Generated Narrative: StructureDefinition ch-emed-dosage-medicationrequest Name Flags Card. Type Description & Constraints Dosage C 0..* CHEMEDDosage CH EMED Dosage (MedicationRequest) Constraints: ch-dosage-3 #xD; Documentation for this format
Definition of the dosage (used in MedicationRequest)
Indicates how the medication is/was taken or should be taken by the patient.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
For split dosage timing event and dose/rate are REQUIRED
sequence.exists() implies (timing.repeat.when.exists() and doseAndRate.dose.exists())
Patient instruction/free text dosage instruction, or timing and dose/rate has to be specified
patientInstruction.exists() or (timing.exists() and doseAndRate.exists())
.outboundRelationship[typeCode=COMP].target[classCode=SBADM, moodCode=INT]
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
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.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
Defines the type of posology (Daily, FreeText, Single, Cyclic, Sequence)
Extensions that cannot be ignored even if unrecognized
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 can 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 element that contains them
Indicates the order in which the dosage instructions should be applied or interpreted.
If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. If the sequence number is different, then the Dosages are intended to be sequential.
No sequence number (for one dosage element) or sequence number = 1 (for more than one dosage element)
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. Additional information about administration or preparation of the medication should be included as text.
Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
Supplemental instructions to the patient on how to take the medication (e.g. "with meals" or"take half to one hour before food") or warnings for the patient about the medication (e.g. "may cause drowsiness" or "avoid exposure of skin to direct sunlight or sunlamps").
Information about administration or preparation of the medication (e.g. "infuse as rapidly as possibly via intraperitoneal port" or "immediately following drug x") should be populated in dosage.text.
Additional instruction is intended to be coded, but where no code exists, the element could include text. For example, "Swallow with plenty of water" which might or might not be coded.
A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
Patient instructions (e.g. 'take with food'), incl. free text dosage instructions (e.g. for complex dosage)
Instructions in terms that are understood by the patient or consumer.
This attribute might not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.
The timing schedule for giving the medication to the patient. This data type allows many different expressions. For example: "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.
Identifies specific times when the event occurs.
In a Medication Administration Record, for instance, you need to take a general specification, and turn it into a precise specification.
A set of rules that describe when the event is scheduled.
Many timing schedules are determined by regular repetitions.
if there's a duration, there needs to be duration units
duration.empty() or durationUnit.exists()
not(exists(f:duration)) or exists(f:durationUnit)
if there's a period, there needs to be period units
not(exists(f:period)) or exists(f:periodUnit)
f:duration/@value >= 0 or not(f:duration/@value)
f:period/@value >= 0 or not(f:period/@value)
If there's a periodMax, there must be a period
not(exists(f:periodMax)) or exists(f:period)
If there's a durationMax, there must be a duration
durationMax.empty() or duration.exists()
not(exists(f:durationMax)) or exists(f:duration)
If there's a countMax, there must be a count
not(exists(f:countMax)) or exists(f:count)
If there's an offset, there must be a when (and not C, CM, CD, CV)
offset.empty() or (when.exists() and ((when in ('C' | 'CM' | 'CD' | 'CV')).not()))
If there's a timeOfDay, there cannot be a when, or vice versa
not(exists(f:timeOfDay)) or not(exists(f:when))
Length/Range of lengths, or (Start and/or end) limits
Either a duration for the length of the timing schedule, a range of possible length, or outer bounds for start and/or end limits of the timing schedule.
A total count of the desired number of repetitions across the duration of the entire timing specification. If countMax is present, this element indicates the lower bound of the allowed range of count values.
If you have both bounds and count, then this should be understood as within the bounds period, until count times happens.
Repetitions may be limited by end time or total occurrences.
If present, indicates that the count is a range - so to perform the action between [count] and [countMax] times.
How long this thing happens for when it happens. If durationMax is present, this element indicates the lower bound of the allowed range of the duration.
For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).
Some activities are not instantaneous and need to be maintained for a period of time.
If present, indicates that the duration is a range - so to perform the action between [duration] and [durationMax] time length.
s | min | h | d | wk | mo | a - unit of time (UCUM)
The units of time for the duration, in UCUM units.
The number of times to repeat the action within the specified period. If frequencyMax is present, this element indicates the lower bound of the allowed range of the frequency.
If no frequency is stated, the assumption is that the event occurs once per period, but systems SHOULD always be specific about this
Event occurs up to frequencyMax times per period
If present, indicates that the frequency is a range - so to repeat between [frequency] and [frequencyMax] times within the period or period range.
Indicates the duration of time over which repetitions are to occur; e.g. to express "3 times per day", 3 would be the frequency and "1 day" would be the period. If periodMax is present, this element indicates the lower bound of the allowed range of the period length.
If present, indicates that the period is a range from [period] to [periodMax], allowing expressing concepts such as "do this once every 3-5 days.
The units of time for the period in UCUM units.
If one or more days of week is provided, then the action happens only on the specified day(s).
If no days are specified, the action is assumed to happen every day as otherwise specified. The elements frequency and period cannot be used as well as dayOfWeek.
Specified time of day for action to take place.
When time of day is specified, it is inferred that the action happens every day (as filtered by dayofWeek) on the specified times. The elements when, frequency and period cannot be used as well as timeOfDay.
An approximate time period during the day, potentially linked to an event of daily living that indicates when the action should occur.
When more than one event is listed, the event is tied to the union of the specified events.
Timings are frequently determined by occurrences such as waking, eating and sleep.
For the representation of the time of administration according to the 1-1-1-1 scheme, the values MORN-NOON-EVE-NIGHT SHOULD be used.
$this='MORN' or $this='NOON' or $this='EVE' or $this='NIGHT'
Real world event relating to the schedule.
The number of minutes from the event. If the event code does not indicate whether the minutes is before or after the event, then the offset is assumed to be after the event.
BID | TID | QID | AM | PM | QD | QOD | +
A code for the timing schedule (or just text in code.text). Some codes such as BID are ubiquitous, but many institutions define their own additional codes. If a code is provided, the code is understood to be a complete statement of whatever is specified in the structured timing data, and either the code or the data may be used to interpret the Timing, with the exception that .repeat.bounds still applies over the code (and is not contained in the code).
BID etc. are defined as 'at institutionally specified times'. For example, an institution may choose that BID is "always at 7am and 6pm". If it is inappropriate for this choice to be made, the code BID should not be used. Instead, a distinct organization-specific code should be used in place of the HL7-defined BID code and/or a structured representation should be used (in this case, specifying the two event times).
Code for a known / defined timing pattern.
Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept).
Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not "prn" or "as needed".
A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.
.outboundRelationship[typeCode=PRCN].target[classCode=OBS, moodCode=EVN, code="as needed"].value=boolean or codable concept
In reserve (to be taken by the patient only if the need arises - e.g. pains)
If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [bodySite](http://hl7.org/fhir/R4/extension-bodysite.html). May be a summary code, or a reference to a very precise definition of the location, or both.
A coded specification of the anatomic site where the medication first enters the body.
A coded concept describing the site location the medicine enters into or onto the body.
A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.
A reference to a code defined by a terminology system.
Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
Allows for alternative encodings within a code system, and translations to other code systems.
fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
The identification of the code system that defines the meaning of the symbol in the code.
The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.
Need to be unambiguous about the source of the definition of the symbol.
fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
Need to refer to a particular code in the system.
fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
A representation of the meaning of the code in the system, following the rules of the system.
Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
C*E.2 - but note this is not well followed
fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
If this coding was chosen directly by the user
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.
fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
Plain text representation of the concept
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Very often the text is the same as a displayName of one of the codings.
The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
C*E.9. But note many systems use C*E.2 for this
fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
Terminologies used often pre-coordinate this term with the route and or form of administration.
A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV.
The kind of dose or rate specified, for example, ordered or calculated.
If the type is not populated, assume to be "ordered".
Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.
The amount of therapeutic or other substance given at one administration event.
It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate. It is possible to specify a rate over time (for example, 100 ml/hour) using either the rateRatio and rateQuantity. The rateQuantity approach requires systems to have the capability to parse UCUM grammer where ml/hour is included rather than a specific ratio where the time is specified as the denominator. Where a rate such as 500ml over 2 hours is specified, the use of rateRatio may be more semantically correct than specifying using a rateQuantity of 250 mg/hour.
Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.
Upper limit on medication per unit of time
Upper limit on medication per unit of time.
This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".
The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours.
Upper limit on medication per administration
Upper limit on medication per administration.
This is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg.
The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.
Upper limit on medication per lifetime of the patient
Upper limit on medication per lifetime of the patient.
The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.