FHIR R4
Pharmacy Work GroupMaturity Level: 3 Trial UseSecurity Category: Patient Compartments: Encounter, Patient, Practitioner

Detailed Descriptions for the elements in the MedicationRequest resource.

MedicationRequest
Element IdMedicationRequest
Definition 给患者提供药物及用药说明的医嘱或处方。此资源可用于门诊、住院及照护方案等多种场景。在FHIR工作流框架中,它属于“请求”类资源。
Cardinality0..*
TypeDomainResource
Alternate NamesPrescription; Order
MedicationRequest.identifier
Element IdMedicationRequest.identifier
Definition

Identifiers associated with this medication request that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server.

NoteThis is a business identifier, not a resource identifier (see discussion)
Cardinality0..*
TypeIdentifier
Comments

This is a business identifier, not a resource identifier.

MedicationRequest.status
Element IdMedicationRequest.status
Definition 用编码形式表示此医嘱当前状态。通常指活动状态或完成状态。
Cardinality1..1
Terminology BindingMedicationrequest status (Required)
Typecode
Is Modifiertrue (Reason: This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid)
Summarytrue
Comments若此元素值的改变会引起整个药品处方意义发生改变。如:已取消、输入错误、已停止
MedicationRequest.statusReason
Element IdMedicationRequest.statusReason
Definition

Captures the reason for the current state of the MedicationRequest.

Cardinality0..1
Terminology BindingMedication request status reason codes (Example)
TypeCodeableConcept
Comments

This is generally only used for "exception" statuses such as "suspended" or "cancelled". The reason why the MedicationRequest was created at all is captured in reasonCode, not here.

MedicationRequest.intent
Element IdMedicationRequest.intent
Definition 本次用药需求是属于医嘱、建议还是计划。
Cardinality1..1
Terminology Binding Medication request intent (Required)
Typecode
Is Modifier true (Reason: 此元素会更改整个资源实际应用的时间和方式。 例如:当此元素值为“proposal”时,意为“执行医嘱的推荐时间”和“建议由谁来执行医嘱”; 当值为“order”时,意为“经授权的可执行医嘱的时间”与“授权谁可执行医嘱”。
Summarytrue
Comments 根据用药请求所处的不同阶段,请求类型将受到限制。例如,用药需求和用药计划可以由患者、相关人员、医务人员甚至由设备创建。 原始医嘱只能由医务人员创建。
实例医嘱是请求或医嘱的实例,可作为用药记录。
MedicationRequest.category
Element IdMedicationRequest.category
Definition 药品处方/医嘱的类别。例如,以用药地点可分类为:住院医嘱、门诊处方、出院带药等。
Cardinality0..*
Terminology BindingMedication request category codes (Example)
TypeCodeableConcept
Comments 用于服务药物的预期地点分类或药品医嘱的其它分类。

The category can be used to include where the medication is expected to be consumed or other types of requests.

MedicationRequest.priority
Element IdMedicationRequest.priority
Definition 相对于其他医嘱,应以多快的速度响应并执行此医嘱。
Cardinality0..1
Terminology BindingRequest priority (Required)
Typecode
Summarytrue
MedicationRequest.doNotPerform
Element IdMedicationRequest.doNotPerform
Definition 如果此元素值为true,则表示医嘱下达者要求停止执行此药品医嘱。
Cardinality0..1
Typeboolean
Is Modifiertrue (Reason: 这个元素被标记为修饰符,因为这个元素否定了发生的请求。即,这是停止执行医嘱或处方的请求。 )
Summarytrue
Comments 如果未提供此元素,则意味着此医嘱需求被“执行”。
MedicationRequest.reported[x]
Element IdMedicationRequest.reported[x]
Definition 当此医嘱不是原始下达的而是从外部获取时,可以将元素值设为“true”,或者引用信息的来源。如,由患者口述的历史医嘱、转诊时从其它系统获取的医嘱信息。 指示是否将此记录捕获为次要的“已报告”记录,而不是真实记录的原始主源。它也可能指出报告的来源。
Cardinality0..1
Typeboolean|Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | Organization)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
MedicationRequest.medication[x]
Element IdMedicationRequest.medication[x]
Definition 用于标识医嘱中的药物。可以使用药品编码,也可以引用一个药物资源(Medication)。
Cardinality1..1
Terminology BindingSNOMED CT Medication Codes (Example)
TypeCodeableConcept|Reference(Medication)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
Comments 如果只使用一个编码,则它必须是特定药品编码。如果需要更多信息(如药品的性状、批号或制剂等),建议使用药物资源。
MedicationRequest.subject
Element IdMedicationRequest.subject
Definition 此医嘱的用药对象,可以是一个患者或一个群体。
Cardinality1..1
TypeReference(Patient | Group)
Summarytrue
Comments 药品处方/医嘱的用药患者不可或缺的。即使在某些情况下无法提供实际患者,也必须指定一个匿名对象。
MedicationRequest.encounter
Element IdMedicationRequest.encounter
Definition 此医嘱/处方是在这个医疗就诊活动期间产生的,或与这个医疗就诊活动密切相关
Cardinality0..1
TypeReference(Encounter)
Comments 通常此医嘱/处方是在这个医疗就诊活动期间产生的,如果是在这个医疗活动正式开始之前或结束之后才产生的,那么它们之间一定关联紧密。 如果需要引用治疗/照护期资源(EpisodeOfCare),则请使用用扩展来处理。
MedicationRequest.supportingInformation
Element IdMedicationRequest.supportingInformation
Definition 支持此药品医嘱的附加信息(例如患者的身高体重)。
Cardinality0..*
TypeReference(Any)
MedicationRequest.authoredOn
Element IdMedicationRequest.authoredOn
Definition 下达医嘱(或对医嘱授权)的时间。
Cardinality0..1
TypedateTime
Summarytrue
MedicationRequest.requester
Element IdMedicationRequest.requester
Definition 发起此用药请求并对请求生效后负责的个人、单位或设备。
Cardinality0..1
TypeReference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device)
Summarytrue
MedicationRequest.performer
Element IdMedicationRequest.performer
Definition 药物治疗的执行者,即给药者。
Cardinality0..1
TypeReference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam)
MedicationRequest.performerType
Element IdMedicationRequest.performerType
Definition 对用药执行者的所属分类的要求。
Cardinality0..1
Terminology BindingProcedure Performer Role Codes (Example)
TypeCodeableConcept
Summarytrue
Comments 如果未填写给药者,则表示给药者必须属于此元素指定的分类。 如果填写了给药者的同时又填写了此无素,则意味着已填写的给药者并不是期望的最佳人选,并通过此元素来表示对给药者的要求。
MedicationRequest.recorder
Element IdMedicationRequest.recorder
Definition 录入(记录)医嘱的人,例如,某护士将医生的口头医嘱或电话医嘱录入信息系统。
Cardinality0..1
TypeReference(Practitioner | PractitionerRole)
MedicationRequest.reasonCode
Element IdMedicationRequest.reasonCode
Definition 用编码来表示在医嘱中使用或不使用相关药品的原因。
Cardinality0..*
Terminology BindingCondition/Problem/Diagnosis Codes (Example)
TypeCodeableConcept
Comments 这可能是诊断编码。如果有完整病症与诊断资源或需要附加细节,请使用“MedicationRequest.reasonReference”元素。
MedicationRequest.reasonReference
Element IdMedicationRequest.reasonReference
Definition 用病症与诊断资源(Condition)或观测资源(Observation)来说明用药原因。
Cardinality0..*
TypeReference(Condition | Observation)
Comments 如果用药理由只有编码而没有具体的相关资源,可以使用MedicationRequest.reasonCode元素。
MedicationRequest.instantiatesCanonical
Element IdMedicationRequest.instantiatesCanonical
Definition

The URL pointing to a protocol, guideline, orderset, or other definition that is adhered to in whole or in part by this MedicationRequest.

Cardinality0..*
Typecanonical
Summarytrue
MedicationRequest.instantiatesUri
Element IdMedicationRequest.instantiatesUri
Definition 此药品医嘱需要完全遵守或部分遵守的指南、规章等。
Cardinality0..*
Typeuri
Summarytrue
MedicationRequest.basedOn
Element IdMedicationRequest.basedOn
Definition 此药品请求资源是基于此元素中的计划类资源或请求类资源来的,即此元素中的资源的实现是全部或部分由此药品请求资源来完成的。
Cardinality0..*
TypeReference(CarePlan | MedicationRequest | ServiceRequest | ImmunizationRecommendation)
Summarytrue
MedicationRequest.groupIdentifier
Element IdMedicationRequest.groupIdentifier
Definition 用于标识医嘱/处方/请求的ID,它是由一组几乎在同一时间下达的医嘱共同使用的组别ID。
Cardinality0..1
TypeIdentifier
Requirements 医嘱/处方/请求可以通过两种方式关联,一是使用"MedicationRequest.basedOn"元素直接引用关联,二是使用此元素来建立一个共用的分组。 组内的单个医嘱/处方/请求在其创建后通常是单独维护,对其状态的变更也是分别进行的。
Summarytrue
MedicationRequest.courseOfTherapyType
Element IdMedicationRequest.courseOfTherapyType
Definition 患者用药的模式,如:长期、临时。
Cardinality0..1
Terminology BindingMedication request course of therapy codes (Example)
TypeCodeableConcept
Comments 此元素不能用于表示药品规定(说明)。
MedicationRequest.insurance
Element IdMedicationRequest.insurance
Definition 此用药医嘱/处方/请求相关的医保或商保信息,包括理赔范围、预审核信息。
Cardinality0..*
TypeReference(Coverage | ClaimResponse)
MedicationRequest.note
Element IdMedicationRequest.note
Definition 其他需要备注的额外信息。
Cardinality0..*
TypeAnnotation
MedicationRequest.dosageInstruction
Element IdMedicationRequest.dosageInstruction
Definition 患者如何使用药物。
Cardinality0..*
TypeDosage
Comments 有时用药医嘱既可以是口服用药也可以是静脉注射或肌肉注射。 例如,“昂丹司琼8mg口服或静脉注射,每日两次,视恶心情况而定” 或“康帕嗪(前氯培嗪)5-10mg PO或25mg PR bid prn恶心或呕吐”。 在这种情况下,将创建两个可以组合在一起的药物请求资源。给药途径和剂量取决于患者在需要用药时的情况。

There are examples where a medication request may include the option of an oral dose or an Intravenous or Intramuscular dose. For example, "Ondansetron 8mg orally or IV twice a day as needed for nausea" or "Compazine® (prochlorperazine) 5-10mg PO or 25mg PR bid prn nausea or vomiting". In these cases, two medication requests would be created that could be grouped together. The decision on which dose and route of administration to use is based on the patient's condition at the time the dose is needed.

MedicationRequest.dispenseRequest
Element IdMedicationRequest.dispenseRequest
Definition

Indicates the specific details for the dispense or medication supply part of a medication request (also known as a Medication Prescription or Medication Order). Note that this information is not always sent with the order. There may be in some settings (e.g. hospitals) institutional or system support for completing the dispense details in the pharmacy department.

Cardinality0..1
MedicationRequest.dispenseRequest.initialFill
Element IdMedicationRequest.dispenseRequest.initialFill
Definition

Indicates the quantity or duration for the first dispense of the medication.

Cardinality0..1
Comments

If populating this element, either the quantity or the duration must be included.

MedicationRequest.dispenseRequest.initialFill.quantity
Element IdMedicationRequest.dispenseRequest.initialFill.quantity
Definition

The amount or quantity to provide as part of the first dispense.

Cardinality0..1
TypeSimpleQuantity
MedicationRequest.dispenseRequest.initialFill.duration
Element IdMedicationRequest.dispenseRequest.initialFill.duration
Definition

The length of time that the first dispense is expected to last.

Cardinality0..1
TypeDuration
MedicationRequest.dispenseRequest.dispenseInterval
Element IdMedicationRequest.dispenseRequest.dispenseInterval
Definition

The minimum period of time that must occur between dispenses of the medication.

Cardinality0..1
TypeDuration
MedicationRequest.dispenseRequest.validityPeriod
Element IdMedicationRequest.dispenseRequest.validityPeriod
Definition

This indicates the validity period of a prescription (stale dating the Prescription).

Cardinality0..1
TypePeriod
Requirements

Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription.

Comments

It reflects the prescribers' perspective for the validity of the prescription. Dispenses must not be made against the prescription outside of this period. The lower-bound of the Dispensing Window signifies the earliest date that the prescription can be filled for the first time. If an upper-bound is not specified then the Prescription is open-ended or will default to a stale-date based on regulations.

MedicationRequest.dispenseRequest.numberOfRepeatsAllowed
Element IdMedicationRequest.dispenseRequest.numberOfRepeatsAllowed
Definition

An integer indicating the number of times, in addition to the original dispense, (aka refills or repeats) that the patient can receive the prescribed medication. Usage Notes: This integer does not include the original order dispense. This means that if an order indicates dispense 30 tablets plus "3 repeats", then the order can be dispensed a total of 4 times and the patient can receive a total of 120 tablets. A prescriber may explicitly say that zero refills are permitted after the initial dispense.

Cardinality0..1
TypeunsignedInt
Comments

If displaying "number of authorized fills", add 1 to this number.

MedicationRequest.dispenseRequest.quantity
Element IdMedicationRequest.dispenseRequest.quantity
Definition

The amount that is to be dispensed for one fill.

Cardinality0..1
TypeSimpleQuantity
MedicationRequest.dispenseRequest.expectedSupplyDuration
Element IdMedicationRequest.dispenseRequest.expectedSupplyDuration
Definition

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

Cardinality0..1
TypeDuration
Comments

In some situations, this attribute may be used instead of quantity to identify the amount supplied by how long it is expected to last, rather than the physical quantity issued, e.g. 90 days supply of medication (based on an ordered dosage). When possible, it is always better to specify quantity, as this tends to be more precise. expectedSupplyDuration will always be an estimate that can be influenced by external factors.

MedicationRequest.dispenseRequest.performer
Element IdMedicationRequest.dispenseRequest.performer
Definition

Indicates the intended dispensing Organization specified by the prescriber.

Cardinality0..1
TypeReference(Organization)
MedicationRequest.substitution
Element IdMedicationRequest.substitution
Definition

Indicates whether or not substitution can or should be part of the dispense. In some cases, substitution must happen, in other cases substitution must not happen. This block explains the prescriber's intent. If nothing is specified substitution may be done.

Cardinality0..1
MedicationRequest.substitution.allowed[x]
Element IdMedicationRequest.substitution.allowed[x]
Definition

True if the prescriber allows a different drug to be dispensed from what was prescribed.

Cardinality1..1
Terminology BindingV3 Value SetActSubstanceAdminSubstitutionCode (Example)
Typeboolean|CodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Comments

This element is labeled as a modifier because whether substitution is allow or not, it cannot be ignored.

MedicationRequest.substitution.reason
Element IdMedicationRequest.substitution.reason
Definition

Indicates the reason for the substitution, or why substitution must or must not be performed.

Cardinality0..1
Terminology BindingV3 Value SetSubstanceAdminSubstitutionReason (Example)
TypeCodeableConcept
MedicationRequest.priorPrescription
Element IdMedicationRequest.priorPrescription
Definition

A link to a resource representing an earlier order related order or prescription.

Cardinality0..1
TypeReference(MedicationRequest)
MedicationRequest.detectedIssue
Element IdMedicationRequest.detectedIssue
Definition

Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. Drug-drug interaction, duplicate therapy, dosage alert etc.

Cardinality0..*
TypeReference(DetectedIssue)
Alternate NamesContraindication; Drug Utilization Review (DUR); Alert
Comments

This element can include a detected issue that has been identified either by a decision support system or by a clinician and may include information on the steps that were taken to address the issue.

MedicationRequest.eventHistory
Element IdMedicationRequest.eventHistory
Definition

Links to Provenance records for past versions of this resource or fulfilling request or event resources that identify key state transitions or updates that are likely to be relevant to a user looking at the current version of the resource.

Cardinality0..*
TypeReference(Provenance)
Comments

This might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.).