--- type: "resource" title: "MedicationRequest" resource: "MedicationRequest" --- # MedicationRequest ## Introduction ## Scope and Usage This resource covers all type of orders for medications for a patient. This includes inpatient medication orders as well as community orders (whether filled by the prescriber or by a pharmacy). It also includes orders for over-the-counter medications (e.g., Aspirin), total parenteral nutrition and diet/vitamin supplements. It may be used to support the order of medication-related devices e.g., prefilled syringes such as patient-controlled analgesia (PCA) syringes, or syringes used to administer other types of medications. e.g., insulin, narcotics. It can can also be used to order medication or substances NOT be taken. This resource would not be used when ordering a device(s) that may have a medication coating e.g. heparin coated stints, or similar types of devices. These types of devices would be ordered using the Device Request or the SupplyRequest resources. It is not intended for use in prescribing particular diets, or for ordering non-medication-related items (eyeglasses, supplies, etc.). In addition, the MedicationRequest may be used to report orders/request from external systems that have been reported for informational purposes and are not authoritative and are not expected to be acted upon (e.g. dispensed or administered). The MedicationRequest resource is a "request" resource from a FHIR workflow perspective - see [Workflow Request.](workflow#request) The MedicationRequest resource allows requesting only a single medication. If a workflow requires requesting multiple items simultaneously, this is done using multiple instances of this resource. These instances can be linked in different ways, depending on the needs of the workflow. For guidance, refer to [the Request pattern](request#compound). ## Boundaries and Relationships The MedicationRequest resource is used to request or order medication for a subject. It may also be used to report a medication request or order from one organization or source to another. When requesting supplies or devices when there is a patient focus or instructions regarding their use, [SupplyRequest](https://build.fhir.org/ig/HL7/oo-incubator/StructureDefinition-SupplyRequest.html) or [DeviceRequest](devicerequest) should be used instead. When reporting on the usage of a medication by a patient, the [MedicationStatement](medicationstatement) resource should be used. **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](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 or order or request). | | [MedicationAdministration](medicationadministration) | When a patient actually consumes a medicine, or it is otherwise administered to them. | | [MedicationStatement](medicationstatement) | This is a record of medication being taken by a patient, or that the medication has been given to a patient where the record is the result of a report from the patient, or another clinician. 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. | The MedicationRequest resource represents an authorization for both a dispense and an administration to be provided. Details about the fulfillment of the authorization are typically handled by the [Task](task) resource. For further information about this separation of responsibilities, refer to the link [Fulfillment/Execution](request#fulfillment) section of the Request pattern. MedicationRequests can be instantiated from a protocol which is represented by a Definition resource - ActivityDefinition or PlanDefinition. For more information on protocols, see [applying a PlanDefinition](https://hl7.org/fhir/plandefinition.html#12.23.4.3). There are examples where a medication request may include the option of an oral dose or an Intravenous or Intramuscular dose. For example, "Ondansetron 8mg orally or IV twice a day as needed for nausea" or "Compazine® (prochlorperazine) 5-10mg PO or 25mg PR bid prn nausea or vomiting". In these cases, two MedicationRequest resources would be created that could be grouped together. The decision on which dose and route of administration to use is based on the patient's condition at the time the dose is needed. In general, each prescribed drug will be a separate Medication Request. When drug orders are grouped together at the time of order entry, but each of the drugs can be manipulated independently e.g. changing the status of one order to 'completed' or 'cancelled', changing another order status to 'on-hold', the method to 'group' all of the medication requests together is to use MedicationRequest.groupIdentifier element. All of the orders grouped together in this manner will have the same groupIdentifier, and separately, each order in the group may have a unique identifier. There are cases that require grouping of Medication orders together when it is necessary to specify optionality e.g. order two drugs at one time, but stating either of these drugs may be used to treat the patient. The use of a RequestOrchestration should be used as a parent for the Medication orders that require this type of grouping. An example when it may be necessary to group medication orders together is when you specify timing relationships e.g. order drug 'xyz' with dose 123, then taper the same drug to a different dose after some interval of time precedence: - e.g. give drug 'abc' followed by drug 'def' - e.g. give drug 30 minutes before some procedure was performed - more generically this supports - hierarchical groups of actions, where each specific action references the action to be performed (in terms of a Request resource), and each group describes additional behavior, relationships, and applicable conditions between the actions in the overall group. - Note that one should NOT use the List or Composition resource to accomplish the above requirements. You may use List or Composition for other business requirements, but not to address the specific requirements of grouping medication orders. ## Notes ### Dosage Instructions Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing. #### Grouping Medication Requests In general, each prescribed drug will be a separate Medication Request. When drug orders are grouped together at the time of order entry, but each of the drugs can be manipulated independently e.g. changing the status of one order to "completed" or "cancelled", changing another order status to "on-hold", the method to "group" all of the medication requests together is to use MedicationRequest.groupIdentifier element. All of the orders grouped together in this manner will have the same groupIdentifier, and separately, each order in the group may have a unique identifier. There are cases that require grouping of Medication orders together when it is necessary to specify optionality e.g. order two drugs at one time, but stating either of these drugs may be used to treat the patient. The use of a RequestOrchestration should be used as a parent for the Medication orders that require this type of grouping. An example when it may be necessary to group medication orders together is when you specify: - timing relationships e.g. order drug "xyz" with dose 123, then taper the same drug to a different dose after some interval of time precedence. For example: - give drug "abc" followed by drug "def" - give drug 30 minutes before some procedure was performed. - more generically this supports - hierarchical groups of actions, where each specific action references the action to be performed (in terms of a Request resource), and each group describes additional behavior, relationships, and applicable conditions between the actions in the overall group. Note that one should NOT use the List or Composition resource to accomplish the above requirements. You may use List or Composition for other business requirements, but not to address the specific requirements of grouping medication orders. ## StructureDefinition ### Elements (Simplified) - **[MedicationRequest](/medicationrequest-definitions#MedicationRequest)** [0..*]: - Ordering of medication for patient or group - **[MedicationRequest.identifier](/medicationrequest-definitions#MedicationRequest.identifier)** [0..*]: [Identifier](/Identifier) External ids for this request - **[MedicationRequest.basedOn](/medicationrequest-definitions#MedicationRequest.basedOn)** [0..*]: [Reference(CarePlan](/Reference(CarePlan), [MedicationRequest](/MedicationRequest), [ServiceRequest](/ServiceRequest), [RequestOrchestration)](/RequestOrchestration)) A plan or request that is fulfilled in whole or in part by this medication request - **[MedicationRequest.priorPrescription](/medicationrequest-definitions#MedicationRequest.priorPrescription)** [0..1]: Reference([MedicationRequest](/MedicationRequest)) Reference to an order/prescription that is being replaced by this MedicationRequest - **[MedicationRequest.groupIdentifier](/medicationrequest-definitions#MedicationRequest.groupIdentifier)** [0..1]: [Identifier](/Identifier) Composite request this is part of - **[MedicationRequest.status](/medicationrequest-definitions#MedicationRequest.status)** [1..1]: [code](/code) required:[medicationrequest-status](/valueset-medicationrequest-status) active | on-hold | ended | stopped | completed | cancelled | entered-in-error | draft | unknown - **[MedicationRequest.statusReason](/medicationrequest-definitions#MedicationRequest.statusReason)** [0..1]: [CodeableConcept](/CodeableConcept) example:[medicationrequest-status-reason](/valueset-medicationrequest-status-reason) Reason for current status - **[MedicationRequest.statusChanged](/medicationrequest-definitions#MedicationRequest.statusChanged)** [0..1]: [dateTime](/dateTime) When the status was changed - **[MedicationRequest.intent](/medicationrequest-definitions#MedicationRequest.intent)** [1..1]: [code](/code) required:[medicationrequest-intent](/valueset-medicationrequest-intent) proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option (immutable) - **[MedicationRequest.category](/medicationrequest-definitions#MedicationRequest.category)** [0..*]: [CodeableConcept](/CodeableConcept) example:[medicationrequest-category](/valueset-medicationrequest-category) Grouping or category of medication request - **[MedicationRequest.priority](/medicationrequest-definitions#MedicationRequest.priority)** [0..1]: [code](/code) required:[request-priority](/valueset-request-priority) routine | urgent | asap | stat - **[MedicationRequest.doNotPerform](/medicationrequest-definitions#MedicationRequest.doNotPerform)** [0..1]: [boolean](/boolean) If true, indicates the provider is ordering a patient should not take the specified medication - **[MedicationRequest.medication](/medicationrequest-definitions#MedicationRequest.medication)** [1..1]: [CodeableReference](/CodeableReference) example:[medication-codes](/valueset-medication-codes) Medication to be taken - **[MedicationRequest.subject](/medicationrequest-definitions#MedicationRequest.subject)** [1..1]: [Reference(Patient](/Reference(Patient), [Group)](/Group)) Individual or group for whom the medication has been requested - **[MedicationRequest.informationSource](/medicationrequest-definitions#MedicationRequest.informationSource)** [0..*]: [Reference(Patient](/Reference(Patient), [Practitioner](/Practitioner), [PractitionerRole](/PractitionerRole), [RelatedPerson](/RelatedPerson), [Organization](/Organization), [Group)](/Group)) The person or organization who provided the information about this request, if the source is someone other than the requestor - **[MedicationRequest.encounter](/medicationrequest-definitions#MedicationRequest.encounter)** [0..1]: Reference([Encounter](/Encounter)) Encounter created as part of encounter/admission/stay - **[MedicationRequest.supportingInformation](/medicationrequest-definitions#MedicationRequest.supportingInformation)** [0..*]: Reference([Resource](/Resource)) Information to support fulfilling of the medication - **[MedicationRequest.authoredOn](/medicationrequest-definitions#MedicationRequest.authoredOn)** [0..1]: [dateTime](/dateTime) When request was initially authored - **[MedicationRequest.requester](/medicationrequest-definitions#MedicationRequest.requester)** [0..1]: [Reference(Practitioner](/Reference(Practitioner), [PractitionerRole](/PractitionerRole), [Organization](/Organization), [Patient](/Patient), [RelatedPerson](/RelatedPerson), [Device)](/Device)) Who/What requested the Request - **[MedicationRequest.isRecordOfRequest](/medicationrequest-definitions#MedicationRequest.isRecordOfRequest)** [0..1]: [boolean](/boolean) Whether this is record of a Medication Request or the actual request itself - **[MedicationRequest.performerType](/medicationrequest-definitions#MedicationRequest.performerType)** [0..1]: [CodeableConcept](/CodeableConcept) extensible:[medication-intended-performer-role](/valueset-medication-intended-performer-role) Desired kind of performer of the medication administration - **[MedicationRequest.performer](/medicationrequest-definitions#MedicationRequest.performer)** [0..*]: [Reference(Practitioner](/Reference(Practitioner), [PractitionerRole](/PractitionerRole), [Organization](/Organization), [Patient](/Patient), [DeviceDefinition](/DeviceDefinition), [RelatedPerson](/RelatedPerson), [CareTeam](/CareTeam), [HealthcareService](/HealthcareService), [Group)](/Group)) Intended performer of administration - **[MedicationRequest.device](/medicationrequest-definitions#MedicationRequest.device)** [0..*]: [CodeableReference](/CodeableReference) Intended type of device for the administration - **[MedicationRequest.recorder](/medicationrequest-definitions#MedicationRequest.recorder)** [0..1]: [Reference(Practitioner](/Reference(Practitioner), [PractitionerRole)](/PractitionerRole)) Person who entered the request - **[MedicationRequest.reason](/medicationrequest-definitions#MedicationRequest.reason)** [0..*]: [CodeableReference](/CodeableReference) example:[condition-code](/valueset-condition-code) Reason or indication for ordering or not ordering the medication - **[MedicationRequest.courseOfTherapyType](/medicationrequest-definitions#MedicationRequest.courseOfTherapyType)** [0..1]: [CodeableConcept](/CodeableConcept) extensible:[medicationrequest-course-of-therapy](/valueset-medicationrequest-course-of-therapy) Overall pattern of medication administration - **[MedicationRequest.insurance](/medicationrequest-definitions#MedicationRequest.insurance)** [0..*]: [Reference(Coverage](/Reference(Coverage), [ClaimResponse)](/ClaimResponse)) Associated insurance coverage - **[MedicationRequest.note](/medicationrequest-definitions#MedicationRequest.note)** [0..*]: [Annotation](/Annotation) Information about the prescription - **[MedicationRequest.effectiveTiming[x]](/medicationrequest-definitions#MedicationRequest.effectiveTiming%5Bx%5D)** [0..1]: [Duration](/Duration), [Range](/Range), [Period](/Period) Period over which the medication is to be taken, can be specified as a duration or a range - **[MedicationRequest.dosageInstruction](/medicationrequest-definitions#MedicationRequest.dosageInstruction)** [0..1]: [DosageDetails](/DosageDetails) Specific instructions for how the medication should be taken - **[MedicationRequest.dispenseRequest](/medicationrequest-definitions#MedicationRequest.dispenseRequest)** [0..1]: [BackboneElement](/BackboneElement) Medication supply authorization - **[MedicationRequest.dispenseRequest.initialFill](/medicationrequest-definitions#MedicationRequest.dispenseRequest.initialFill)** [0..1]: [BackboneElement](/BackboneElement) First fill details - **[MedicationRequest.dispenseRequest.initialFill.quantity](/medicationrequest-definitions#MedicationRequest.dispenseRequest.initialFill.quantity)** [0..1]: [Quantity](/Quantity)([SimpleQuantity](/SimpleQuantity)) First fill quantity - **[MedicationRequest.dispenseRequest.initialFill.duration](/medicationrequest-definitions#MedicationRequest.dispenseRequest.initialFill.duration)** [0..1]: [Duration](/Duration) First fill duration - **[MedicationRequest.dispenseRequest.dispenseInterval](/medicationrequest-definitions#MedicationRequest.dispenseRequest.dispenseInterval)** [0..1]: [Duration](/Duration) Minimum period of time between dispenses - **[MedicationRequest.dispenseRequest.validityPeriod](/medicationrequest-definitions#MedicationRequest.dispenseRequest.validityPeriod)** [0..1]: [Period](/Period) Time period supply is authorized for - **[MedicationRequest.dispenseRequest.numberOfRepeatsAllowed](/medicationrequest-definitions#MedicationRequest.dispenseRequest.numberOfRepeatsAllowed)** [0..1]: [unsignedInt](/unsignedInt) Number of refills authorized - **[MedicationRequest.dispenseRequest.quantity](/medicationrequest-definitions#MedicationRequest.dispenseRequest.quantity)** [0..1]: [Quantity](/Quantity)([SimpleQuantity](/SimpleQuantity)) Amount of medication to supply per dispense - **[MedicationRequest.dispenseRequest.expectedSupplyDuration](/medicationrequest-definitions#MedicationRequest.dispenseRequest.expectedSupplyDuration)** [0..1]: [Duration](/Duration) Number of days supply per dispense - **[MedicationRequest.dispenseRequest.dispenser](/medicationrequest-definitions#MedicationRequest.dispenseRequest.dispenser)** [0..1]: Reference([Organization](/Organization)) Intended performer of dispense - **[MedicationRequest.dispenseRequest.dispenserInstruction](/medicationrequest-definitions#MedicationRequest.dispenseRequest.dispenserInstruction)** [0..*]: [CodeableConcept](/CodeableConcept) example:[medicationrequest-dispenser-instructions](/valueset-medicationrequest-dispenser-instructions) Additional information for the dispenser - **[MedicationRequest.dispenseRequest.doseAdministrationAid](/medicationrequest-definitions#MedicationRequest.dispenseRequest.doseAdministrationAid)** [0..1]: [CodeableConcept](/CodeableConcept) example:[medication-dose-aid](/valueset-medication-dose-aid) Type of adherence packaging to use for the dispense - **[MedicationRequest.dispenseRequest.destination](/medicationrequest-definitions#MedicationRequest.dispenseRequest.destination)** [0..1]: Reference([Location](/Location)) Where the medication is expected to be delivered - **[MedicationRequest.substitution](/medicationrequest-definitions#MedicationRequest.substitution)** [0..1]: [BackboneElement](/BackboneElement) Any restrictions on medication substitution - **[MedicationRequest.substitution.allowed[x]](/medicationrequest-definitions#MedicationRequest.substitution.allowed%5Bx%5D)** [1..1]: [boolean](/boolean), [CodeableConcept](/CodeableConcept) preferred:[v3-ActSubstanceAdminSubstitutionCode](/valueset-v3-ActSubstanceAdminSubstitutionCode) Whether substitution is allowed or not - **[MedicationRequest.substitution.reason](/medicationrequest-definitions#MedicationRequest.substitution.reason)** [0..1]: [CodeableConcept](/CodeableConcept) example:[v3-SubstanceAdminSubstitutionReason](/valueset-v3-SubstanceAdminSubstitutionReason) Why should (not) substitution be made - **[MedicationRequest.eventHistory](/medicationrequest-definitions#MedicationRequest.eventHistory)** [0..*]: Reference([Provenance](/Provenance)) A list of events of interest in the lifecycle ## Mappings - [MedicationRequest Mappings](/medicationrequest-mappings) — 114 mapping entries ## Resource Packs ### list-MedicationRequest-packs.xml ```xml ``` ## Search Parameters - [authoredon](/medicationrequest-search#authoredon) — **date** — Return prescriptions written on this date — `MedicationRequest.authoredOn` - [category](/medicationrequest-search#category) — **token** — Returns prescriptions with different categories — `MedicationRequest.category` - [code](/medicationrequest-search#code) — **token** — Return prescriptions of this medication code — `MedicationRequest.medication.concept` - [encounter](/medicationrequest-search#encounter) — **reference** — Return prescriptions with this encounter identifier — `MedicationRequest.encounter` - [group-identifier](/medicationrequest-search#group-identifier) — **token** — Composite request this is part of — `MedicationRequest.groupIdentifier` - [identifier](/medicationrequest-search#identifier) — **token** — Return prescriptions with this external identifier — `MedicationRequest.identifier` - [intended-dispenser](/medicationrequest-search#intended-dispenser) — **reference** — Returns prescriptions intended to be dispensed by this Organization — `MedicationRequest.dispenseRequest.dispenser` - [intended-performer](/medicationrequest-search#intended-performer) — **reference** — Returns the intended performer of the administration of the medication request — `MedicationRequest.performer` - [intended-performertype](/medicationrequest-search#intended-performertype) — **token** — Returns requests for a specific type of performer — `MedicationRequest.performerType` - [intent](/medicationrequest-search#intent) — **token** — Returns prescriptions with different intents — `MedicationRequest.intent` - [medication](/medicationrequest-search#medication) — **reference** — Return prescriptions for this medication reference — `MedicationRequest.medication.reference` - [patient](/medicationrequest-search#patient) — **reference** — Returns prescriptions for a specific patient — `MedicationRequest.subject.where(resolve() is Patient)` - [priority](/medicationrequest-search#priority) — **token** — Returns prescriptions with different priorities — `MedicationRequest.priority` - [requester](/medicationrequest-search#requester) — **reference** — Returns prescriptions prescribed by this prescriber — `MedicationRequest.requester` - [status](/medicationrequest-search#status) — **token** — Status of the prescription — `MedicationRequest.status` - [subject](/medicationrequest-search#subject) — **reference** — The identity of a patient to list orders for — `MedicationRequest.subject` - [group-or-identifier](/medicationrequest-search#group-or-identifier) — **token** — Group ID or other identifier — `MedicationRequest.groupIdentifier | MedicationRequest.identifier` [Full Search Parameters](/medicationrequest-search) ## Examples - [medicationrequest-example](/medicationrequest-example-medicationrequest-example) — medicationrequest-example - [medicationrequest-examples-header](/medicationrequest-example-medicationrequest-examples-header) — medicationrequest-examples-header - [medicationrequest0349](/medicationrequest-example-medicationrequest0349) — medicationrequest0349 — Request to not perform due to allergy. - [medicationrequest0350](/medicationrequest-example-medicationrequest0350) — medicationrequest0350 — Request with 3 reasons to justify alternative. - [medrx002](/medicationrequest-example-medrx002) — medicationrequestexample2 — Order for a medication that includes the dosage of a prescription in text - [medrx003](/medicationrequest-example-medrx003) — medicationrequestexample3 — Request that uses both calculated and ordered dosage - [medrx004](/medicationrequest-example-medrx004) — medicationrequestexample4 — Request with multiple dosages and timings. - [medrx0301](/medicationrequest-example-medrx0301) — medicationrequest0301 — Order with as needed (PRN) dosage with pre-condition - Oxycodone - active with reasonCode, note, dispenseRequest and substitution - [medrx0302](/medicationrequest-example-medrx0302) — medicationrequest0302 — Active Order with link to encounter, reasonCode, note multiple dosage lines, dispenseRequest and substitution - Azithromycin - [medrx0303](/medicationrequest-example-medrx0303) — medicationrequest0303 — Order for Tapering Dose - Prednisone - active with note and multiple DosageInstructions with boundsPeriod - [medrx0304](/medicationrequest-example-medrx0304) — medicationrequest0304 — Order for Oral Drops - Nystatin Suspension - completed - with Dispense Request - [medrx0305](/medicationrequest-example-medrx0305) — medicationrequest0305 — Order with Dosage with a Pre-Condition - Alprazolam - dosageInstructions includes boundsPeriod with periodMax and asNeededCodeableConcept - [medrx0306](/medicationrequest-example-medrx0306) — medicationrequest0306 — Oral Chemotherapy Order - Myleran - completed - with reasonCode - [medrx0307](/medicationrequest-example-medrx0307) — medicationrequest0307 — Order with as needed (PRN) dosage - Percocet - completed with link to encounter, dispenseRequest and substitution - [medrx0308](/medicationrequest-example-medrx0308) — medicationrequest0308 — Order for as needed (PRN) dosage - Vicodin - completed with dosageInstruction with additionalInstruction (coded) and as needed with reason, dispenseRequest and substitution - [medrx0309](/medicationrequest-example-medrx0309) — medicationrequest0309 — Oral Chemotherapy Order - Capecitabine - active medication with dosing by Body Surface Area (BSA) (mg/m2) - [medrx0310](/medicationrequest-example-medrx0310) — medicationrequest0310 — Request for Over the Counter Medication - Tylenol PM - with dosage range as needed with pre-condition for use - [medrx0311](/medicationrequest-example-medrx0311) — medicationrequestexample1 — Fully populated example of a MedicationRequest - Chlorthalidone - active - with link to encounter, reasonReference, note, dispenseRequest, substitution and eventHistory - [medrx0312](/medicationrequest-example-medrx0312) — medicationrequest0312 — Liquid Medication - Phenytoin with link to prior prescription - [medrx0313](/medicationrequest-example-medrx0313) — medicationrequest0313 — Request with a single dosage line - Azithromycin - completed - with link to prior prescription and reason code - [medrx0314](/medicationrequest-example-medrx0314) — medicationrequest0314 — Request - Levothyroxine - completed with reasonCode, dosageInstructions and dispenseRequest - [medrx0315](/medicationrequest-example-medrx0315) — medicationrequest0315 — Request for an injectable medication - Lorazepam - active - with link to encounter, reasonCode and dosageInstruction - [medrx0316](/medicationrequest-example-medrx0316) — medicationrequest0316 — Request for Intravenous Chemotherapy (inpatient order) - Brentuximab Vedotin - completed - [medrx0317](/medicationrequest-example-medrx0317) — medicationrequest0317 — Request for Intravenous Chemotherapy (inpatient order) - Alemtuzumab - completed with multiple dosageInstruction lines - [medrx0318](/medicationrequest-example-medrx0318) — medicationrequest0318 — Request for Intravenous Antibiotic - Vancomycin - active - with link to encounter, reasonCode, and note - [medrx0319](/medicationrequest-example-medrx0319) — medicationrequest0319 — Request for Intravenous Antibiotic with a Dosage Rate - Piperacillin - completed with reason code - [medrx0320](/medicationrequest-example-medrx0320) — medicationrequest0320 — Request for Subcutaneous injection - Insulin - Lantus - completed, with reason code and dispense request - [medrx0321](/medicationrequest-example-medrx0321) — medicationrequest0321 — Request for Subcutaneous injection with multiple dosage lines - Insulin - Novolog - active - includes reasonCode and note. Dosage includes additionalInstructions as text - [medrx0322](/medicationrequest-example-medrx0322) — medicationrequest0322 — Request for Intravenous Admixture - Potassium Chloride in D5W - completed with reason code - [medrx0323](/medicationrequest-example-medrx0323) — medicationrequest0323 — Request for TPN Solution - completed - [medrx0324](/medicationrequest-example-medrx0324) — medicationrequest0324 — Request using Medication Code for Rectal Suppository - Acetaminophen - completed with reasonCode, dispenseRequest and substitution - [medrx0325](/medicationrequest-example-medrx0325) — medicationrequest0325 — Request using Medication Code for Topical Ointment - Nystatin - on hold and with dispense request - [medrx0326](/medicationrequest-example-medrx0326) — medicationrequest0326 — Request using Medication Code for Inhaler - Proventil - on hold with dispenseRequest and substitution - [medrx0327](/medicationrequest-example-medrx0327) — medicationrequest0327 — Request using Medication Code for Patch - Fentanyl - active, with dispense request - [medrx0328](/medicationrequest-example-medrx0328) — medicationrequest0328 — Request referencing Medication Resource for Nasal Spray - Nasonex - [medrx0329](/medicationrequest-example-medrx0329) — medicationrequest0329 — Request referencing Medication Resource for Compounded Product - HC 1%, Salicylic Acid 5% in Glaxal Base - on hold with dispenseRequest - [medrx0330](/medicationrequest-example-medrx0330) — medicationrequest0330 — Request referencing Medication Resource for Eye Drops - Timoptic - active - with link to encounter, dispenseRequest and substitution flag - [medrx0331](/medicationrequest-example-medrx0331) — medicationrequest0331 — Request for a Dosage that needs to be dispensed as different strength tablets - Warfarin - active - [medrx0332](/medicationrequest-example-medrx0332) — medicationrequest0332 — Request for a medication that is intended to be given as a single, once only dose - [medrx0333](/medicationrequest-example-medrx0333) — medicationrequest0333 — Request for a medication that is intended to be given in the morning - [medrx0334](/medicationrequest-example-medrx0334) — medicationrequest0334 — Request for a medication that is intended to be given on a specific day - [medrx0335](/medicationrequest-example-medrx0335) — medicationrequest0335 — Request for a medication that is intended to be given at a specific time - [medrx0336](/medicationrequest-example-medrx0336) — medicationrequest0336 — Request for Intravenous Dopamine - Weight based calculation with rateQuantity - [medrx0337](/medicationrequest-example-medrx0337) — medicationrequest0337 — Request for Intravenous Admixture Dopamine - with rateQuantity - [medrx0338](/medicationrequest-example-medrx0338) — medicationrequest0338 — Request for Intravenous Admixture Dopamine - with doseQuantity and rateQuantity - [medrx0339](/medicationrequest-example-medrx0339) — medicationrequest0339 — Request for a product that contains multiple dosage forms - [medrx0343a](/medicationrequest-example-medrx0343a) — medicationrequest0343a — Request medication where there is an option of the route of administration - includes group identifier - [medrx0343b](/medicationrequest-example-medrx0343b) — medicationrequest0343b — Request medication where there is an option of the route of administration - includes group identifier [Full Examples](/medicationrequest-examples) ## Mapping Exceptions ### medicationrequest-fivews-mapping-exceptions.xml ### Divergent Elements - **FiveWs.class** → **MedicationRequest.intent** - **FiveWs.context** → **MedicationRequest.supportingInformation** ### Unmapped Elements - **FiveWs.cause** — Unknown - **FiveWs.version** — Unknown - **FiveWs.witness** — Unknown - **FiveWs.where** — Unknown - **FiveWs.init** — Unknown - **FiveWs.source** — Unknown - **FiveWs.planned** — Unknown - **FiveWs.done** — Unknown ### medicationrequest-request-mapping-exceptions.xml ### Divergent Elements - **Request.identifier** → **MedicationRequest.identifier** - summary | reason=Unknown | pattern=true - shortUnmatched | reason=Unknown | pattern=Business Identifier for medication request | resource=External ids for this request - definitionUnmatched | reason=Unknown | pattern=Business identifiers assigned to this medication request by the author and/or other systems. These identifiers remain constant as the resource is updated and propagates from server to server. | resource=Identifiers associated with this medication request that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server. - commentsUnmatched | reason=Unknown | pattern=The identifier.type element is used to distinguish between the identifiers assigned by the requester/placer and the performer/filler. Note: This is a business identifier, not a resource identifier (see [discussion](resource.html#identifiers)). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number. | resource=This is a business identifier, not a resource identifier. - requirementsUnmatched | reason=Unknown | pattern=Allows identification of the medication request as it is known by various participating systems and in a way that remains consistent across servers. - **Request.basedOn** → **MedicationRequest.basedOn** - missingTypes | reason=Unknown | pattern=Reference(Request) - extraTypes | reason=Unknown - shortUnmatched | reason=Unknown | pattern=Fulfills plan, proposal or order | resource=A plan or request that is fulfilled in whole or in part by this medication request - definitionUnmatched | reason=Unknown | pattern=A higher-level request resource (i.e. a plan, proposal or order) that is fulfilled in whole or in part by this medication request. Authorization from the 'basedOn' request flows through to the referencing medication request. | resource=Whenever the medication request is being issued because of another request, eg. a procedure that is being planned (ServiceRequest) and MedicationRequests are known to be needed, this element documents those requests. - commentsUnmatched | reason=Unknown | pattern=basedOn represents the 'authorization' chain for an action, not the 'reason for action'. For example, an order might be placed on hold under the authorization for a surgery. However the 'reason' for placing the hold is "to avoid interaction with anesthesia medications" . - requirementsUnmatched | reason=Unknown | pattern=Allows tracing of authorization for the request and tracking whether proposals/recommendations were acted upon. - **Request.replaces** → **MedicationRequest.priorPrescription** - missingTypes | reason=Unknown | pattern=Reference(Request) - extraTypes | reason=Unknown - summary | reason=Unknown | pattern=true - shortUnmatched | reason=Unknown | pattern=Request(s) replaced by this medication request | resource=Reference to an order/prescription that is being replaced by this MedicationRequest - definitionUnmatched | reason=Unknown | pattern=Completed or terminated request(s) whose function is taken by this new medication request. | resource=Reference to an order/prescription that is being replaced by this MedicationRequest. - commentsUnmatched | reason=Unknown | pattern=The replacement could be because the initial request was immediately rejected (due to an issue) or because the previous request was completed, but the need for the action described by the request remains ongoing. - requirementsUnmatched | reason=Unknown | pattern=Allows tracing the continuation of a therapy or administrative process instantiated through multiple requests. - **Request.groupIdentifier** → **MedicationRequest.groupIdentifier** - definitionUnmatched | reason=Unknown | pattern=A shared identifier common to all requests that were authorized more or less simultaneously by a single author, representing the identifier of the requisition, prescription or similar form. | resource=A shared identifier common to multiple independent Request instances that were activated/authorized more or less simultaneously by a single author. The presence of the same identifier on each request ties those requests together and may have business ramifications in terms of reporting of results, billing, etc. E.g. a requisition number shared by a set of lab tests ordered together, or a prescription number shared by all meds ordered at one time. - commentsUnmatched | reason=Unknown | pattern=Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation. - requirementsUnmatched | reason=Unknown | pattern=Some business processes need to know if multiple items were ordered as part of the same "prescription" or "requisition" for billing or other purposes. | resource=Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation. - **Request.status** → **MedicationRequest.status** - shortUnmatched | reason=Unknown | pattern=draft | active | on-hold | revoked | completed | entered-in-error | unknown | resource=active | on-hold | ended | stopped | completed | cancelled | entered-in-error | draft | unknown - definitionUnmatched | reason=Unknown | pattern=The current state of the medication request. | resource=A code specifying the current state of the order. Generally, this will be active or completed state. - commentsUnmatched | reason=Unknown | pattern=The status is generally fully in the control of the requester - they determine whether the order is draft or active and, after it has been activated, completed, cancelled or suspended. States relating to the activities of the performer are reflected on either the corresponding]](s) or using the]] resource. A nominal state-transition diagram can be found in the] documentation Unknown does not represent "other" - one of the defined statuses must apply. Unknown is used when the authoring system is not sure what the current status is. A status of 'active' when doNotPerform is true means that the request to not perform is currently in force. A status of completed for a "doNotPerform" request indicates that the period of non-performance is now satisfied and the request no longer holds. | resource=This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. Clinical decision support systems should take the status into account when determining which medications to include in their algorithms. - **Request.statusReason** → **MedicationRequest.statusReason** - definitionUnmatched | reason=Unknown | pattern=Captures the reason for the current state of the medication request. Note that any change to the state requires the removal of any existing statusReasons, and, if appropriate, populating new statusReasons. | resource=Captures the reason for the current state of the MedicationRequest. - commentsUnmatched | reason=Unknown | pattern=This is generally only used for "exception" statuses such as "suspended" or "cancelled". The reason why the medication request was created at all is captured in reasonCode, not here. . | resource=This is generally only used for "exception" statuses such as "suspended" or "cancelled". The reason why the MedicationRequest was created at all is captured in reasonCode, not here. - **Request.intent** → **MedicationRequest.intent** - shortUnmatched | reason=Unknown | pattern=proposal | plan | order (immutable) | resource=proposal | plan | order | original-order | reflex-order | filler-order | instance-order | option (immutable) - definitionUnmatched | reason=Unknown | pattern=Indicates the level of authority/intentionality associated with the medication request and where the request fits into the workflow chain. | resource=Whether the request is a proposal, plan, or an original order. - commentsUnmatched | reason=Unknown | pattern=This element is expected to be immutable. E.g. A "proposal" instance should never change to be a "plan" instance or "order" instance. Instead, a new instance 'basedOn' the prior instance should be created with the new 'intent' value. One exception to this is that the granularity of Request.intent is allowed to change. For example, a Request identified as an "order" might later be clarified to be a "filler-order". Or, in rarer cases (to meet recipient constraints), the reverse might also occur. When resources map to this element, they are free to define as many codes as necessary to cover their space and will map to "proposal, plan or order". Can have multiple codes that map to one of these. E.g. "original order", "encoded order", "reflex order" would all map to "order". Expectation is that the set of codes is mutually exclusive or a strict all-encompassing hierarchy. | resource=This element is expected to be immutable. E.g. A 'proposal' instance should never change to be a 'plan' instance or 'order' instance. Instead, a new instance 'basedOn' the prior instance should be created with the new 'intent' value. It is expected that the type of requester will be restricted for different stages of a MedicationRequest. For example, Proposals can be created by a patient, relatedPerson, Practitioner or Device. Plans can be created by Practitioners, Patients, RelatedPersons and Devices. Original orders can be created by a Practitioner only. An instance-order is an instantiation of a request or order and may be used to populate Medication Administration Record. This element is labeled as a modifier because the intent alters when and how the resource is actually applicable. - requirementsUnmatched | reason=Unknown | pattern=Proposals/recommendations, plans and orders all use the same structure and can exist in the same fulfillment chain. - **Request.priority** → **MedicationRequest.priority** - definitionUnmatched | reason=Unknown | pattern=Indicates how quickly the medication request should be addressed with respect to other requests. | resource=Indicates how quickly the Medication Request should be addressed with respect to other requests. - **Request.code** → **MedicationRequest.medication** - missingTypes | reason=Unknown | pattern=CodeableConcept - extraTypes | reason=Unknown - shortUnmatched | reason=Unknown | pattern=Service requested/ordered | resource=Medication to be taken - definitionUnmatched | reason=Unknown | pattern=A code that identifies the specific service or action being asked to be done (or not done). | resource=Identifies the medication being requested. This is a link to a resource that represents the medication which may be the details of the medication or simply an attribute carrying a code that identifies the medication from a known list of medications. - **Request.subject** → **MedicationRequest.subject** - shortUnmatched | reason=Unknown | pattern=Individual the service is ordered/prohibited for | resource=Individual or group for whom the medication has been requested - definitionUnmatched | reason=Unknown | pattern=The individual or set of individuals the action is to be performed/not performed on or for. | resource=The individual or group for whom the medication has been requested. - requirementsUnmatched | reason=Unknown | pattern=Links the request to the Patient context. - **Request.encounter** → **MedicationRequest.encounter** - summary | reason=Unknown | pattern=true - shortUnmatched | reason=Unknown | pattern=Encounter the medication request is tied to | resource=Encounter created as part of encounter/admission/stay - definitionUnmatched | reason=Unknown | pattern=The Encounter during which this medication request was created or to which the creation of this record is tightly associated. | resource=The Encounter during which this [x] was created or to which the creation of this record is tightly associated. - commentsUnmatched | reason=Unknown | pattern=This will typically be the encounter during which the medication request was created. However, some {{title}s may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission activities). | resource=This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter." If there is a need to link to episodes of care they will be handled with an extension. - requirementsUnmatched | reason=Unknown | pattern=Links the medication request to the Encounter context. - **Request.authoredOn** → **MedicationRequest.authoredOn** - shortUnmatched | reason=Unknown | pattern=When request was created/transitioned to active | resource=When request was initially authored - definitionUnmatched | reason=Unknown | pattern=For draft medication requests, indicates the date of initial creation. For requests with other statuses, indicates the date of activation. | resource=The date (and perhaps time) when the prescription was initially written or authored on. - **Request.requester** → **MedicationRequest.requester** - shortUnmatched | reason=Unknown | pattern=Who/what is requesting service | resource=Who/What requested the Request - definitionUnmatched | reason=Unknown | pattern=Who initiated the {{request}} and has responsibility for its activation. | resource=The individual, organization, or device that initiated the request and has responsibility for its activation. - **Request.performerType** → **MedicationRequest.performerType** - bindingStrength | reason=Unknown | pattern=example - shortUnmatched | reason=Unknown | pattern=Desired kind of service performer | resource=Desired kind of performer of the medication administration - definitionUnmatched | reason=Unknown | pattern=The type of individual that is desired to act upon/ not act upon the {{request}}. | resource=Indicates the type of performer of the administration of the medication. - commentsUnmatched | reason=Unknown | pattern=If specified without indicating a performer, this indicates that the performer must be (or can't be) of the specified type. If specified with a performer then it indicates the requirements of the performer if the designated performer is not available. If doNotPerform is true, then only one of performerType and performer should be present. | resource=If specified without indicating a performer, this indicates that the performer must be of the specified type. If specified with a performer then it indicates the requirements of the performer if the designated performer is not available. - **Request.performer** → **MedicationRequest.performer** - missingTypes | reason=Unknown | pattern=Reference(Device) - extraTypes | reason=Unknown - summary | reason=Unknown | pattern=true - shortUnmatched | reason=Unknown | pattern=Specific desired (non)performer | resource=Intended performer of administration - definitionUnmatched | reason=Unknown | pattern=Indicates who or what is being asked to perform (or not perform) the {{request}}. | resource=The specified desired performer of the medication treatment (e.g. the performer of the medication administration). For devices, this is the device that is intended to perform the administration of the medication. An IV Pump would be an example of a device that is performing the administration. Both the IV Pump and the practitioner that set the rate or bolus on the pump can be listed as performers. - **Request.reason** → **MedicationRequest.reason** - summary | reason=Unknown | pattern=true - shortUnmatched | reason=Unknown | pattern=Why is service (not) needed? | resource=Reason or indication for ordering or not ordering the medication - definitionUnmatched | reason=Unknown | pattern=Describes why the request is being made in coded or textual form, or Indicates another resource whose existence justifies this request. | resource=When the medication request was issued as a result of something that occurred, i.e. a lab test or a performed procedure, this documents those reasons. - commentsUnmatched | reason=Unknown | pattern=Textual reasons can be captured using reasonCode.text. If doNoPerform is true, this will be the reason why the request is being made to not act. | resource=This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonReference. - **Request.insurance** → **MedicationRequest.insurance** - definitionUnmatched | reason=Unknown | pattern=Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be relevant in delivering the requested service. | resource=Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be required for delivering the requested service. - **Request.supportingInfo** → **MedicationRequest.supportingInformation** - missingTypes | reason=Unknown | pattern=Reference(Any) - extraTypes | reason=Unknown - shortUnmatched | reason=Unknown | pattern=Extra information to use in performing request | resource=Information to support fulfilling of the medication - definitionUnmatched | reason=Unknown | pattern=Information that may be needed by/relevant to the performer in their execution of this medication request. | resource=Information to support fulfilling (i.e. dispensing or administering) of the medication, for example, patient height and weight, a MedicationStatement for the patient). - commentsUnmatched | reason=Unknown | pattern=See guidance on [notes vs. supportingInfo](request.html#notes). | resource=This attribute can be used to reference a MedicationStatement about the patients' medication use. - **Request.note** → **MedicationRequest.note** - shortUnmatched | reason=Unknown | pattern=Comments made about medication request | resource=Information about the prescription - definitionUnmatched | reason=Unknown | pattern=Comments made about the medication request by the requester, performer, subject or other participants. | resource=Extra information about the prescription that could not be conveyed by the other attributes. - commentsUnmatched | reason=Unknown | pattern=See guidance on [notes vs. supportingInfo](request.html#notes). - **Request.relevantHistory** → **MedicationRequest.eventHistory** - missingTypes | reason=Unknown | pattern=Reference(ProvenanceRelevantHistory) - extraTypes | reason=Unknown - shortUnmatched | reason=Unknown | pattern=Key events in history of medication request | resource=A list of events of interest in the lifecycle - commentsUnmatched | reason=Unknown | pattern=This element does not point to the Provenance associated with the *current* version of the resource - as it would be created after this version existed. The Provenance for the current version can be retrieved with a _revinclude. Referenced provenances SHOULD adhere to the [provenance-relevant-history profile](provenance-relevant-history.html). See additional guidance [here](request.html#history). | resource=This might not include provenances for all versions of the request – only those deemed "relevant" or important. This SHALL NOT include the provenance associated with this current version of the resource. (If that provenance is deemed to be a "relevant" change, it will need to be added as part of a later update. Until then, it can be queried directly as the provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.). ### Unmapped Elements - **Request.occurrence** — Unknown - **Request.deliverTo** — Unknown - **Request.category** — Unknown - **Request.reported** — Unknown - **Request.doNotPerform** — Unknown - **Request.product** — Unknown