RIVO-Noord Zorgviewer Implementation Guide
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RIVO-Noord Zorgviewer Implementation Guide - Local Development build (v1.9.1) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: MedicationUse - Detailed Descriptions

Active as of 2024-12-10

Definitions for the MedicationStatement resource profile.

Guidance on how to interpret the contents of this table can be found here

0. MedicationStatement
2. MedicationStatement.category
4. MedicationStatement.category.text
Must Supporttrue
6. MedicationStatement.medicationReference
8. MedicationStatement.medicationReference.display
Must Supporttrue
10. MedicationStatement.dateAsserted
Must Supporttrue
12. MedicationStatement.dosage
14. MedicationStatement.dosage.text
Must Supporttrue
16. MedicationStatement.dosage.route
18. MedicationStatement.dosage.route.text
Must Supporttrue

Guidance on how to interpret the contents of this table can be found here

0. MedicationStatement
Definition

MedicationUse is a statement on the historic, current or intended use of a certain medicine.


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.

ShortMedicationUseRecord of medication being taken by a patient
Comments

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.

Control0..*
Alternate NamesMedicatiegebruik
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.empty())
dom-4: 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())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (contained.where(('#'+id in %resource.descendants().reference).not()).empty())
mst-1: Reason not taken is only permitted if Taken is No (reasonNotTaken.exists().not() or (taken = 'n'))
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.empty())
dom-4: 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())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (contained.where(('#'+id in %resource.descendants().reference).not()).empty())
mst-1: Reason not taken is only permitted if Taken is No (reasonNotTaken.exists().not() or (taken = 'n'))
2. MedicationStatement.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

ShortA set of rules under which this content was created
Comments

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.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

Control0..1
Typeuri
Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
4. MedicationStatement.extension:asAgreedIndicator
Slice NameasAgreedIndicator
Definition

Is the medicine used as outlined in the medication agreement?

ShortAsAgreedIndicator
Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(HCIM As AgreedIndicator) (Extension Type: boolean)
Alternate NamesVolgensAfspraakIndicator
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
6. MedicationStatement.extension:asAgreedIndicator.url
Definition

Source of the definition for the extension code - a logical name or a URL.

Shortidentifies the meaning of the extension
Comments

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.

Control1..1
Typeuri
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
XML FormatIn the XML format, this property is represented as an attribute.
Fixed Valuehttp://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse-AsAgreedIndicator
8. MedicationStatement.extension:asAgreedIndicator.value[x]
Definition

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

ShortValue of extension
Control0..1
Typeboolean, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept
[x] NoteSeeChoice of Data Typesfor further information about how to use [x]
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
SlicingThis element introduces a set of slices on MedicationStatement.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
  • type @ $this
  • 10. MedicationStatement.extension:asAgreedIndicator.value[x]:valueBoolean
    Slice NamevalueBoolean
    Definition

    Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

    ShortValue of extension
    Control0..1
    Typeboolean, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Example<br/><b>Example of asAgreed</b>:true
    12. MedicationStatement.extension:prescriber
    Slice Nameprescriber
    Definition

    The health professional that entered the medication agreement with the patient.

    ShortPrescriber
    Comments

    The health professional's specialty, role, and organization are captured and communicated through the PractitionerRole Resource based on the nl-core-practitionerrole profile.

    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(HCIM MedicationUse Prescriber) (Extension Type: Reference)
    Alternate NamesVoorschrijver
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    14. MedicationStatement.extension:author
    Slice Nameauthor
    Definition

    The author of this MedicationStatement. This is either a patient, a health professional or a healthcare provicer.

    ShortAuthor
    Comments

    The health professional's specialty, role, and organization are captured and communicated through the PractitionerRole Resource based on the nl-core-practitionerrole profile.

    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(HCIM MedicationUse Author) (Extension Type: Reference)
    Alternate NamesAuteur
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    16. MedicationStatement.extension:medicationTreatment
    Slice NamemedicationTreatment
    Definition

    This extension is to describe which overarching medical treatment this information is part of. This is done by the use of an identifier of that medical treatment.

    ShortMedical Treatment
    Comments

    No HCIM concept is available for this element. Therefore a mapping to the relevant element Medication Process data element is provided.

    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(HCIM MedicationTreatment) (Extension Type: Identifier)
    Alternate NamesMedicamenteuze Behandeling
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    18. MedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse
    Slice NamereasonForChangeOrDiscontinuationOfUse
    Definition

    Reason for changing or discontinuing use of medication.

    ShortReasonForChangeOrDiscontinuationOfUse
    Control0..*
    This element is affected by the following invariants: ele-1
    TypeExtension(HCIM MedicationUse ReasonForChangeOrDiscontinuationOfUse) (Extension Type: CodeableConcept)
    Alternate NamesRedenWijzigenOfStoppenGebruik, Reden wijzigen of stoppen gebruik
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    20. MedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse.url
    Definition

    Source of the definition for the extension code - a logical name or a URL.

    Shortidentifies the meaning of the extension
    Comments

    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.

    Control1..1
    Typeuri
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    Fixed Valuehttp://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse-ReasonForChangeOrDiscontinuationOfUse
    22. MedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse.value[x]
    Definition

    Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

    ShortValue of extension
    Control0..1
    TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    SlicingThis element introduces a set of slices on MedicationStatement.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
    • type @ $this
    • 24. MedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse.value[x]:valueCodeableConcept
      Slice NamevalueCodeableConcept
      Definition

      Reason for changing or discontinuing use of medication.


      Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

      ShortReasonForChangeOrDiscontinuationOfUseValue of extension
      Control0..1
      BindingUnless not suitable, these codes SHALL be taken from For codes, see RedenWijzigenOfStoppenGebruikCodelijst
      (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.11.2--20171231000000)
      TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Alternate NamesReden wijzigen of stoppen gebruik
      Example<br/><b>Example of ReasonForChangeOrDiscontinuationOfUse</b>:{ "coding" : [{ "system" : "http://snomed.info/sct", "code" : "79899007", "display" : "Drug interaction (finding)" }] }
      26. MedicationStatement.modifierExtension
      Definition

      An Extension


      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. Usually modifier elements provide negation or qualification. In order 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.

      ShortExtensionExtensions that cannot be ignored
      Comments

      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.

      Control0..*
      TypeExtension
      Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
      Alternate Namesextensions, user content
      SlicingThis element introduces a set of slices on MedicationStatement.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 28. MedicationStatement.modifierExtension:repeatPeriodCyclicalSchedule
        Slice NamerepeatPeriodCyclicalSchedule
        Definition

        The repeated period in a cyclical schedule (of one or more dosing instructions). A cyclic schedule is noted in days, the corresponding dosing duration is also in days.

        Examples of a cyclical schedule: contraceptive pill (21 days, 1 pill 1x a day, then skip for 7 days, repeat), repeat period here is 28 days. RepeatPeriodCyclicalSchedule

        ShortRepeatPeriodCyclicalSchedule
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(HCIM Medication RepeatPeriodCyclicalSchedule) (Extension Type: Duration)
        Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
        LabelHerhaalperiodeCyclischSchema
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        30. MedicationStatement.status
        Definition

        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.

        ShortMedicationUseStopTypeactive | completed | entered-in-error | intended | stopped | on-hold
        Comments

        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 also used for the concept 'Stop type'; the manner in which this medication is discontinued (temporary or definitive).


        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.

        Control1..1
        BindingThe codes SHALL be taken from MedicationStatementStatushttp://hl7.org/fhir/ValueSet/medication-statement-status
        (required to http://hl7.org/fhir/ValueSet/medication-statement-status)

        Allergy Intolerance critically Code list


        A coded concept indicating the current status of a MedicationStatement.

        Typecode
        Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Alternate NamesMedicatieGebruikStopType
        32. MedicationStatement.category
        Definition

        Indicates where type of medication statement and where the medication is expected to be consumed or administered.

        ShortType of medication usage
        Control10..1
        BindingThe codes SHOULD be taken from MedicationStatementCategoryhttp://hl7.org/fhir/ValueSet/medication-statement-category
        (preferred to http://hl7.org/fhir/ValueSet/medication-statement-category)

        A coded concept identifying where the medication included in the medicationstatement is expected to be consumed or administered

        TypeCodeableConcept
        Summarytrue
        34. MedicationStatement.category.coding
        Definition

        A reference to a code defined by a terminology system.

        ShortCode defined by a terminology system
        Comments

        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.

        Control0..*
        TypeCoding
        Summarytrue
        Requirements

        Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

        SlicingThis element introduces a set of slices on MedicationStatement.category.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ code
        • 36. MedicationStatement.category.coding:medicationUseCode
          Slice NamemedicationUseCode
          Definition

          Category code used for indexing/retrieval of the HCIM MedicationUse. The system and code are stated in the Medication Process v09.


          A reference to a code defined by a terminology system.

          ShortMedicationUseCodeCode defined by a terminology system
          Comments

          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.

          Control0..*
          TypeCoding
          Summarytrue
          Requirements

          Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

          38. MedicationStatement.category.coding:medicationUseCode.system
          Definition

          The identification of the code system that defines the meaning of the symbol in the code.

          ShortIdentity of the terminology system
          Comments

          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 de-reference to some definition that establish the system clearly and unambiguously.

          Control0..1
          Typeuri
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          Need to be unambiguous about the source of the definition of the symbol.

          Fixed Valueurn:oid:2.16.840.1.113883.2.4.3.11.60.20.77.5.3
          40. MedicationStatement.category.coding:medicationUseCode.code
          Definition

          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).

          ShortSymbol in syntax defined by the system
          Control0..1
          Typecode
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          Need to refer to a particular code in the system.

          Fixed Value6
          42. MedicationStatement.category.text
          Definition

          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.

          ShortPlain text representation of the concept
          Comments

          Very often the text is the same as a displayName of one of the codings.

          Control0..1
          Typestring
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Requirements

          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.

          44. MedicationStatement.medication[x]
          Definition

          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.

          ShortWhat medication was taken
          Comments

          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. .

          Control1..1
          TypeReference(Medication), CodeableConcept
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Summarytrue
          SlicingThis element introduces a set of slices on MedicationStatement.medication[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
          • type @ $this
          • 46. MedicationStatement.medication[x]:medicationReference
            Slice NamemedicationReference
            Definition

            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.

            ShortProductUsedWhat medication was taken
            Comments

            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. .

            Control1..1
            TypeReference(HCIM PharmaceuticalProduct, Medication), CodeableConcept
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Summarytrue
            Alternate NamesGebruiksproduct
            48. MedicationStatement.medication[x]:medicationReference.display
            Definition

            Plain text narrative that identifies the resource in addition to the resource reference.

            ShortText alternative for the resource
            Comments

            This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

            Control0..1
            Typestring
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            50. MedicationStatement.effective[x]
            Definition

            The interval of time during which it is being asserted that the patient was taking the medication (or was not taking, when the wasNotGiven element is true).

            ShortThe date/time or interval when the medication was taken
            Comments

            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.

            Control0..1
            TypePeriod, dateTime
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Summarytrue
            SlicingThis element introduces a set of slices on MedicationStatement.effective[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
            • type @ $this
            • 52. MedicationStatement.effective[x]:effectivePeriod
              Slice NameeffectivePeriod
              Definition

              Medication use can be recorded for a certain moment or over a certain period. Thus, medication use can be recorded multiple times during the use of medication. The usage period is the period or moment over which the data is recorded.

              Start date: This is the time at which the agreement was to take effect (or took effect or will take effect).

              Duration: The intended duration of use. E.g. 5 days or 8 weeks. It is not allowed to indicate the duration in months, because different months have a variable duration in days.

              End date: The time at which the period of use ends (or ended or will end). To avoid confusion between 'to' and 'up to', the submission of time is always mandatory for the end date.


              The interval of time during which it is being asserted that the patient was taking the medication (or was not taking, when the wasNotGiven element is true).

              ShortPeriodOfUseThe date/time or interval when the medication was taken
              Comments

              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.

              Control0..1
              TypePeriod, dateTime
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Summarytrue
              Alternate NamesGebruiksperiode
              54. MedicationStatement.effective[x]:effectivePeriod.extension:Duration
              Slice NameDuration
              Definition

              The intended duration of use. E.g. 5 days or 8 weeks. It is not allowed to indicate the duration in months, because different months have a variable duration in days.

              ShortDuration
              Control0..1
              TypeExtension(HCIM MedicationUse Duration) (Extension Type: Duration)
              Alternate NamestijdsDuur
              56. MedicationStatement.effective[x]:effectivePeriod.extension:Duration.url
              Definition

              Source of the definition for the extension code - a logical name or a URL.

              Shortidentifies the meaning of the extension
              Comments

              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.

              Control1..1
              Typeuri
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              XML FormatIn the XML format, this property is represented as an attribute.
              Fixed Valuehttp://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse-Duration
              58. MedicationStatement.effective[x]:effectivePeriod.extension:Duration.value[x]
              Definition

              Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

              ShortValue of extension
              Control0..1
              TypeDuration, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              SlicingThis element introduces a set of slices on MedicationStatement.effective[x].extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
              • type @ $this
              • 60. MedicationStatement.effective[x]:effectivePeriod.extension:Duration.value[x]:valueDuration
                Slice NamevalueDuration
                Definition

                Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                ShortUsageDurationValue of extension
                Control0..1
                TypeDuration, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Alternate NamesGebruiksduur
                Example<br/><b>Example of Duration</b>:{ "value" : 3, "unit" : "day", "system" : "http://unitsofmeasure.org", "code" : "d" }
                62. MedicationStatement.dateAsserted
                Definition

                Date on which this use is entered.


                The date when the medication statement was asserted by the information source.

                ShortMedicationUseDateTimeWhen the statement was asserted?
                Control10..1
                TypedateTime
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Summarytrue
                Alternate NamesRegistratiedatum
                Example<br/><b>Example of MedicationUseDateTime</b>:2017-06-14
                64. MedicationStatement.subject
                Definition

                The person, animal or group who is/was taking the medication.

                ShortWho is/was taking the medication
                Control1..1
                TypeReference(nl-core-patient, Patient, Group)
                Summarytrue
                66. MedicationStatement.taken
                Definition

                Is this medicine used or not?


                Indicator of the certainty of whether the medication was taken by the patient.

                ShortUseIndicatory | n | unk | na
                Comments

                This element is labeled as a modifier because it indicates that the medication was not taken.

                Control1..1
                BindingThe codes SHALL be taken from MedicationStatementTakenhttp://hl7.org/fhir/ValueSet/medication-statement-taken
                (required to http://hl7.org/fhir/ValueSet/medication-statement-taken)

                A coded concept identifying level of certainty if patient has taken or has not taken the medication

                Typecode
                Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Alternate NamesGebruikIndicator
                Example<br/><b>Example of taken</b>:y
                68. MedicationStatement.dosage
                Definition

                Instructions for the use of the medication, e.g. dose and route of administration. In the event of medication use, this is the pattern of use established by the patient or which the patient followed


                Indicates how the medication is/was or should be taken by the patient.

                ShortInstructionsForUseDetails of how medication is/was taken or should be taken
                Comments

                The wiki page https://informatiestandaarden.nictiz.nl/wiki/mp:V9.0Voorbeeldendoseringen provides dosage instruction examples. These examples consists of functional data and their representation in FHIR and CDA.


                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.

                Control0..*
                This element is affected by the following invariants: ele-1
                TypeDosage(HCIM InstructionsForUse)
                Alternate NamesGebruiksinstructie
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                70. MedicationStatement.dosage.text
                Definition

                Textual description of the complete instructions for use including the period of use.


                Free text dosage instructions e.g. SIG.

                ShortDescriptionFree text dosage instructions e.g. SIG
                Control0..1
                Typestring
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Summarytrue
                Requirements

                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.

                Alternate NamesOmschrijving
                72. MedicationStatement.dosage.asNeeded[x]
                Definition

                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).

                ShortTake "as needed" (for x)
                Comments

                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".

                Control0..1
                BindingFor example codes, see SNOMED CT Medication As Needed Reason Codeshttp://hl7.org/fhir/ValueSet/medication-as-needed-reason
                (example to http://hl7.org/fhir/ValueSet/medication-as-needed-reason)

                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.

                TypeCodeableConcept, boolean
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Summarytrue
                SlicingThis element introduces a set of slices on MedicationStatement.dosage.asNeeded[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                • type @ $this
                • 74. MedicationStatement.dosage.asNeeded[x]:asNeededCodeableConcept
                  Slice NameasNeededCodeableConcept
                  Definition

                  As needed means that the dose is only to be administered under certain conditions.


                  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).

                  ShortAsNeededTake "as needed" (for x)
                  Comments

                  Using the term 'as needed' or a specific reason (eg 'in case of pain') to use medication leads to ambiguity. It is not always clear whether the whole dose is 'as needed' or only part of the dose. For example: 1x daily 1-2 tablets as needed. This can mean: 1 tablet fixed per day and 1 tablet as needed or, as needed, a maximum of 2 tablets.As needed medication is not included in GDS. In the first situation, 1 tablet comes in the GDS (drug dispensing systems) and 1 tablet is delivered separately. In the second situation there is only separate delivery.The system must make sufficiently clear whether the entire instruction or part of the dose is necessary. The HCIM supports both options described above.


                  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".

                  Control0..1
                  BindingUnless not suitable, these codes SHALL be taken from For example codes, see ZonodigCriteriumCodelijsthttp://hl7.org/fhir/ValueSet/medication-as-needed-reason
                  (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.12.4--20171231000000)

                  ZonodigCriteriumCodelijst


                  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.

                  TypeCodeableConcept, boolean
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Summarytrue
                  Alternate NamesZo nodig, Criterium
                  76. MedicationStatement.dosage.route
                  Definition

                  The route through which the medication is administered (oral, nasal, intravenous, etc.)


                  How drug should enter body.

                  ShortRouteOfAdministrationHow drug should enter body
                  Control0..1
                  BindingUnless not suitable, these codes SHALL be taken from For example codes, see MedicatieToedieningswegCodelijsthttp://hl7.org/fhir/ValueSet/route-codes
                  (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.12.1--20171231000000)

                  ToedieningswegCodelijst


                  A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

                  TypeCodeableConcept
                  Summarytrue
                  Requirements

                  A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.

                  Alternate NamesToedieningsweg
                  Example<br/><b>Example of RouteOfAdministration</b>:{ "coding" : [{ "system" : "urn:oid:2.16.840.1.113883.2.4.4.9", "code" : "oraal", "display" : "Oraal" }] }
                  78. MedicationStatement.dosage.route.text
                  Definition

                  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.

                  ShortPlain text representation of the concept
                  Comments

                  Very often the text is the same as a displayName of one of the codings.

                  Control0..1
                  Typestring
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  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.

                  80. MedicationStatement.dosage.dose[x]
                  Definition

                  The dose indicates the dose amount per administration.

                  The dosage is described in the unit accompanying the product; usually, this is just a number of units or doses. Liquids and other divisible products will usually include a unit of volume (preferably "ml").

                  In many cases, the prescriber will want to indicate the dose in units of weight of the active ingredient.

                  If only the ingredient is included and not the product, then the amount of that ingredient will be given. Paracetamol 1000mg is equivalent to 2 Paracetamol 500mg tablets or units.

                  The dosage is sometimes given as a calculation, in which the patient’s body weight or body surface area is used as a parameter. The calculation is however no more than an aid in reaching a decision.

                  In the event of constant administration, sometimes the dose is given in addition to the administration speed (infusion rate) (e.g. 20ml in a syringe or 500ml in a bag), but it is often also omitted.

                  A general dosage recommendation such as ‘Use according to protocol’ or ‘See instructions’ can be sufficient. In that case, no dose is given.


                  Amount of medication per dose.

                  ShortDoseAmount of medication per dose
                  Comments

                  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.

                  Control0..1
                  TypeChoice of: Range, Quantity(SimpleQuantity)
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Summarytrue
                  Requirements

                  The amount of therapeutic or other substance given at one administration event.

                  Alternate NamesKeerdosis
                  SlicingThis element introduces a set of slices on MedicationStatement.dosage.dose[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                  • type @ $this
                  • 82. MedicationStatement.dosage.dose[x]:doseQuantity
                    Slice NamedoseQuantity
                    Definition

                    The comparator is not used on a SimpleQuantity


                    Amount of medication per dose.

                    ShortA fixed quantity (no comparator)Amount of medication per dose
                    Comments

                    The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.


                    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.

                    Control0..1
                    This element is affected by the following invariants: ele-1
                    BindingThe codes SHALL be taken from For codes, see G-Standaard Eenhedentabel
                    (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453)

                    GstdTabel902

                    TypeQuantity(SimpleQuantity), Range
                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                    Requirements

                    The amount of therapeutic or other substance given at one administration event.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                    qty-3: If a code for the unit is present, the system SHALL also be present (code.empty() or system.exists())
                    sqty-1: The comparator is not used on a SimpleQuantity (comparator.empty())
                    84. MedicationStatement.dosage.dose[x]:doseRange
                    Slice NamedoseRange
                    Definition

                    Amount of medication per dose.

                    ShortAmount of medication per dose
                    Comments

                    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.

                    Control0..1
                    TypeRange, Quantity(SimpleQuantity)
                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                    Summarytrue
                    Requirements

                    The amount of therapeutic or other substance given at one administration event.

                    Guidance on how to interpret the contents of this table can be found here

                    0. MedicationStatement
                    Definition

                    MedicationUse is a statement on the historic, current or intended use of a certain medicine.

                    ShortMedicationUse
                    Comments

                    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.

                    Control0..*
                    Alternate NamesMedicatiegebruik
                    Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                    dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.empty())
                    dom-4: 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())
                    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (contained.where(('#'+id in %resource.descendants().reference).not()).empty())
                    mst-1: Reason not taken is only permitted if Taken is No (reasonNotTaken.exists().not() or (taken = 'n'))
                    2. MedicationStatement.id
                    Definition

                    The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

                    ShortLogical id of this artifact
                    Comments

                    The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

                    Control0..1
                    Typeid
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    4. MedicationStatement.meta
                    Definition

                    The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

                    ShortMetadata about the resource
                    Control0..1
                    TypeMeta
                    Summarytrue
                    6. MedicationStatement.implicitRules
                    Definition

                    A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

                    ShortA set of rules under which this content was created
                    Comments

                    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.

                    This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

                    Control0..1
                    Typeuri
                    Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    8. MedicationStatement.language
                    Definition

                    The base language in which the resource is written.

                    ShortLanguage of the resource content
                    Comments

                    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).

                    Control0..1
                    BindingUnless not suitable, these codes SHALL be taken from Common Languages
                    (extensible to http://hl7.org/fhir/ValueSet/languages)

                    A human language.

                    Additional BindingsPurpose
                    All LanguagesMax Binding
                    Typecode
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    10. MedicationStatement.text
                    Definition

                    A human-readable narrative that contains a summary of the resource, and may 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.

                    ShortText summary of the resource, for human interpretation
                    Comments

                    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 in formation is added later.

                    Control0..1
                    This element is affected by the following invariants: dom-1
                    TypeNarrative
                    Alternate Namesnarrative, html, xhtml, display
                    12. MedicationStatement.contained
                    Definition

                    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.

                    ShortContained, inline Resources
                    Comments

                    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.

                    Control0..*
                    TypeResource
                    Alternate Namesinline resources, anonymous resources, contained resources
                    14. MedicationStatement.extension
                    Definition

                    An Extension

                    ShortExtension
                    Control0..*
                    TypeExtension
                    SlicingThis element introduces a set of slices on MedicationStatement.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ url
                    • 16. MedicationStatement.extension:asAgreedIndicator
                      Slice NameasAgreedIndicator
                      Definition

                      Is the medicine used as outlined in the medication agreement?

                      ShortAsAgreedIndicator
                      Control0..1
                      This element is affected by the following invariants: ele-1
                      TypeExtension(HCIM As AgreedIndicator) (Extension Type: boolean)
                      Alternate NamesVolgensAfspraakIndicator
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      18. MedicationStatement.extension:asAgreedIndicator.id
                      Definition

                      unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                      Shortxml:id (or equivalent in JSON)
                      Control0..1
                      Typestring
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      XML FormatIn the XML format, this property is represented as an attribute.
                      20. MedicationStatement.extension:asAgreedIndicator.extension
                      Definition

                      May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                      ShortAdditional Content defined by implementations
                      Comments

                      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.

                      Control0..*
                      TypeExtension
                      Alternate Namesextensions, user content
                      SlicingThis element introduces a set of slices on MedicationStatement.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 22. MedicationStatement.extension:asAgreedIndicator.url
                        Definition

                        Source of the definition for the extension code - a logical name or a URL.

                        Shortidentifies the meaning of the extension
                        Comments

                        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.

                        Control1..1
                        Typeuri
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Fixed Valuehttp://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse-AsAgreedIndicator
                        24. MedicationStatement.extension:asAgreedIndicator.value[x]
                        Definition

                        Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                        ShortValue of extension
                        Control0..1
                        Typeboolean
                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        SlicingThis element introduces a set of slices on MedicationStatement.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                        • type @ $this
                        • 26. MedicationStatement.extension:asAgreedIndicator.value[x]:valueBoolean
                          Slice NamevalueBoolean
                          Definition

                          Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                          ShortValue of extension
                          Control0..1
                          Typeboolean
                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Example<br/><b>Example of asAgreed</b>:true
                          28. MedicationStatement.extension:prescriber
                          Slice Nameprescriber
                          Definition

                          The health professional that entered the medication agreement with the patient.

                          ShortPrescriber
                          Comments

                          The health professional's specialty, role, and organization are captured and communicated through the PractitionerRole Resource based on the nl-core-practitionerrole profile.

                          Control0..1
                          This element is affected by the following invariants: ele-1
                          TypeExtension(HCIM MedicationUse Prescriber) (Extension Type: Reference)
                          Alternate NamesVoorschrijver
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          30. MedicationStatement.extension:author
                          Slice Nameauthor
                          Definition

                          The author of this MedicationStatement. This is either a patient, a health professional or a healthcare provicer.

                          ShortAuthor
                          Comments

                          The health professional's specialty, role, and organization are captured and communicated through the PractitionerRole Resource based on the nl-core-practitionerrole profile.

                          Control0..1
                          This element is affected by the following invariants: ele-1
                          TypeExtension(HCIM MedicationUse Author) (Extension Type: Reference)
                          Alternate NamesAuteur
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          32. MedicationStatement.extension:medicationTreatment
                          Slice NamemedicationTreatment
                          Definition

                          This extension is to describe which overarching medical treatment this information is part of. This is done by the use of an identifier of that medical treatment.

                          ShortMedical Treatment
                          Comments

                          No HCIM concept is available for this element. Therefore a mapping to the relevant element Medication Process data element is provided.

                          Control0..1
                          This element is affected by the following invariants: ele-1
                          TypeExtension(HCIM MedicationTreatment) (Extension Type: Identifier)
                          Alternate NamesMedicamenteuze Behandeling
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          34. MedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse
                          Slice NamereasonForChangeOrDiscontinuationOfUse
                          Definition

                          Reason for changing or discontinuing use of medication.

                          ShortReasonForChangeOrDiscontinuationOfUse
                          Control0..*
                          This element is affected by the following invariants: ele-1
                          TypeExtension(HCIM MedicationUse ReasonForChangeOrDiscontinuationOfUse) (Extension Type: CodeableConcept)
                          Alternate NamesRedenWijzigenOfStoppenGebruik, Reden wijzigen of stoppen gebruik
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          36. MedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse.id
                          Definition

                          unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                          Shortxml:id (or equivalent in JSON)
                          Control0..1
                          Typestring
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          38. MedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse.extension
                          Definition

                          May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                          ShortAdditional Content defined by implementations
                          Comments

                          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.

                          Control0..*
                          TypeExtension
                          Alternate Namesextensions, user content
                          SlicingThis element introduces a set of slices on MedicationStatement.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 40. MedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse.url
                            Definition

                            Source of the definition for the extension code - a logical name or a URL.

                            Shortidentifies the meaning of the extension
                            Comments

                            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.

                            Control1..1
                            Typeuri
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Fixed Valuehttp://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse-ReasonForChangeOrDiscontinuationOfUse
                            42. MedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse.value[x]
                            Definition

                            Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                            ShortValue of extension
                            Control0..1
                            TypeCodeableConcept
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            SlicingThis element introduces a set of slices on MedicationStatement.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                            • type @ $this
                            • 44. MedicationStatement.extension:reasonForChangeOrDiscontinuationOfUse.value[x]:valueCodeableConcept
                              Slice NamevalueCodeableConcept
                              Definition

                              Reason for changing or discontinuing use of medication.

                              ShortReasonForChangeOrDiscontinuationOfUse
                              Control0..1
                              BindingUnless not suitable, these codes SHALL be taken from RedenWijzigenOfStoppenGebruikCodelijst
                              (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.11.2--20171231000000)
                              TypeCodeableConcept
                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                              Alternate NamesReden wijzigen of stoppen gebruik
                              Example<br/><b>Example of ReasonForChangeOrDiscontinuationOfUse</b>:{ "coding" : [{ "system" : "http://snomed.info/sct", "code" : "79899007", "display" : "Drug interaction (finding)" }] }
                              46. MedicationStatement.modifierExtension
                              Definition

                              An Extension

                              ShortExtension
                              Control0..*
                              TypeExtension
                              Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                              SlicingThis element introduces a set of slices on MedicationStatement.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ url
                              • 48. MedicationStatement.modifierExtension:repeatPeriodCyclicalSchedule
                                Slice NamerepeatPeriodCyclicalSchedule
                                Definition

                                The repeated period in a cyclical schedule (of one or more dosing instructions). A cyclic schedule is noted in days, the corresponding dosing duration is also in days.

                                Examples of a cyclical schedule: contraceptive pill (21 days, 1 pill 1x a day, then skip for 7 days, repeat), repeat period here is 28 days. RepeatPeriodCyclicalSchedule

                                ShortRepeatPeriodCyclicalSchedule
                                Control0..1
                                This element is affected by the following invariants: ele-1
                                TypeExtension(HCIM Medication RepeatPeriodCyclicalSchedule) (Extension Type: Duration)
                                Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                LabelHerhaalperiodeCyclischSchema
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                50. MedicationStatement.identifier
                                Definition

                                External identifier - FHIR will generate its own internal identifiers (probably URLs) which do not need to be explicitly managed by the resource. The identifier here is one that would be used by another non-FHIR system - for example an automated medication pump would provide a record each time it operated; an administration while the patient was off the ward might be made with a different system and entered after the event. Particularly important if these records have to be updated.

                                ShortExternal identifier
                                NoteThis is a business identifier, not a resource identifier (see discussion)
                                Control0..*
                                TypeIdentifier
                                Summarytrue
                                52. MedicationStatement.basedOn
                                Definition

                                A plan, proposal or order that is fulfilled in whole or in part by this event.

                                ShortFulfils plan, proposal or order
                                Control0..*
                                TypeReference(MedicationRequest, CarePlan, ProcedureRequest, ReferralRequest)
                                Summarytrue
                                Requirements

                                Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.

                                54. MedicationStatement.partOf
                                Definition

                                A larger event of which this particular event is a component or step.

                                ShortPart of referenced event
                                Control0..*
                                TypeReference(MedicationAdministration, MedicationDispense, MedicationStatement, Procedure, Observation)
                                Summarytrue
                                Requirements

                                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.

                                56. MedicationStatement.context
                                Definition

                                The encounter or episode of care that establishes the context for this MedicationStatement.

                                ShortEncounter / Episode associated with MedicationStatement
                                Control0..1
                                TypeReference(Encounter, EpisodeOfCare)
                                Summarytrue
                                58. MedicationStatement.status
                                Definition

                                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.

                                ShortMedicationUseStopType
                                Comments

                                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 also used for the concept 'Stop type'; the manner in which this medication is discontinued (temporary or definitive).

                                Control1..1
                                BindingThe codes SHALL be taken from MedicationStatementStatus
                                (required to http://hl7.org/fhir/ValueSet/medication-statement-status)

                                Allergy Intolerance critically Code list

                                Typecode
                                Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summarytrue
                                Alternate NamesMedicatieGebruikStopType
                                60. MedicationStatement.category
                                Definition

                                Indicates where type of medication statement and where the medication is expected to be consumed or administered.

                                ShortType of medication usage
                                Control1..1
                                BindingThe codes SHOULD be taken from MedicationStatementCategory
                                (preferred to http://hl7.org/fhir/ValueSet/medication-statement-category)

                                A coded concept identifying where the medication included in the medicationstatement is expected to be consumed or administered

                                TypeCodeableConcept
                                Summarytrue
                                62. MedicationStatement.category.id
                                Definition

                                unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                Shortxml:id (or equivalent in JSON)
                                Control0..1
                                Typestring
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                XML FormatIn the XML format, this property is represented as an attribute.
                                64. MedicationStatement.category.extension
                                Definition

                                May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                ShortAdditional Content defined by implementations
                                Comments

                                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.

                                Control0..*
                                TypeExtension
                                Alternate Namesextensions, user content
                                SlicingThis element introduces a set of slices on MedicationStatement.category.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • value @ url
                                • 66. MedicationStatement.category.coding
                                  Definition

                                  A reference to a code defined by a terminology system.

                                  ShortCode defined by a terminology system
                                  Comments

                                  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.

                                  Control0..*
                                  TypeCoding
                                  Summarytrue
                                  Requirements

                                  Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                                  SlicingThis element introduces a set of slices on MedicationStatement.category.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • value @ code
                                  • 68. MedicationStatement.category.coding:medicationUseCode
                                    Slice NamemedicationUseCode
                                    Definition

                                    Category code used for indexing/retrieval of the HCIM MedicationUse. The system and code are stated in the Medication Process v09.

                                    ShortMedicationUseCode
                                    Comments

                                    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.

                                    Control0..*
                                    TypeCoding
                                    Summarytrue
                                    Requirements

                                    Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                                    70. MedicationStatement.category.coding:medicationUseCode.id
                                    Definition

                                    unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    Shortxml:id (or equivalent in JSON)
                                    Control0..1
                                    Typestring
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    72. MedicationStatement.category.coding:medicationUseCode.extension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                    ShortAdditional Content defined by implementations
                                    Comments

                                    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.

                                    Control0..*
                                    TypeExtension
                                    Alternate Namesextensions, user content
                                    SlicingThis element introduces a set of slices on MedicationStatement.category.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                    • value @ url
                                    • 74. MedicationStatement.category.coding:medicationUseCode.system
                                      Definition

                                      The identification of the code system that defines the meaning of the symbol in the code.

                                      ShortIdentity of the terminology system
                                      Comments

                                      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 de-reference to some definition that establish the system clearly and unambiguously.

                                      Control0..1
                                      Typeuri
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Requirements

                                      Need to be unambiguous about the source of the definition of the symbol.

                                      Fixed Valueurn:oid:2.16.840.1.113883.2.4.3.11.60.20.77.5.3
                                      76. MedicationStatement.category.coding:medicationUseCode.version
                                      Definition

                                      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.

                                      ShortVersion of the system - if relevant
                                      Comments

                                      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.

                                      NoteThis is a business version Id, not a resource version Id (see discussion)
                                      Control0..1
                                      Typestring
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      78. MedicationStatement.category.coding:medicationUseCode.code
                                      Definition

                                      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).

                                      ShortSymbol in syntax defined by the system
                                      Control0..1
                                      Typecode
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Requirements

                                      Need to refer to a particular code in the system.

                                      Fixed Value6
                                      80. MedicationStatement.category.coding:medicationUseCode.display
                                      Definition

                                      A representation of the meaning of the code in the system, following the rules of the system.

                                      ShortRepresentation defined by the system
                                      Control0..1
                                      Typestring
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Requirements

                                      Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                      82. MedicationStatement.category.coding:medicationUseCode.userSelected
                                      Definition

                                      Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

                                      ShortIf this coding was chosen directly by the user
                                      Comments

                                      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.

                                      Control0..1
                                      Typeboolean
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Requirements

                                      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.

                                      84. MedicationStatement.category.text
                                      Definition

                                      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.

                                      ShortPlain text representation of the concept
                                      Comments

                                      Very often the text is the same as a displayName of one of the codings.

                                      Control0..1
                                      Typestring
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Must Supporttrue
                                      Summarytrue
                                      Requirements

                                      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.

                                      86. MedicationStatement.medication[x]
                                      Definition

                                      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.

                                      ShortWhat medication was taken
                                      Comments

                                      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. .

                                      Control1..1
                                      TypeReference
                                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                      Summarytrue
                                      SlicingThis element introduces a set of slices on MedicationStatement.medication[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                      • type @ $this
                                      • 88. MedicationStatement.medication[x]:medicationReference
                                        Slice NamemedicationReference
                                        Definition

                                        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.

                                        ShortProductUsed
                                        Control1..1
                                        TypeReference(HCIM PharmaceuticalProduct)
                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                        Summarytrue
                                        Alternate NamesGebruiksproduct
                                        90. MedicationStatement.medication[x]:medicationReference.id
                                        Definition

                                        unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                        Shortxml:id (or equivalent in JSON)
                                        Control0..1
                                        Typestring
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        XML FormatIn the XML format, this property is represented as an attribute.
                                        92. MedicationStatement.medication[x]:medicationReference.extension
                                        Definition

                                        May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                        ShortAdditional Content defined by implementations
                                        Comments

                                        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.

                                        Control0..*
                                        TypeExtension
                                        Alternate Namesextensions, user content
                                        SlicingThis element introduces a set of slices on MedicationStatement.medication[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                        • value @ url
                                        • 94. MedicationStatement.medication[x]:medicationReference.reference
                                          Definition

                                          A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                          ShortLiteral reference, Relative, internal or absolute URL
                                          Comments

                                          Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                          Control0..1
                                          This element is affected by the following invariants: ref-1
                                          Typestring
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summarytrue
                                          96. MedicationStatement.medication[x]:medicationReference.identifier
                                          Definition

                                          An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                          ShortLogical reference, when literal reference is not known
                                          Comments

                                          When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                          When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                          Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                          NoteThis is a business identifier, not a resource identifier (see discussion)
                                          Control0..1
                                          TypeIdentifier
                                          Summarytrue
                                          98. MedicationStatement.medication[x]:medicationReference.display
                                          Definition

                                          Plain text narrative that identifies the resource in addition to the resource reference.

                                          ShortText alternative for the resource
                                          Comments

                                          This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                          Control0..1
                                          Typestring
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Must Supporttrue
                                          Summarytrue
                                          100. MedicationStatement.effective[x]
                                          Definition

                                          The interval of time during which it is being asserted that the patient was taking the medication (or was not taking, when the wasNotGiven element is true).

                                          ShortThe date/time or interval when the medication was taken
                                          Comments

                                          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.

                                          Control0..1
                                          TypePeriod
                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                          Summarytrue
                                          SlicingThis element introduces a set of slices on MedicationStatement.effective[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                          • type @ $this
                                          • 102. MedicationStatement.effective[x]:effectivePeriod
                                            Slice NameeffectivePeriod
                                            Definition

                                            Medication use can be recorded for a certain moment or over a certain period. Thus, medication use can be recorded multiple times during the use of medication. The usage period is the period or moment over which the data is recorded.

                                            Start date: This is the time at which the agreement was to take effect (or took effect or will take effect).

                                            Duration: The intended duration of use. E.g. 5 days or 8 weeks. It is not allowed to indicate the duration in months, because different months have a variable duration in days.

                                            End date: The time at which the period of use ends (or ended or will end). To avoid confusion between 'to' and 'up to', the submission of time is always mandatory for the end date.

                                            ShortPeriodOfUse
                                            Comments

                                            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.

                                            Control0..1
                                            TypePeriod
                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                            Summarytrue
                                            Alternate NamesGebruiksperiode
                                            104. MedicationStatement.effective[x]:effectivePeriod.id
                                            Definition

                                            unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                            Shortxml:id (or equivalent in JSON)
                                            Control0..1
                                            Typestring
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            106. MedicationStatement.effective[x]:effectivePeriod.extension
                                            Definition

                                            An Extension

                                            ShortExtension
                                            Control0..*
                                            TypeExtension
                                            SlicingThis element introduces a set of slices on MedicationStatement.effective[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                            • value @ url
                                            • 108. MedicationStatement.effective[x]:effectivePeriod.extension:Duration
                                              Slice NameDuration
                                              Definition

                                              The intended duration of use. E.g. 5 days or 8 weeks. It is not allowed to indicate the duration in months, because different months have a variable duration in days.

                                              ShortDuration
                                              Control0..1
                                              TypeExtension(HCIM MedicationUse Duration) (Extension Type: Duration)
                                              Alternate NamestijdsDuur
                                              110. MedicationStatement.effective[x]:effectivePeriod.extension:Duration.id
                                              Definition

                                              unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                              Shortxml:id (or equivalent in JSON)
                                              Control0..1
                                              Typestring
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              XML FormatIn the XML format, this property is represented as an attribute.
                                              112. MedicationStatement.effective[x]:effectivePeriod.extension:Duration.extension
                                              Definition

                                              May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                              ShortAdditional Content defined by implementations
                                              Comments

                                              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.

                                              Control0..*
                                              TypeExtension
                                              Alternate Namesextensions, user content
                                              SlicingThis element introduces a set of slices on MedicationStatement.effective[x].extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                              • value @ url
                                              • 114. MedicationStatement.effective[x]:effectivePeriod.extension:Duration.url
                                                Definition

                                                Source of the definition for the extension code - a logical name or a URL.

                                                Shortidentifies the meaning of the extension
                                                Comments

                                                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.

                                                Control1..1
                                                Typeuri
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                Fixed Valuehttp://nictiz.nl/fhir/StructureDefinition/zib-MedicationUse-Duration
                                                116. MedicationStatement.effective[x]:effectivePeriod.extension:Duration.value[x]
                                                Definition

                                                Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                                                ShortValue of extension
                                                Control0..1
                                                TypeDuration
                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                SlicingThis element introduces a set of slices on MedicationStatement.effective[x].extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                • type @ $this
                                                • 118. MedicationStatement.effective[x]:effectivePeriod.extension:Duration.value[x]:valueDuration
                                                  Slice NamevalueDuration
                                                  Definition

                                                  Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                                                  ShortUsageDuration
                                                  Control0..1
                                                  TypeDuration
                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                  Alternate NamesGebruiksduur
                                                  Example<br/><b>Example of Duration</b>:{ "value" : 3, "unit" : "day", "system" : "http://unitsofmeasure.org", "code" : "d" }
                                                  120. MedicationStatement.effective[x]:effectivePeriod.start
                                                  Definition

                                                  This is the time at which the agreement was to take effect (or took effect or will take effect).

                                                  ShortStartDate
                                                  Comments

                                                  If the low element is missing, the meaning is that the low boundary is not known.

                                                  Control0..1
                                                  This element is affected by the following invariants: per-1
                                                  TypedateTime
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Alternate NamesIngangsdatum
                                                  122. MedicationStatement.effective[x]:effectivePeriod.end
                                                  Definition

                                                  The time at which the period of use ends (or ended or will end). To avoid confusion between 'to' and 'up to', the submission of time is always mandatory for the end date.

                                                  ShortEndDate
                                                  Comments

                                                  The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03.

                                                  Control0..1
                                                  This element is affected by the following invariants: per-1
                                                  TypedateTime
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Alternate NamesEinddatum
                                                  Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
                                                  124. MedicationStatement.dateAsserted
                                                  Definition

                                                  Date on which this use is entered.

                                                  ShortMedicationUseDateTime
                                                  Control1..1
                                                  TypedateTime
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Must Supporttrue
                                                  Summarytrue
                                                  Alternate NamesRegistratiedatum
                                                  Example<br/><b>Example of MedicationUseDateTime</b>:2017-06-14
                                                  126. MedicationStatement.informationSource
                                                  Definition

                                                  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.

                                                  ShortPerson or organization that provided the information about the taking of this medication
                                                  Comments

                                                  If a health professional is the informationSource the PractitionerRole reference extension can be used for a PractitionerRole reference. The health professional's specialty, role, and organization are captured and communicated through the PractitionerRole Resource based on the nl-core-practitionerrole profile.

                                                  Control0..1
                                                  TypeReference(nl-core-patient, nl-core-practitioner, nl-core-relatedperson, nl-core-organization)
                                                  128. MedicationStatement.informationSource.id
                                                  Definition

                                                  unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                  Shortxml:id (or equivalent in JSON)
                                                  Control0..1
                                                  Typestring
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  130. MedicationStatement.informationSource.extension
                                                  Definition

                                                  An Extension

                                                  ShortExtension
                                                  Control0..*
                                                  TypeExtension
                                                  SlicingThis element introduces a set of slices on MedicationStatement.informationSource.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                  • value @ url
                                                  • 132. MedicationStatement.informationSource.extension:practitionerRole
                                                    Slice NamepractitionerRole
                                                    Definition

                                                    Optional Extension Element - found in all resources.

                                                    ShortOptional Extensions Element
                                                    Control0..1
                                                    TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
                                                    134. MedicationStatement.informationSource.reference
                                                    Definition

                                                    A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                                    ShortLiteral reference, Relative, internal or absolute URL
                                                    Comments

                                                    Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                                    Control0..1
                                                    This element is affected by the following invariants: ref-1
                                                    Typestring
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summarytrue
                                                    136. MedicationStatement.informationSource.identifier
                                                    Definition

                                                    An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                    ShortLogical reference, when literal reference is not known
                                                    Comments

                                                    When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                    When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                    Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                    NoteThis is a business identifier, not a resource identifier (see discussion)
                                                    Control0..1
                                                    TypeIdentifier
                                                    Summarytrue
                                                    138. MedicationStatement.informationSource.display
                                                    Definition

                                                    Plain text narrative that identifies the resource in addition to the resource reference.

                                                    ShortText alternative for the resource
                                                    Comments

                                                    This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                    Control0..1
                                                    Typestring
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summarytrue
                                                    140. MedicationStatement.subject
                                                    Definition

                                                    The person, animal or group who is/was taking the medication.

                                                    ShortWho is/was taking the medication
                                                    Control1..1
                                                    TypeReference(nl-core-patient)
                                                    Summarytrue
                                                    142. MedicationStatement.derivedFrom
                                                    Definition

                                                    Allows linking the MedicationStatement to the underlying MedicationRequest, or to other information that supports or is used to derive the MedicationStatement.

                                                    ShortAdditional supporting information
                                                    Comments

                                                    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.

                                                    Control0..*
                                                    TypeReference(Resource)
                                                    144. MedicationStatement.taken
                                                    Definition

                                                    Is this medicine used or not?

                                                    ShortUseIndicator
                                                    Comments

                                                    This element is labeled as a modifier because it indicates that the medication was not taken.

                                                    Control1..1
                                                    BindingThe codes SHALL be taken from MedicationStatementTaken
                                                    (required to http://hl7.org/fhir/ValueSet/medication-statement-taken)

                                                    A coded concept identifying level of certainty if patient has taken or has not taken the medication

                                                    Typecode
                                                    Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summarytrue
                                                    Alternate NamesGebruikIndicator
                                                    Example<br/><b>Example of taken</b>:y
                                                    146. MedicationStatement.reasonNotTaken
                                                    Definition

                                                    A code indicating why the medication was not taken.

                                                    ShortTrue if asserting medication was not given
                                                    Control0..*
                                                    This element is affected by the following invariants: mst-1
                                                    BindingFor example codes, see SNOMED CT Drugs not taken/completed Codes
                                                    (example to http://hl7.org/fhir/ValueSet/reason-medication-not-taken-codes)

                                                    A coded concept indicating the reason why the medication was not taken

                                                    TypeCodeableConcept
                                                    148. MedicationStatement.reasonCode
                                                    Definition

                                                    A reason for why the medication is being/was taken.

                                                    ShortReason for why the medication is being/was taken
                                                    Comments

                                                    This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonForUseReference.

                                                    Control0..*
                                                    BindingFor example codes, see Condition/Problem/Diagnosis Codes
                                                    (example to http://hl7.org/fhir/ValueSet/condition-code)

                                                    A coded concept identifying why the medication is being taken.

                                                    TypeCodeableConcept
                                                    150. MedicationStatement.reasonCode.id
                                                    Definition

                                                    unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                    Shortxml:id (or equivalent in JSON)
                                                    Control0..1
                                                    Typestring
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                    152. MedicationStatement.reasonCode.extension
                                                    Definition

                                                    May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                                    ShortAdditional Content defined by implementations
                                                    Comments

                                                    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.

                                                    Control0..*
                                                    TypeExtension
                                                    Alternate Namesextensions, user content
                                                    SlicingThis element introduces a set of slices on MedicationStatement.reasonCode.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                    • value @ url
                                                    • 154. MedicationStatement.reasonCode.coding
                                                      Definition

                                                      A reference to a code defined by a terminology system.

                                                      ShortCode defined by a terminology system
                                                      Comments

                                                      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.

                                                      Control0..*
                                                      TypeCoding
                                                      Summarytrue
                                                      Requirements

                                                      Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                                                      156. MedicationStatement.reasonCode.text
                                                      Definition

                                                      The reason for using the medication, particularly in self-care medicine purchased by the patient themselves.

                                                      ShortReasonForUse
                                                      Comments

                                                      Very often the text is the same as a displayName of one of the codings.

                                                      Control0..1
                                                      Typestring
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      Requirements

                                                      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.

                                                      Alternate NamesRedenGebruik
                                                      158. MedicationStatement.reasonReference
                                                      Definition

                                                      Condition or observation that supports why the medication is being/was taken.

                                                      ShortCondition or observation that supports why the medication is being/was taken
                                                      Comments

                                                      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.

                                                      Control0..*
                                                      TypeReference(Condition, Observation)
                                                      160. MedicationStatement.note
                                                      Definition

                                                      Comments on the medication use.

                                                      ShortComment
                                                      Control0..*
                                                      TypeAnnotation
                                                      Alternate NamesToelichting
                                                      162. MedicationStatement.dosage
                                                      Definition

                                                      Instructions for the use of the medication, e.g. dose and route of administration. In the event of medication use, this is the pattern of use established by the patient or which the patient followed

                                                      ShortInstructionsForUse
                                                      Comments

                                                      The wiki page https://informatiestandaarden.nictiz.nl/wiki/mp:V9.0Voorbeeldendoseringen provides dosage instruction examples. These examples consists of functional data and their representation in FHIR and CDA.

                                                      Control0..*
                                                      This element is affected by the following invariants: ele-1
                                                      TypeDosage(HCIM InstructionsForUse)
                                                      Alternate NamesGebruiksinstructie
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                      164. MedicationStatement.dosage.id
                                                      Definition

                                                      unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                      Shortxml:id (or equivalent in JSON)
                                                      Control0..1
                                                      Typestring
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                      166. MedicationStatement.dosage.extension
                                                      Definition

                                                      May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                                      ShortAdditional Content defined by implementations
                                                      Comments

                                                      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.

                                                      Control0..*
                                                      TypeExtension
                                                      Alternate Namesextensions, user content
                                                      SlicingThis element introduces a set of slices on MedicationStatement.dosage.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                      • value @ url
                                                      • 168. MedicationStatement.dosage.sequence
                                                        Definition

                                                        This indicates the sequence of the dosing instructions within the medication agreement.

                                                        ShortSequenceNumber
                                                        Control0..1
                                                        Typeinteger
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summarytrue
                                                        Requirements

                                                        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.

                                                        Alternate NamesVolgnummer
                                                        170. MedicationStatement.dosage.text
                                                        Definition

                                                        Textual description of the complete instructions for use including the period of use.

                                                        ShortDescription
                                                        Control0..1
                                                        Typestring
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Must Supporttrue
                                                        Summarytrue
                                                        Requirements

                                                        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.

                                                        Alternate NamesOmschrijving
                                                        172. MedicationStatement.dosage.additionalInstruction
                                                        Definition

                                                        The additional instructions contain extra information on the use of or considerations for the current prescription. This can also include all instructions for use. The text can come from the original 'paper' medication prescription, but can also be generated from the coded information. This concept may contain more information than what is structurally coded in the information below, but may not conflict with it. The instructions may not conflict with other components of the request for administration. The instructions can also refer to an existing protocol. The G standard contains many texts that can support this attribute, in for example G standard table 362, which contains texts from the general practitioners’ standard WCIA table 25. If desired, these texts can be used to structure this concept.

                                                        ShortAdditionalInstructions
                                                        Control0..*
                                                        BindingUnless not suitable, these codes SHALL be taken from Aanvullende gebruiksinstructie
                                                        (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.9--20160407000000)
                                                        TypeCodeableConcept
                                                        Summarytrue
                                                        Requirements

                                                        Additional instruction such as "Swallow with plenty of water" which may or may not be coded.

                                                        Alternate NamesAanvullendeInstructie
                                                        174. MedicationStatement.dosage.patientInstruction
                                                        Definition

                                                        Instructions in terms that are understood by the patient or consumer.

                                                        ShortPatient or consumer oriented instructions
                                                        Control0..1
                                                        Typestring
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summarytrue
                                                        176. MedicationStatement.dosage.timing
                                                        Definition

                                                        Specifications of the times at which the medication is to be administered. This is indicated as follows: Time(s) (16:00) or indications (“before meals”) at which the medication is to be taken each day. A specific number of times the medication is to be taken each day (“3x a day“), indicated with the frequency A time interval between consecutive doses (“Every 2 hours”, “every 3 days”), indicated with the word Interval. Combined periods with an interval and duration (“1 daily for three out of four weeks: the pill schedule”) If a certain medication is not to be taken daily, the aforementioned can be combined with daily indications: One or more week days on which the medication is to be administered (e.g. “Monday, Wednesday, Friday”) ”3x a week”, “2x a month”. The specified administration “infinite” is automatically to be repeated until: The end date and time has been reached The total administration duration has been reached (14 days) A specific amount of administrations has been reached (“20 doses”, “one-time only”), to be entered in the NumberOfDoses concept.

                                                        ShortAdministeringSchedule
                                                        Comments

                                                        A timing schedule can be either a list of events - intervals on which the event occurs, or a single event with repeating criteria or just repeating criteria with no actual event. When both event and a repeating specification are provided, the list of events should be understood as an interpretation of the information in the repeat structure.

                                                        Control0..1
                                                        This element is affected by the following invariants: ele-1
                                                        TypeTiming(HCIM AdministrationSchedule)
                                                        Requirements

                                                        The timing schedule for giving the medication to the patient. The Schedule 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.

                                                        Alternate NamesToedieningsschema
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                        178. MedicationStatement.dosage.asNeeded[x]
                                                        Definition

                                                        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).

                                                        ShortTake "as needed" (for x)
                                                        Comments

                                                        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".

                                                        Control0..1
                                                        BindingFor example codes, see SNOMED CT Medication As Needed Reason Codes
                                                        (example to http://hl7.org/fhir/ValueSet/medication-as-needed-reason)

                                                        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.

                                                        TypeCodeableConcept
                                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                        Summarytrue
                                                        SlicingThis element introduces a set of slices on MedicationStatement.dosage.asNeeded[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                        • type @ $this
                                                        • 180. MedicationStatement.dosage.asNeeded[x]:asNeededCodeableConcept
                                                          Slice NameasNeededCodeableConcept
                                                          Definition

                                                          As needed means that the dose is only to be administered under certain conditions.

                                                          ShortAsNeeded
                                                          Comments

                                                          Using the term 'as needed' or a specific reason (eg 'in case of pain') to use medication leads to ambiguity. It is not always clear whether the whole dose is 'as needed' or only part of the dose. For example: 1x daily 1-2 tablets as needed. This can mean: 1 tablet fixed per day and 1 tablet as needed or, as needed, a maximum of 2 tablets.As needed medication is not included in GDS. In the first situation, 1 tablet comes in the GDS (drug dispensing systems) and 1 tablet is delivered separately. In the second situation there is only separate delivery.The system must make sufficiently clear whether the entire instruction or part of the dose is necessary. The HCIM supports both options described above.

                                                          Control0..1
                                                          BindingUnless not suitable, these codes SHALL be taken from ZonodigCriteriumCodelijst
                                                          (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.12.4--20171231000000)

                                                          ZonodigCriteriumCodelijst

                                                          TypeCodeableConcept
                                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                          Summarytrue
                                                          Alternate NamesZo nodig, Criterium
                                                          182. MedicationStatement.dosage.site
                                                          Definition

                                                          Body site to administer to.

                                                          ShortBody site to administer to
                                                          Comments

                                                          If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension body-site-instance. May be a summary code, or a reference to a very precise definition of the location, or both.

                                                          Control0..1
                                                          BindingFor example codes, see SNOMED CT Anatomical Structure for Administration Site Codes
                                                          (example to http://hl7.org/fhir/ValueSet/approach-site-codes)

                                                          A coded concept describing the site location the medicine enters into or onto the body.

                                                          TypeCodeableConcept
                                                          Summarytrue
                                                          Requirements

                                                          A coded specification of the anatomic site where the medication first enters the body.

                                                          184. MedicationStatement.dosage.route
                                                          Definition

                                                          The route through which the medication is administered (oral, nasal, intravenous, etc.)

                                                          ShortRouteOfAdministration
                                                          Control0..1
                                                          BindingUnless not suitable, these codes SHALL be taken from MedicatieToedieningswegCodelijst
                                                          (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.12.1--20171231000000)

                                                          ToedieningswegCodelijst

                                                          TypeCodeableConcept
                                                          Summarytrue
                                                          Requirements

                                                          A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.

                                                          Alternate NamesToedieningsweg
                                                          Example<br/><b>Example of RouteOfAdministration</b>:{ "coding" : [{ "system" : "urn:oid:2.16.840.1.113883.2.4.4.9", "code" : "oraal", "display" : "Oraal" }] }
                                                          186. MedicationStatement.dosage.route.id
                                                          Definition

                                                          unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                          Shortxml:id (or equivalent in JSON)
                                                          Control0..1
                                                          Typestring
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                          188. MedicationStatement.dosage.route.extension
                                                          Definition

                                                          May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                                          ShortAdditional Content defined by implementations
                                                          Comments

                                                          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.

                                                          Control0..*
                                                          TypeExtension
                                                          Alternate Namesextensions, user content
                                                          SlicingThis element introduces a set of slices on MedicationStatement.dosage.route.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                          • value @ url
                                                          • 190. MedicationStatement.dosage.route.coding
                                                            Definition

                                                            A reference to a code defined by a terminology system.

                                                            ShortCode defined by a terminology system
                                                            Comments

                                                            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.

                                                            Control0..*
                                                            TypeCoding
                                                            Summarytrue
                                                            Requirements

                                                            Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                                                            192. MedicationStatement.dosage.route.text
                                                            Definition

                                                            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.

                                                            ShortPlain text representation of the concept
                                                            Comments

                                                            Very often the text is the same as a displayName of one of the codings.

                                                            Control0..1
                                                            Typestring
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Must Supporttrue
                                                            Summarytrue
                                                            Requirements

                                                            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.

                                                            194. MedicationStatement.dosage.method
                                                            Definition

                                                            Technique for administering medication.

                                                            ShortTechnique for administering medication
                                                            Comments

                                                            Terminologies used often pre-coordinate this term with the route and or form of administration.

                                                            Control0..1
                                                            BindingFor example codes, see SNOMED CT Administration Method Codes
                                                            (example to http://hl7.org/fhir/ValueSet/administration-method-codes)

                                                            A coded concept describing the technique by which the medicine is administered.

                                                            TypeCodeableConcept
                                                            Summarytrue
                                                            Requirements

                                                            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.

                                                            196. MedicationStatement.dosage.dose[x]
                                                            Definition

                                                            The dose indicates the dose amount per administration.

                                                            The dosage is described in the unit accompanying the product; usually, this is just a number of units or doses. Liquids and other divisible products will usually include a unit of volume (preferably "ml").

                                                            In many cases, the prescriber will want to indicate the dose in units of weight of the active ingredient.

                                                            If only the ingredient is included and not the product, then the amount of that ingredient will be given. Paracetamol 1000mg is equivalent to 2 Paracetamol 500mg tablets or units.

                                                            The dosage is sometimes given as a calculation, in which the patient’s body weight or body surface area is used as a parameter. The calculation is however no more than an aid in reaching a decision.

                                                            In the event of constant administration, sometimes the dose is given in addition to the administration speed (infusion rate) (e.g. 20ml in a syringe or 500ml in a bag), but it is often also omitted.

                                                            A general dosage recommendation such as ‘Use according to protocol’ or ‘See instructions’ can be sufficient. In that case, no dose is given.

                                                            ShortDose
                                                            Comments

                                                            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.

                                                            Control0..1
                                                            TypeChoice of: Range, Quantity(SimpleQuantity)
                                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                            Summarytrue
                                                            Requirements

                                                            The amount of therapeutic or other substance given at one administration event.

                                                            Alternate NamesKeerdosis
                                                            SlicingThis element introduces a set of slices on MedicationStatement.dosage.dose[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                                            • type @ $this
                                                            • 198. MedicationStatement.dosage.dose[x]:doseQuantity
                                                              Slice NamedoseQuantity
                                                              Definition

                                                              The comparator is not used on a SimpleQuantity

                                                              ShortA fixed quantity (no comparator)
                                                              Comments

                                                              The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

                                                              Control0..1
                                                              This element is affected by the following invariants: ele-1
                                                              BindingThe codes SHALL be taken from G-Standaard Eenhedentabel
                                                              (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453)

                                                              GstdTabel902

                                                              TypeQuantity(SimpleQuantity)
                                                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                              Requirements

                                                              The amount of therapeutic or other substance given at one administration event.

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                              qty-3: If a code for the unit is present, the system SHALL also be present (code.empty() or system.exists())
                                                              sqty-1: The comparator is not used on a SimpleQuantity (comparator.empty())
                                                              200. MedicationStatement.dosage.dose[x]:doseRange
                                                              Slice NamedoseRange
                                                              Definition

                                                              Amount of medication per dose.

                                                              ShortAmount of medication per dose
                                                              Comments

                                                              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.

                                                              Control0..1
                                                              TypeRange
                                                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                              Summarytrue
                                                              Requirements

                                                              The amount of therapeutic or other substance given at one administration event.

                                                              202. MedicationStatement.dosage.dose[x]:doseRange.id
                                                              Definition

                                                              unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                              Shortxml:id (or equivalent in JSON)
                                                              Control0..1
                                                              Typestring
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                              204. MedicationStatement.dosage.dose[x]:doseRange.extension
                                                              Definition

                                                              May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                                              ShortAdditional Content defined by implementations
                                                              Comments

                                                              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.

                                                              Control0..*
                                                              TypeExtension
                                                              Alternate Namesextensions, user content
                                                              SlicingThis element introduces a set of slices on MedicationStatement.dosage.dose[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                              • value @ url
                                                              • 206. MedicationStatement.dosage.dose[x]:doseRange.low
                                                                Definition

                                                                The low limit. The boundary is inclusive.

                                                                ShortLow limit
                                                                Comments

                                                                If the low element is missing, the low boundary is not known.

                                                                Control0..1
                                                                This element is affected by the following invariants: rng-2
                                                                BindingThe codes SHALL be taken from G-Standaard Eenhedentabel
                                                                (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453)

                                                                GstdTabel902

                                                                TypeQuantity(SimpleQuantity)
                                                                Summarytrue
                                                                208. MedicationStatement.dosage.dose[x]:doseRange.high
                                                                Definition

                                                                The high limit. The boundary is inclusive.

                                                                ShortHigh limit
                                                                Comments

                                                                If the high element is missing, the high boundary is not known.

                                                                Control0..1
                                                                This element is affected by the following invariants: rng-2
                                                                BindingThe codes SHALL be taken from G-Standaard Eenhedentabel
                                                                (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453)

                                                                GstdTabel902

                                                                TypeQuantity(SimpleQuantity)
                                                                Summarytrue
                                                                210. MedicationStatement.dosage.maxDosePerPeriod
                                                                Definition

                                                                A maximum dose indicates the maximum duration a product can be used with an ‘as needed’ prescription.

                                                                For example: - Max 6 units per day - Max 200ml per week

                                                                ShortMaximumDose
                                                                Comments

                                                                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".

                                                                Control0..1
                                                                TypeRatio
                                                                Summarytrue
                                                                Requirements

                                                                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.

                                                                Alternate NamesMaximale dosering, Maximale dosis (per dag enz.)
                                                                212. MedicationStatement.dosage.maxDosePerPeriod.id
                                                                Definition

                                                                unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                Shortxml:id (or equivalent in JSON)
                                                                Control0..1
                                                                Typestring
                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                214. MedicationStatement.dosage.maxDosePerPeriod.extension
                                                                Definition

                                                                May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                                                ShortAdditional Content defined by implementations
                                                                Comments

                                                                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.

                                                                Control0..*
                                                                TypeExtension
                                                                Alternate Namesextensions, user content
                                                                SlicingThis element introduces a set of slices on MedicationStatement.dosage.maxDosePerPeriod.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                • value @ url
                                                                • 216. MedicationStatement.dosage.maxDosePerPeriod.numerator
                                                                  Definition

                                                                  The value of the numerator.

                                                                  ShortNumerator value
                                                                  Control0..1
                                                                  BindingThe codes SHALL be taken from G-Standaard Eenhedentabel
                                                                  (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453)

                                                                  GstdTabel902

                                                                  TypeQuantity
                                                                  Summarytrue
                                                                  218. MedicationStatement.dosage.maxDosePerPeriod.denominator
                                                                  Definition

                                                                  The value of the denominator.

                                                                  ShortDenominator value
                                                                  Control0..1
                                                                  TypeQuantity
                                                                  Summarytrue
                                                                  220. MedicationStatement.dosage.maxDosePerAdministration
                                                                  Definition

                                                                  Upper limit on medication per administration.

                                                                  ShortUpper limit on medication per administration
                                                                  Comments

                                                                  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.

                                                                  Control0..1
                                                                  TypeQuantity(SimpleQuantity)
                                                                  Summarytrue
                                                                  Requirements

                                                                  The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.

                                                                  222. MedicationStatement.dosage.maxDosePerLifetime
                                                                  Definition

                                                                  Upper limit on medication per lifetime of the patient.

                                                                  ShortUpper limit on medication per lifetime of the patient
                                                                  Control0..1
                                                                  TypeQuantity(SimpleQuantity)
                                                                  Summarytrue
                                                                  Requirements

                                                                  The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.

                                                                  224. MedicationStatement.dosage.rate[x]
                                                                  Definition

                                                                  The administering speed is used in slow administration of liquid. In practice, the measuring unit is almost always ml/hour. Entering an interval (such as 0-10 ml/hour) is also a commonly used option. For example, with an administering speed of 10ml/hour: amount = 10, dose unit = ml time unit = hour

                                                                  ShortAdministeringSpeed
                                                                  Comments

                                                                  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.

                                                                  Control0..1
                                                                  TypeChoice of: Ratio, Range, Quantity(SimpleQuantity)
                                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                                  Summarytrue
                                                                  Requirements

                                                                  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.

                                                                  Alternate NamesToedieningssnelheid, Inloopsnelheid