Narrativa gerada: StructureDefinition br-core-medicationrequest Nome Bandeiras Card. Tipo Descrição e condicionalismos MedicationRequest 0..* MedicationRequest Ordering of medication for patient or group #xD; id 0..1 id Identificador lógico deste artefato #xD; meta 0..1 Meta Metadados sobre o recurso #xD; implicitRules 0..1 uri Um conjunto de regras sob as quais este conteúdo foi criado #xD; language 0..1 code Idioma do recurso #xD; text 0..1 Narrative Resumo do texto do recurso em linguagem natural #xD; contained 0..* Resource Recursos contidos no recurso #xD; extension 0..* Extension Extensões adicionais que não fazem parte do modelo base #xD; modifierExtension 0..* Extension Extensões adicionais que não podem ser ignoradas, mesmo que não reconhecidas #xD; identifier 1..1 Identifier Identificadores para este recurso #xD; status 1..1 code Status atual da requisição de medicamento: ativa, em espera, cancelada, concluída, registrada por engano, interrompida, rascunho, desconhecido #xD; statusReason 0..1 CodeableConcept Motivo do status atual #xD; intent 1..1 code Tipo de requisição de medicamento: prescrição, prescrição original, prescrição automática, reposição, refill, planejada, opcional (a critério médico), instância específica da prescrição #xD; category 0..* CodeableConcept Código que identifica a categoria de uso do medicamento requisitado #xD; priority 0..0 Identifica o grau de prioridade da requisição de medicamentos #xD; doNotPerform 0..1 boolean Verdadeiro se a requisição for de proibição de execução #xD; Fatias para reported[x] 0..1 boolean, Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | Organization) Informado em vez de registro primário Fatia: Não ordenado, Aberto por type:$this #xD; reported[x]:reportedReference 0..1 Reference(BRCorePractitioner | BRCorePractitionerRole | BRCorePatient | BRCoreRelatedPerson | BRCoreOrganization) Reportado em vez de ser o registro primário #xD; Fatias para medication[x] 1..1 CodeableConcept, Reference(Medication) Medicamento prescrito Fatia: Não ordenado, Aberto por type:$this #xD; medication[x]:medicationReference 0..1 Reference(br-core-medication) Referência ao br-core-medication #xD; subject 1..1 Reference(BRCorePatient) Referência oa paciente que se destina esta requisição de medicamento #xD; id 0..1 string Identificador único para referência entre elementos #xD; extension 0..* Extension Extensões adicionais que não fazem parte do modelo de dados básico #xD; reference 0..1 string Referência literal. URL relativa, interna ou externa #xD; type 0..1 uri Tipo de recurso ao qual a referência é feita #xD; identifier 0..1 Identifier Referência lógica, quando a referência literal não é conhecida #xD; display 0..1 string Alternativa de texto para o recurso #xD; encounter 0..1 Reference(br-core-encounter) Referência ao atendimento #xD; supportingInformation 0..* Reference(Resource) Informações para apoiar a requisição do medicamento #xD; authoredOn 1..1 dateTime Data de criação desta requisição de medicamento #xD; requester 1..1 Reference(BRCorePractitioner | BRCorePractitionerRole | BRCoreOrganization | BRCorePatient | BRCoreRelatedPerson | Device) Referência à quem ou o quê solicitou esta requisição #xD; performer 0..1 Reference(BRCorePractitioner | BRCorePractitionerRole | BRCoreOrganization | BRCorePatient | Device | BRCoreRelatedPerson | CareTeam) Referência ao prescritor indicado para a administração do medicamento #xD; performerType 0..1 CodeableConcept Especialidade do prescritor para a administração do medicamento Vínculo: BR Ocupacao (example) #xD; recorder 0..1 Reference(BRCorePractitioner | BRCorePractitionerRole) Pessoa que registrou a requisição #xD; reasonCode 0..* CodeableConcept Motivo ou indicação para solicitar ou não o medicamento. Conceito codificado que indica o motivo pelo qual o medicamento foi solicitado ou não Vínculo: BRCID 10 (example) #xD; reasonReference 0..* Reference(BRCoreCondition | BRCoreObservation) Condição ou observação que apoia o motivo pelo qual a prescrição está sendo escrita #xD; instantiatesCanonical 0..* canonical() Instancia do protocolo ou definição FHIR #xD; instantiatesUri 0..* uri URI da instancia do protocolo ou a definição FHIR externa #xD; basedOn 0..1 Reference(BRCoreCarePlan | br-core-medicationrequest | BRCoreServiceRequest | ImmunizationRecommendation) o quê a requisição atende #xD; groupIdentifier 0..1 Identifier requisição composta da qual esta requisição faz parte #xD; courseOfTherapyType 0..1 CodeableConcept Identifica o padrão de administração de medicamentos #xD; insurance 0..* Reference(Coverage | ClaimResponse) Cobertura de planos/seguros de saúde associada #xD; note 0..* Annotation Informações sobre a requisição #xD; dosageInstruction 0..1 Dosage Como o medicamento deve ser usado #xD; id 0..1 string Identificador exclusivo para referência entre elementos #xD; extension 0..* Extension Conteúdo adicional definido pelas implementações #xD; modifierExtension 0..* Extension Extensões que não podem ser ignoradas mesmo que não sejam reconhecidas #xD; sequence 0..1 integer Ordem na requisição #xD; text 0..1 string Instruções de dosagem em texto livre, por exemplo, SIG #xD; additionalInstruction 0..* CodeableConcept Instruções suplementares ou advertências ao paciente #xD; patientInstruction 0..1 string Instruções orientadas ao paciente ou ao consumidor #xD; timing 0..1 Timing Quando a medicamento deve ser administrado #xD; repeat 1..1 Element Quando o evento ocorre #xD; asNeeded[x] 0..1 boolean, CodeableConcept Conceito codificado que identifica a pré-condição que deve ser atendida ou avaliada antes de consumir ou administrar uma dose de medicamento Vínculo: BRCID 10 (required) #xD; site 0..1 CodeableConcept Local anatômico de administração do medicamento #xD; route 0..1 CodeableConcept Via de admiminstração do medicamento Vínculo: Medicine Route of Administration - IPS (required) #xD; method 0..1 CodeableConcept Método de administração do medicamento #xD; doseAndRate 0..* Element Quantidade a ser administrada do medicamento #xD; id 0..1 string Identificador exclusivo para referência entre elementos #xD; extension 0..* Extension Conteúdo adicional definido pelas implementações #xD; type 0..1 CodeableConcept O tipo de dose ou taxa de administração especificada #xD; dose[x] 1..1 Range, SimpleQuantity(4.0.1) Quantidade de medicamento por dose #xD; rate[x] 0..1 Ratio, Range, SimpleQuantity(4.0.1) Quantidade de medicamento por unidade de tempo #xD; maxDosePerPeriod 0..1 Ratio Quantidade máxima de medicamento por unidade de tempo #xD; maxDosePerAdministration 0..1 SimpleQuantity(4.0.1) Quantidade máxima de medicamento por administração #xD; maxDosePerLifetime 0..1 SimpleQuantity(4.0.1) Quantidade máxima de medicamento por toda a vida do paciente #xD; dispenseRequest 0..1 BackboneElement Autorização de fornecimento de medicamentos #xD; id 0..1 string Identificador exclusivo para referência entre elementos #xD; extension 0..* Extension Conteúdo adicional definido por implementações #xD; modifierExtension 0..* Extension Extensões que não podem ser ignoradas mesmo que não sejam reconhecidas #xD; initialFill 0..1 BackboneElement Preenchimento dos primeiros detalhes da autorização de fornecimento de medicamentos #xD; id 0..1 string Identificador exclusivo para referência entre elementos #xD; extension 0..* Extension Conteúdo adicional definido por implementações #xD; modifierExtension 0..* Extension Extensões que não podem ser ignoradas mesmo que não sejam reconhecidas #xD; quantity 0..1 SimpleQuantity(4.0.1) Quantidade inicial de fornecimento autorizada #xD; duration 0..1 Duration Duração da primeira autorização de fornecimento de medicamentos #xD; dispenseInterval 0..1 Duration Período mínimo de tempo entre dispensações de medicamentos autorizado #xD; validityPeriod 1..1 Period Validade da autorização de fornecimento de medicamentos #xD; id 0..1 string Identificador exclusivo para referência entre elementos #xD; start 0..1 dateTime Data/Hora do início da validade da autorização(intervalo fechado) #xD; end 0..1 dateTime Data/Hora do final da validade da autorização(intervalo fechado) #xD; numberOfRepeatsAllowed 0..1 unsignedInt Número de refills autorizados #xD; quantity 0..1 SimpleQuantity(4.0.1) Quantidade de medicamento a ser fornecido por dispensação #xD; expectedSupplyDuration 0..1 Duration Número de dias de fornecimento de medicamentos por dispensação #xD; performer 0..1 Reference(BRCoreOrganization) Referência à organização preferencial para a dispensação #xD; substitution 0..1 BackboneElement Restrições à substituição de medicamentos #xD; id 0..1 string Identificador exclusivo para referência entre elementos #xD; extension 0..* Extension Conteúdo adicional definido por implementações #xD; modifierExtension 0..* Extension Extensões que não podem ser ignoradas mesmo que não sejam reconhecidas #xD; allowed[x] 1..1 boolean, CodeableConcept Informa se a substituição de medicamentos é ou não permitida #xD; reason 0..1 CodeableConcept Porque (ou não) a substituição foi feita #xD; priorPrescription 0..1 Reference(br-core-medicationrequest) Referência à requisição anterior que está sendo substituída #xD; detectedIssue 0..* Reference(DetectedIssue) Referência à condição clínica detectada #xD; eventHistory 0..* Reference(Provenance) Referência à uma lista de eventos de interesse na linha do tempo #xD; Documentação para este formato
Um pedido ou solicitação para fornecimento do medicamento e instruções para administração do medicamento a um paciente. O recurso é chamado de 'MedicationRequest' em vez de 'MedicationPrescription' ou 'MedicationOrder' para generalizar o uso em ambientes de internação e ambulatorial, incluindo planos de cuidados, etc., e para harmonizar com padrões de fluxo de trabalho
Ordering of medication for patient or group
An order or request for both supply of the medication and the instructions for administration of the medication to a patient. The resource is called "MedicationRequest" rather than "MedicationPrescription" or "MedicationOrder" to generalize the use across inpatient and outpatient settings, including care plans, etc., and to harmonize with workflow patterns.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Um conjunto de regras sob as quais este conteúdo foi criado
Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
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).
Resumo do texto do recurso em linguagem natural
Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Extensões adicionais que não fazem parte do modelo base
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
Extensões adicionais que não podem ser ignoradas, mesmo que não reconhecidas
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
This is a business identifier, not a resource identifier.
ORC-2-Placer Order Number / ORC-3-Filler Order Number
Status atual da requisição de medicamento: ativa, em espera, cancelada, concluída, registrada por engano, interrompida, rascunho, desconhecido
This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
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
A coded concept specifying the state of the prescribing event. Describes the lifecycle of the prescription.
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.
Identifies the reasons for a given status.
.inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde
Tipo de requisição de medicamento: prescrição, prescrição original, prescrição automática, reposição, refill, planejada, opcional (a critério médico), instância específica da prescrição
It is expected that the type of requester will be restricted for different stages of a MedicationRequest. For example, Proposals can be created by a patient, relatedPerson, Practitioner or Device. Plans can be created by Practitioners, Patients, RelatedPersons and Devices. Original orders can be created by a Practitioner only. An instance-order is an instantiation of a request or order and may be used to populate Medication Administration Record. This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.
This element changes the interpretation of all descriptive attributes. For example "the time the request is recommended to occur" vs. "the time the request is authorized to occur" or "who is recommended to perform the request" vs. "who is authorized to perform the request
.moodCode (nuances beyond PRP/PLAN/RQO would need to be elsewhere)
Código que identifica a categoria de uso do medicamento requisitado
The category can be used to include where the medication is expected to be consumed or other types of requests.
A coded concept identifying the category of medication request. For example, where the medication is to be consumed or administered, or the type of medication treatment.
Message/Body/NewRx/MedicationPrescribed/Directions or Message/Body/NewRx/MedicationPrescribed/StructuredSIG
.inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="type of medication usage"].value
Identifica o grau de prioridade da requisição de medicamentos
Identifica o grau de prioridade da requisição de medicamentos: rotina | urgente | o mais rápido possível | emergência
Identifies the level of importance to be assigned to actioning the request.
Verdadeiro se a requisição for de proibição de execução
If do not perform is not specified, the request is a positive request e.g. "do perform".
This element is labeled as a modifier because this element negates the request to occur (ie, this is a request for the medication not to be ordered or prescribed, etc)
Reportado em vez de ser o registro primário
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 or if the medication is compounded or extemporaneously prepared, then you must reference the Medication resource.
A coded concept identifying substance or product that can be ordered.
Message/Body/NewRx/MedicationPrescribed Medication.code.coding.code = Message/Body/NewRx/MedicationPrescribed/DrugCoded/ProductCode Medication.code.coding.system = Message/Body/NewRx/MedicationPrescribed/DrugCoded/ProductCodeQualifier Medication.code.coding.display = Message/Body/NewRx/MedicationPrescribed/DrugDescription
RXE-2-Give Code / RXO-1-Requested Give Code / RXC-2-Component Code
Referência oa paciente que se destina esta requisição de medicamento
The subject on a medication request is mandatory. For the secondary use case where the actual subject is not provided, there still must be an anonymized subject specified.
Message/Body/NewRx/Patient (need detail to link to specific patient … Patient.Identification in SCRIPT)
Identificador único para referência entre elementos
Extensions are always sliced by (at least) url
Extensões adicionais que não fazem parte do modelo de dados básico
Referência literal. URL relativa, interna ou externa
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.
Tipo de recurso ao qual a referência é feita
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
Aa resource (or, for logical models, the URI of the logical model).
Referência lógica, quando a referência literal não é conhecida
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. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
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.
This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter." If there is a need to link to episodes of care they will be handled with an extension.
.inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code="type of encounter or episode"]
Informações para apoiar a requisição do medicamento
.outboundRelationship[typeCode=PERT].target[A_SupportingClinicalStatement CMET minimal with many different choices of classCodes(ORG, ENC, PROC, SPLY, SBADM, OBS) and each of the act class codes draws from one or more of the following moodCodes (EVN, DEF, INT PRMS, RQO, PRP, APT, ARQ, GOL)]
Data de criação desta requisição de medicamento
RXE-32-Original Order Date/Time / ORC-9-Date/Time of Transaction
Referência à quem ou o quê solicitou esta requisição
Referência ao prescritor indicado para a administração do medicamento
Especialidade do prescritor para a administração do medicamento
If specified without indicating a performer, this indicates that the performer must be of the specified type. If specified with a performer then it indicates the requirements of the performer if the designated performer is not available.
.participation[typeCode=TRANS].role[classCode=ASSIGNED].code (HealthcareProviderType)
Motivo ou indicação para solicitar ou não o medicamento. Conceito codificado que indica o motivo pelo qual o medicamento foi solicitado ou não
This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonReference.
ORC-16-Order Control Code Reason /RXE-27-Give Indication/RXO-20-Indication / RXD-21-Indication / RXG-22-Indication / RXA-19-Indication
Condição ou observação que apoia o motivo pelo qual a prescrição está sendo escrita
This is a reference to a condition or observation that is the reason for the medication order. If only a code exists, use reasonCode.
Instancia do protocolo ou definição FHIR
URI da instancia do protocolo ou a definição FHIR externa
URI da instancia do protocolo ou a definição externa
.outboundRelationship[typeCode=FLFS].target[classCode=SBADM or PROC or PCPR or OBS, moodCode=RQO orPLAN or PRP]
requisição composta da qual esta requisição faz parte
Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.
.outboundRelationship(typeCode=COMP].target[classCode=SBADM, moodCode=INT].id
Identifica o padrão de administração de medicamentos
This attribute should not be confused with the protocol of the medication.
Identifies the overall pattern of medication administratio.
Act.code where classCode = LIST and moodCode = EVN
Cobertura de planos/seguros de saúde associada
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.
Identificador exclusivo para referência entre elementos
Conteúdo adicional definido pelas implementações
Extensões que não podem ser ignoradas mesmo que não sejam reconhecidas
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
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.
Instruções de dosagem em texto livre, por exemplo, SIG
Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing. Additional information about administration or preparation of the medication should be included as text.
Instruções suplementares ou advertências ao paciente
Instruções suplementares ou advertências ao paciente - por exemplo: 'com as refeições', 'pode ​​causar sonolência'
Information about administration or preparation of the medication (e.g. "infuse as rapidly as possibly via intraperitoneal port" or "immediately following drug x") should be populated in dosage.text.
Additional instruction is intended to be coded, but where no code exists, the element could include text. For example, "Swallow with plenty of water" which might or might not be coded.
A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
Instruções orientadas ao paciente ou ao consumidor
Quando a medicamento deve ser administrado
This attribute might not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.
The timing schedule for giving the medication to the patient. This data type allows many different expressions. For example: "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Additional content defined by implementations
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extensions that cannot be ignored even if unrecognized
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Identifies specific times when the event occurs.
In a Medication Administration Record, for instance, you need to take a general specification, and turn it into a precise specification.
Many timing schedules are determined by regular repetitions.
if there's a duration, there needs to be duration units
duration.empty() or durationUnit.exists()
not(exists(f:duration)) or exists(f:durationUnit)
if there's a period, there needs to be period units
not(exists(f:period)) or exists(f:periodUnit)
f:duration/@value >= 0 or not(f:duration/@value)
f:period/@value >= 0 or not(f:period/@value)
If there's a periodMax, there must be a period
not(exists(f:periodMax)) or exists(f:period)
If there's a durationMax, there must be a duration
durationMax.empty() or duration.exists()
not(exists(f:durationMax)) or exists(f:duration)
If there's a countMax, there must be a count
not(exists(f:countMax)) or exists(f:count)
If there's an offset, there must be a when (and not C, CM, CD, CV)
offset.empty() or (when.exists() and ((when in ('C' | 'CM' | 'CD' | 'CV')).not()))
If there's a timeOfDay, there cannot be a when, or vice versa
not(exists(f:timeOfDay)) or not(exists(f:when))
Length/Range of lengths, or (Start and/or end) limits
Either a duration for the length of the timing schedule, a range of possible length, or outer bounds for start and/or end limits of the timing schedule.
A total count of the desired number of repetitions across the duration of the entire timing specification. If countMax is present, this element indicates the lower bound of the allowed range of count values.
If you have both bounds and count, then this should be understood as within the bounds period, until count times happens.
Repetitions may be limited by end time or total occurrences.
If present, indicates that the count is a range - so to perform the action between [count] and [countMax] times.
How long this thing happens for when it happens. If durationMax is present, this element indicates the lower bound of the allowed range of the duration.
For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).
Some activities are not instantaneous and need to be maintained for a period of time.
If present, indicates that the duration is a range - so to perform the action between [duration] and [durationMax] time length.
s | min | h | d | wk | mo | a - unit of time (UCUM)
The units of time for the duration, in UCUM units.
The number of times to repeat the action within the specified period. If frequencyMax is present, this element indicates the lower bound of the allowed range of the frequency.
If no frequency is stated, the assumption is that the event occurs once per period, but systems SHOULD always be specific about this
Event occurs up to frequencyMax times per period
If present, indicates that the frequency is a range - so to repeat between [frequency] and [frequencyMax] times within the period or period range.
Indicates the duration of time over which repetitions are to occur; e.g. to express "3 times per day", 3 would be the frequency and "1 day" would be the period. If periodMax is present, this element indicates the lower bound of the allowed range of the period length.
If present, indicates that the period is a range from [period] to [periodMax], allowing expressing concepts such as "do this once every 3-5 days.
The units of time for the period in UCUM units.
If one or more days of week is provided, then the action happens only on the specified day(s).
If no days are specified, the action is assumed to happen every day as otherwise specified. The elements frequency and period cannot be used as well as dayOfWeek.
Specified time of day for action to take place.
When time of day is specified, it is inferred that the action happens every day (as filtered by dayofWeek) on the specified times. The elements when, frequency and period cannot be used as well as timeOfDay.
An approximate time period during the day, potentially linked to an event of daily living that indicates when the action should occur.
When more than one event is listed, the event is tied to the union of the specified events.
Timings are frequently determined by occurrences such as waking, eating and sleep.
Real world event relating to the schedule.
The number of minutes from the event. If the event code does not indicate whether the minutes is before or after the event, then the offset is assumed to be after the event.
BID | TID | QID | AM | PM | QD | QOD | +
A code for the timing schedule (or just text in code.text). Some codes such as BID are ubiquitous, but many institutions define their own additional codes. If a code is provided, the code is understood to be a complete statement of whatever is specified in the structured timing data, and either the code or the data may be used to interpret the Timing, with the exception that .repeat.bounds still applies over the code (and is not contained in the code).
BID etc. are defined as 'at institutionally specified times'. For example, an institution may choose that BID is "always at 7am and 6pm". If it is inappropriate for this choice to be made, the code BID should not be used. Instead, a distinct organization-specific code should be used in place of the HL7-defined BID code and/or a structured representation should be used (in this case, specifying the two event times).
Code for a known / defined timing pattern.
Conceito codificado que identifica a pré-condição que deve ser atendida ou avaliada antes de consumir ou administrar uma dose de medicamento
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".
.outboundRelationship[typeCode=PRCN].target[classCode=OBS, moodCode=EVN, code="as needed"].value=boolean or codable concept
Local anatômico de administração do medicamento
If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [bodySite](http://hl7.org/fhir/R4/extension-bodysite.html). May be a summary code, or a reference to a very precise definition of the location, or both.
A coded specification of the anatomic site where the medication first enters the body.
A coded concept describing the site location the medicine enters into or onto the body.
A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.
Terminologies used often pre-coordinate this term with the route and or form of administration.
A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV.
A coded concept describing the technique by which the medicine is administered.
Quantidade a ser administrada do medicamento
O tipo de dose ou taxa de administração especificada
If the type is not populated, assume to be "ordered".
Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.
The amount of therapeutic or other substance given at one administration event.
Quantidade de medicamento por unidade de tempo
It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate. It is possible to specify a rate over time (for example, 100 ml/hour) using either the rateRatio and rateQuantity. The rateQuantity approach requires systems to have the capability to parse UCUM grammer where ml/hour is included rather than a specific ratio where the time is specified as the denominator. Where a rate such as 500ml over 2 hours is specified, the use of rateRatio may be more semantically correct than specifying using a rateQuantity of 250 mg/hour.
Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.
Quantidade máxima de medicamento por unidade de tempo
This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".
The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours.
Quantidade máxima de medicamento por administração
This is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg.
The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.
Quantidade máxima de medicamento por toda a vida do paciente
The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.
Autorização de fornecimento de medicamentos
Conteúdo adicional definido por implementações
Preenchimento dos primeiros detalhes da autorização de fornecimento de medicamentos
If populating this element, either the quantity or the duration must be included.
SubstanceAdministration -> ActRelationship[sequenceNumber = '1'] -> Supply
Quantidade inicial de fornecimento autorizada
Duração da primeira autorização de fornecimento de medicamentos
Período mínimo de tempo entre dispensações de medicamentos autorizado
Validade da autorização de fornecimento de medicamentos
validade da autorização de fornecimento de medicamentos
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.
Indicates when the Prescription becomes valid, and when it ceases to be a dispensable Prescription.
Data/Hora do início da validade da autorização(intervalo fechado)
Data/Hora de início da validade da autorização (intervalo fechado)
If the low element is missing, the meaning is that the low boundary is not known.
Data/Hora do final da validade da autorização(intervalo fechado)
Data/Hora do final da validade da autorização(intervalo fechado), se não for contínuo
The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.
If the end of the period is missing, it means that the period is ongoing
If displaying "number of authorized fills", add 1 to this number.
Quantidade de medicamento a ser fornecido por dispensação
RXD-4-Actual Dispense Amount / RXD-5.1-Actual Dispense Units.code / RXD-5.3-Actual Dispense Units.name of coding system
Número de dias de fornecimento de medicamentos por dispensação
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.
Referência à organização preferencial para a dispensação
.outboundRelationship[typeCode=COMP].target[classCode=SPLY, moodCode=RQO] .participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]
Restrições à substituição de medicamentos
specific values within Message/Body/NewRx/MedicationPrescribed/Substitutions
Informa se a substituição de medicamentos é ou não permitida
This element is labeled as a modifier because whether substitution is allow or not, it cannot be ignored.
Identifies the type of substitution allowed.
RXO-9-Allow Substitutions / RXE-9-Substitution Status
Porque (ou não) a substituição foi feita
Um conceito codificado que descreve a razão pela qual um medicamento diferente deve (ou não) ser substituído daquele que foi prescrito
A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
Referência à requisição anterior que está sendo substituída
.outboundRelationship[typeCode=?RPLC or ?SUCC]/target[classCode=SBADM,moodCode=RQO]
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.
Referência à uma lista de eventos de interesse na linha do tempo
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.).
.inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]