Generated Narrative: StructureDefinition BeMedicationLine Name Flags Card. Type Description & Constraints MedicationStatement 0..* MedicationStatement Record of medication being taken by a patient #xD; Slices for extension 5..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:recordedDate S 1..1 dateTime Extension URL: https://www.ehealth.fgov.be/standards/fhir/medication/StructureDefinition/BeExtRecordedDate #xD; extension:recorder S 1..1 Reference(BePractitioner | BePractitionerRole | BePatient) Extension URL: https://www.ehealth.fgov.be/standards/fhir/medication/StructureDefinition/BeExtRecorder #xD; extension:exposure-category S 0..1 CodeableConcept Exposure category URL: https://www.ehealth.fgov.be/standards/fhir/medication/StructureDefinition/BeMedicationExposureCategory Binding: Medication exposure intent (extensible) #xD; extension:artifact-version S 1..1 string The business version of the medication line - this version changes when the content update is considered clinically relevant URL: http://hl7.org/fhir/StructureDefinition/artifact-version #xD; extension:artifact-date S 0..1 dateTime The business-relevant recorded date - the date the medication line was created or changed URL: http://hl7.org/fhir/StructureDefinition/artifact-date #xD; extension:adherence S 1..1 (Complex) R5: Indicates whether the medication is or is not being consumed or administered (new) URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationStatement.adherence #xD; Slices for extension Content/Rules for all slices #xD; extension:code S 1..1 Extension Indicates whether the medication is or is not being consumed or administered #xD; extension 0..0 Extension #xD; value[x] 1..1 CodeableConcept Type of adherence Binding: BeExtAdherenceStatus ValueSet (required) #xD; extension:registrationStatus S 1..1 code The registration status of the medication line - preadopting the values in R5 URL: https://www.ehealth.fgov.be/standards/fhir/medication/StructureDefinition/BeExtMedicationLineRegistrationStatus Binding: Medication Line Registration Status Value Set (required) #xD; extension:offLabel S 0..1 (Complex) MedicationRequest - Off-label use URL: https://www.ehealth.fgov.be/standards/fhir/medication/StructureDefinition/BeExtOffLabel #xD; Slices for extension Content/Rules for all slices #xD; extension:reason 0..* Extension The reason why the recommended dosage was overridden #xD; Slices for identifier S 1..* Identifier External identifier Slice: Unordered, Open by pattern:system #xD; identifier:vidis S 0..1 Identifier VIDIS identifier #xD; system 1..1 uri The namespace for the identifier value Required Pattern: http://ehealth.fgov.be/standards/fhir/medication/NamingSystem/be-ns-medicationline #xD; value S 0..1 string The value that is unique #xD; status S 1..1 code active | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken Required Pattern: unknown #xD; statusReason S 0..* CodeableConcept Reason for current status Binding: Adherence Status Reason ValueSet (example) #xD; category S 0..1 CodeableConcept Type of medication usage Binding: Medication origin type value set (required) #xD; medication[x] S 1..1 CodeableConcept, Reference(Medication) What medication was taken #xD; Slices for extension Content/Rules for all slices #xD; extension:medicationType S 0..1 CodeableConcept Type of medication URL: https://www.ehealth.fgov.be/standards/fhir/medication/StructureDefinition/BeExtMedicationType Binding: Medication preparation Type value set (required) #xD; subject S 1..1 Reference(BePatient) Who is/was taking the medication #xD; Slices for effective[x] S 1..1 Period The date/time or interval when the medication is/was/will be taken Slice: Unordered, Open by type:$this #xD; effective[x]:effectivePeriod S 1..1 Period The date/time or interval when the medication is/was/will be taken #xD; start S 1..1 dateTime Starting time with inclusive boundary #xD; end S 0..1 dateTime End time with inclusive boundary, if not ongoing #xD; dateAsserted S 1..1 dateTime When the statement was asserted? #xD; informationSource S 1..1 Reference(BePatient | BePractitioner | BePractitionerRole | RelatedPerson | BeOrganization) Person or organization that provided the information about the taking of this medication #xD; reasonCode S 0..* CodeableConcept Reason for why the medication is being/was taken #xD; reasonReference S 0..1 Reference(Condition | Observation | DiagnosticReport) Condition or observation that supports why the medication is being/was taken #xD; note S 0..* Annotation Further information about the statement #xD; dosage S 0..* BeDosage Details of how medication is/was taken or should be taken #xD; Documentation for this format
Medication Line profile - contains the overview information for a single medication item
Record of medication being taken by a patient
A record of a medication that is being consumed by a patient. A MedicationStatement may indicate that the patient may be taking the medication now or has taken the medication in the past or will be taking the medication in the future. The source of this information can be the patient, significant other (such as a family member or spouse), or a clinician. A common scenario where this information is captured is during the history taking process during a patient visit or stay. The medication information may come from sources such as the patient's memory, from a prescription bottle, or from a list of medications the patient, clinician or other party maintains. The primary difference between a medication statement and a medication administration is that the medication administration has complete administration information and is based on actual administration information from the person who administered the medication. A medication statement is often, if not always, less specific. There is no required date/time when the medication was administered, in fact we only know that a source has reported the patient is taking this medication, where details such as time, quantity, or rate or even medication product may be incomplete or missing or less precise. As stated earlier, the medication statement information may come from the patient's memory, from a prescription bottle or from a list of medications the patient, clinician or other party maintains. Medication administration is more formal and is not missing detailed information.
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.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
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
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
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.
A resource should have narrative for robust management
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
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.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
A set of rules under which this content was created
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.
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's narrative along with other profiles, value sets, etc.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
The base language in which the resource is written.
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).
Text summary of the resource, for human interpretation
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 "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
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 "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
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.
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.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
The person that recorded the information
The business version of the medication line - this version changes when the content update is considered clinically relevant
The identifier that is used to identify this version of the artifact when it is referenced in a specification, model, design or instance. This is an arbitrary value managed by the artifact author and is not expected to be globally unique. For example, it might be a timestamp (e.g. yyyymmdd) if a managed version is not available. There is also no expectation that versions can be placed in a lexicographical sequence.
The business-relevant recorded date - the date the medication line was created or changed
The date (and optionally time) when the artifact was last significantly changed. The date must change when the business version changes and it must change if the status code changes. In addition, it should change when the substantive content of the artifact changes.
The date is often not tracked until the resource is published, but may be present on draft content. Note that this is not the same as the resource last-modified-date, since the resource may be a secondary representation of the artifact. Additional specific dates may be added as extensions or be found by consulting Provenances associated with past versions of the resource.
R5: Indicates whether the medication is or is not being consumed or administered (new)
R5: `MedicationStatement.adherence` (new:BackboneElement)
Element `MedicationStatement.adherence` has a context of MedicationStatement based on following the parent source element upwards and mapping to `MedicationStatement`. Element `MedicationStatement.adherence` has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). This element can be used to indicate whether a patient is following a course of treatment as instructed/prescribed or whether they are taking medications of their own volition. It can also be used to indicate that a patient is not taking a medication, either because they were told not to or because they decided on their own.
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
Indicates whether the medication is or is not being consumed or administered
This is a FHIR R5 element, preadopted as an extension in this FHIR R4 specification. For the full definition see here: [http://hl7.org/fhir/R5/medicationstatement-definitions.html#MedicationStatement.adherence](http://hl7.org/fhir/R5/medicationstatement-definitions.html#MedicationStatement.adherence)
Source of the definition for the extension code - a logical name or a URL.
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.
Type of the adherence for the medication.
R5: Details of the reason for the current use of the medication (new)
R5: `MedicationStatement.adherence.reason` (new:CodeableConcept)
Element `MedicationStatement.adherence.reason` is part of an existing definition because parent element `MedicationStatement.adherence` requires a cross-version extension. Element `MedicationStatement.adherence.reason` has a context of MedicationStatement based on following the parent source element upwards and mapping to `MedicationStatement`. Element `MedicationStatement.adherence.reason` has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). This is generally only used for "exception" statuses such as "entered-in-error". The reason for performing the event at all is captured in reasonCode, not here.
Element `MedicationStatement.adherence.reason` is part of an existing definition because parent element `MedicationStatement.adherence` requires a cross-version extension. Element `MedicationStatement.adherence.reason` has a context of MedicationStatement based on following the parent source element upwards and mapping to `MedicationStatement`. Element `MedicationStatement.adherence.reason` has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).
Additional content defined by implementations
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.
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.
Details of the reason for the current use of the medication
Captures the reason for the current use or adherence of a medication.
This is generally only used for "exception" statuses such as "entered-in-error". The reason for performing the event at all is captured in reasonCode, not here.
Value of extension - must be one of a constrained set of the data types (see [Extensibility](http://hl7.org/fhir/R4/extensibility.html) for a list).
The registration status of the medication line - preadopting the values in R5
The registration status of the medication line, indicating whether it is draft, recorded, or entered-in-error.
Indicates that the order placer has knowingly prescribed the medication for an indication, age group, dosage, or route of administration that is not approved by the regulatory agencies and is not mentioned in the prescribing information for the product.
If isOffLabelUse is true, reason must be provided
extension.where(url = 'isOffLabelUse').value.ofType(boolean).where($this = true).exists() implies extension.where(url = 'reason').exists()
Indicates that the recommended dosage was overridden. Must be 'true' when .reason is provided.
The reason why the recommended dosage was overridden
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'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).
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).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
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.
This is a business identifier, not a resource identifier.
The national identifier for medication lines.
usual | official | temp | secondary | old (If known)
Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Identifies the purpose for this identifier, if known .
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Allows users to make use of identifiers when the identifier system is not known.
A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
Identifier.system is always case sensitive.
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the [Rendered Value extension](http://hl7.org/fhir/R4/extension-rendered-value.html). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
Time period when id is/was valid for use
Time period during which identifier is/was valid for use.
Role.effectiveTime or implied by context
Organization that issued id (may be just text)
Organization that issued/manages the identifier.
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
A plan, proposal or order that is fulfilled in whole or in part by this event.
Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.
.outboundRelationship[typeCode=FLFS].target[classCode=SBADM or PROC or PCPR or OBS, moodCode=RQO orPLAN or PRP]
A larger event of which this particular event is a component or step.
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.
.outboundRelationship[typeCode=COMP]/target[classCode=SPLY or SBADM or PROC or OBS,moodCode=EVN]
active | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken
A code representing the patient or other source's judgment about the state of the medication used that this statement is about. Generally, this will be active or completed.
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.
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
A coded concept indicating the current status of a MedicationStatement.
Captures the reason for the current state of the MedicationStatement.
This is generally only used for "exception" statuses such as "not-taken", "on-hold", "cancelled" or "entered-in-error". The reason for performing the event at all is captured in reasonCode, not here.
.inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde
Indicates where the medication is expected to be consumed or administered.
.inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="type of medication usage"].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.
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.
A coded concept identifying the substance or product being taken.
.participation[typeCode=CSM].role[classCode=ADMM or MANU]
The person, animal or group who is/was taking the medication.
Encounter / Episode associated with MedicationStatement
The encounter or episode of care that establishes the context for this MedicationStatement.
.inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code="type of encounter or episode"]
The date/time or interval when the medication is/was/will be taken
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).
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 "end" 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.
The start of the period. The boundary is inclusive.
If the low element is missing, the meaning is that the low boundary is not known.
End time with inclusive boundary, if not ongoing
The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.
The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.
If the end of the period is missing, it means that the period is ongoing
The date when the medication statement was asserted by the information source.
Person or organization that provided the information about the taking of this medication
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.
.participation[typeCode=INF].role[classCode=PAT, or codes for Practioner or Related Person (if PAT is the informer, then syntax for self-reported =true)
Allows linking the MedicationStatement to the underlying MedicationRequest, or to other information that supports or is used to derive the MedicationStatement.
Likely references would be to MedicationRequest, 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.
Reason for why the medication is being/was taken
A reason for why the medication is being/was taken.
This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonForUseReference.
A coded concept identifying why the medication is being taken.
Condition or observation that supports why the medication is being/was taken
Condition or observation that supports why the medication is being/was taken.
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.
.outboundRelationship[typeCode=RSON]/target[classCode=OBS,moodCode=EVN, code="reason for use"].value
Provides extra information about the medication statement that is not conveyed by the other attributes.
Details of how medication is/was taken or should be taken
Indicates how the medication is/was or should be taken by the patient.
The dates included in the dosage on a Medication Statement reflect the dates for a given dose. For example, "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." 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.