RIVO-Noord Zorgviewer Implementation Guide
1.11.0 - sprint49 Netherlands flag

This page is part of the RIVO-Noord Zorgviewer Implementation Guide (v1.11.0: Release) based on FHIR (HL7® FHIR® Standard) R3. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Resource Profile: MedicationUse - Detailed Descriptions

Active as of 2025-01-20

Definitions for the MedicationStatement resource profile.

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

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

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

                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..*
                TypeDosage(HCIM InstructionsForUse)
                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

                    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
                    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]
                    Summarytrue
                    Requirements

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

                    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.