
Type optional The most specific code (lowest level term) describing the kind or sort of thing being represented.
Category 0 or more A class or division of people or things having particular shared characteristics
RelatedEncounter optional If content was generated during a patient encounter, related encounter is the encounter where the information was gained.
Author optional The person or organization who created the entry and is responsible for (and may certify) the content.
Informant optional The person or entity that provided the information in the entry, as distinct from who created the entry, e.g. the subject (patient), medical professional, family member, device or software program.

MedicationDispenseTopic [Entry]

The action of ordering and deliving a medication to the party responsible for administering the medication.

Based On MedicationTopic

NumberOfRefillsAllowed optional The maximum number of times the dispense can be repeated. For medication dispense, this integer does NOT include the original order dispense. This means that if an order indicates dispense 30 tablets plus 3 repeats, then the order can be dispensed a total of 4 times and the patient can receive a total of 120 tablets.
QuantityPerDispense optional The amount that is to be dispensed for one fill.
SupplyDuration optional Identifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last.
MedicationOrCode required A medication entity or a medication code.
Dosage optional The dosage of the medication as prescribed. Do not include if dosage was not known.
Type optional The most specific code (lowest level term) describing the kind or sort of thing being represented.
Category 0 or more A class or division of people or things having particular shared characteristics
ActionContext required The ontological status of the intervention, e.g., performed/not performed, requested/not requested.
RelatedEncounter optional If content was generated during a patient encounter, related encounter is the encounter where the information was gained.
Author optional The person or organization who created the entry and is responsible for (and may certify) the content.
Informant optional The person or entity that provided the information in the entry, as distinct from who created the entry, e.g. the subject (patient), medical professional, family member, device or software program.

MedicationNotDispensed

Indicates that a medication product has NOT been dispensed for a named person/patient. This may be a result of the timing out of an order or detection of pharmacist of duplicate prescription or other reason.

Based On MedicationDispenseTopic

ActionContext must be a NotPerformedContext required The ontological status of the intervention, e.g., performed/not performed, requested/not requested.
NumberOfRefillsAllowed optional The maximum number of times the dispense can be repeated. For medication dispense, this integer does NOT include the original order dispense. This means that if an order indicates dispense 30 tablets plus 3 repeats, then the order can be dispensed a total of 4 times and the patient can receive a total of 120 tablets.
QuantityPerDispense optional The amount that is to be dispensed for one fill.
SupplyDuration optional Identifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last.
MedicationOrCode required A medication entity or a medication code.
Dosage optional The dosage of the medication as prescribed. Do not include if dosage was not known.
Type optional The most specific code (lowest level term) describing the kind or sort of thing being represented.
Category 0 or more A class or division of people or things having particular shared characteristics
RelatedEncounter optional If content was generated during a patient encounter, related encounter is the encounter where the information was gained.
Author optional The person or organization who created the entry and is responsible for (and may certify) the content.
Informant optional The person or entity that provided the information in the entry, as distinct from who created the entry, e.g. the subject (patient), medical professional, family member, device or software program.

MedicationNotRequested [Entry]

A record of a medication NOT prescribed. Recorded only when deviating from the normal expectation, care plan, or standard of care.

Based On MedicationTopic

ActionContext must be a RequestedAgainstContext must be from MedicationNotUsedReasonVS required The ontological status of the intervention, e.g., performed/not performed, requested/not requested.
         where  Reason must be from http://hl7.org/fhir/ValueSet/no-immunization-reason must be from MedicationChangeReasonVS must be from MedicationNotUsedReasonVS The justification for an action or non-action, conclusion, opinion, etc.
MedicationOrCode required A medication entity or a medication code.
Dosage optional The dosage of the medication as prescribed. Do not include if dosage was not known.
Type optional The most specific code (lowest level term) describing the kind or sort of thing being represented.
Category 0 or more A class or division of people or things having particular shared characteristics
RelatedEncounter optional If content was generated during a patient encounter, related encounter is the encounter where the information was gained.
Author optional The person or organization who created the entry and is responsible for (and may certify) the content.
Informant optional The person or entity that provided the information in the entry, as distinct from who created the entry, e.g. the subject (patient), medical professional, family member, device or software program.

MedicationNotUsed [Entry]

A record of a medication NOT used. Although usually not required, a medication not used is sometimes reported when deviating from normal expectation or care plan.

Based On MedicationTopic

ActionContext must be a NotPerformedContext must be from MedicationNotUsedReasonVS required The ontological status of the intervention, e.g., performed/not performed, requested/not requested.
         where  Reason must be from http://hl7.org/fhir/ValueSet/no-immunization-reason must be from MedicationChangeReasonVS must be from MedicationNotUsedReasonVS must be from MedicationNotUsedReasonVS The justification for an action or non-action, conclusion, opinion, etc.
Category should be from http://hl7.org/fhir/ValueSet/medication-statement-category optional A class or division of people or things having particular shared characteristics
Dosage not used The dosage of the medication as prescribed. Do not include if dosage was not known.
MedicationOrCode required A medication entity or a medication code.
Type optional The most specific code (lowest level term) describing the kind or sort of thing being represented.
RelatedEncounter optional If content was generated during a patient encounter, related encounter is the encounter where the information was gained.
Author optional The person or organization who created the entry and is responsible for (and may certify) the content.
Informant optional The person or entity that provided the information in the entry, as distinct from who created the entry, e.g. the subject (patient), medical professional, family member, device or software program.

MedicationRequested [Entry]

An order for a medication to be dispensed and instructions for use.

Based On MedicationDispenseTopic

ActionContext must be a RequestedContext must be from http://hl7.org/fhir/ValueSet/medication-request-status must be from http://hl7.org/fhir/ValueSet/medication-request-priority required The ontological status of the intervention, e.g., performed/not performed, requested/not requested.
         where  Status must be from http://hl7.org/fhir/ValueSet/device-statement-status must be from http://hl7.org/fhir/ValueSet/medication-request-status required Position in workflow.
         where  Priority must be from http://hl7.org/fhir/ValueSet/medication-request-priority An indication of the importance of an action.
NumberOfRefillsAllowed optional The maximum number of times the dispense can be repeated. For medication dispense, this integer does NOT include the original order dispense. This means that if an order indicates dispense 30 tablets plus 3 repeats, then the order can be dispensed a total of 4 times and the patient can receive a total of 120 tablets.
QuantityPerDispense optional The amount that is to be dispensed for one fill.
SupplyDuration optional Identifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last.
MedicationOrCode required A medication entity or a medication code.
Dosage optional The dosage of the medication as prescribed. Do not include if dosage was not known.
Type optional The most specific code (lowest level term) describing the kind or sort of thing being represented.
Category 0 or more A class or division of people or things having particular shared characteristics
RelatedEncounter optional If content was generated during a patient encounter, related encounter is the encounter where the information was gained.
Author optional The person or organization who created the entry and is responsible for (and may certify) the content.
Informant optional The person or entity that provided the information in the entry, as distinct from who created the entry, e.g. the subject (patient), medical professional, family member, device or software program.

MedicationTopic

A course or dose of medication for a patient, independent of context of being recommended, used, or not used. Medication use can be reported, directly observed, or inferred from clinical events associated with orders, prescriptions written, pharmacy dispensings, procedural administrations, and other patient-reported information.

Based On ActionTopic

MedicationOrCode required A medication entity or a medication code.
Dosage optional The dosage of the medication as prescribed. Do not include if dosage was not known.
Type optional The most specific code (lowest level term) describing the kind or sort of thing being represented.
Category 0 or more A class or division of people or things having particular shared characteristics
ActionContext required The ontological status of the intervention, e.g., performed/not performed, requested/not requested.
RelatedEncounter optional If content was generated during a patient encounter, related encounter is the encounter where the information was gained.
Author optional The person or organization who created the entry and is responsible for (and may certify) the content.
Informant optional The person or entity that provided the information in the entry, as distinct from who created the entry, e.g. the subject (patient), medical professional, family member, device or software program.

MedicationUsed [Entry]

A record of the use of a medication.

Based On MedicationTopic

Category should be from http://hl7.org/fhir/ValueSet/medication-statement-category optional A class or division of people or things having particular shared characteristics
ActionContext must be a PerformedContext required The ontological status of the intervention, e.g., performed/not performed, requested/not requested.
MedicationOrCode required A medication entity or a medication code.
Dosage optional The dosage of the medication as prescribed. Do not include if dosage was not known.
Type optional The most specific code (lowest level term) describing the kind or sort of thing being represented.
RelatedEncounter optional If content was generated during a patient encounter, related encounter is the encounter where the information was gained.
Author optional The person or organization who created the entry and is responsible for (and may certify) the content.
Informant optional The person or entity that provided the information in the entry, as distinct from who created the entry, e.g. the subject (patient), medical professional, family member, device or software program.

NumberOfRefillsAllowed

The maximum number of times the dispense can be repeated. For medication dispense, this integer does NOT include the original order dispense. This means that if an order indicates dispense 30 tablets plus 3 repeats, then the order can be dispensed a total of 4 times and the patient can receive a total of 120 tablets.

Value:  positiveInt

QuantityPerDispense

The amount that is to be dispensed for one fill.

Value:  Quantity A quantity with units, whose value may be bounded from above or below, as defined in FHIR

RouteIntoBody

The way a substance enters an organism after contact, particularly, the route of drug administration. C0013153

Value:  CodeableConcept must be from http://hl7.org/fhir/ValueSet/route-codes A set of codes drawn from different coding systems, representing the same concept.

SupplyDuration

Identifies the period time over which the supplied product is expected to be used, or the length of time the dispense is expected to last.

Value:  Duration The length of time that something continues.

TimingOfDoses

When doses of medication should be administered.

Value:  Timing A timing schedule that specifies an event that may occur multiple times. Timing offers a choice of multiple OccurrenceTime (used is used to specify specific times), or recurrence patterns.