CH EMED (R4)
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This page is part of the CH EMED (R4) (v5.0.0-ballot: STU 5 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. 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

Data Type Profile: CHEMEDDosageSplit - Detailed Descriptions

Active as of 2024-05-16

Definitions for the ch-emed-dosage-split data type profile.

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

0. Dosage
ShortCH EMED Dosage Split (MedicationStatement / MedicationDispense / MedicationRequest)
2. Dosage.sequence
Control1..?
Invariantsch-dosage-2: The sequence number must be greater than 1 ($this > 1)
4. Dosage.text
Control0..0
6. Dosage.additionalInstruction
Control0..0
8. Dosage.patientInstruction
Control0..0
10. Dosage.timing
Control1..?
12. Dosage.timing.repeat
Control1..?
14. Dosage.timing.repeat.bounds[x]
[x] NoteSee Choice of Data Types for further information about how to use [x]
SlicingThis element introduces a set of slices on Dosage.timing.repeat.bounds[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • type @ $this
  • 16. Dosage.timing.repeat.bounds[x]:boundsPeriod
    Slice NameboundsPeriod
    Control0..0
    TypePeriod
    18. Dosage.timing.repeat.when
    Control1..?
    Must Supporttrue
    Invariantsch-emed-event-timing: For the representation of the time of administration according to the 1-1-1-1 scheme, the values MORN-NOON-EVE-NIGHT are highly recommended. ($this='MORN' or $this='NOON' or $this='EVE' or $this='NIGHT')
    20. Dosage.asNeeded[x]
    Control0..0
    22. Dosage.site
    Control0..0
    24. Dosage.route
    Control0..0
    26. Dosage.method
    Control0..0
    28. Dosage.doseAndRate
    Control1..1
    30. Dosage.doseAndRate.dose[x]
    Control1..?
    [x] NoteSee Choice of Data Types for further information about how to use [x]
    Must Supporttrue
    32. Dosage.maxDosePerPeriod
    Control0..0
    34. Dosage.maxDosePerAdministration
    Control0..0
    36. Dosage.maxDosePerLifetime
    Control0..0

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

    0. Dosage
    Definition

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

    ShortCH EMED Dosage Split (MedicationStatement / MedicationDispense / MedicationRequest)How the medication is/was taken or should be taken
    Control0..*
    Is Modifierfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    2. Dosage.modifierExtension
    Definition

    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).

    ShortExtensions that cannot be ignored even if unrecognized
    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 Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
    Summarytrue
    Requirements

    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.

    Alternate Namesextensions, user content, modifiers
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    4. Dosage.sequence
    Definition

    Indicates the order in which the dosage instructions should be applied or interpreted.

    ShortThe order of the dosage instructions
    Control10..1
    Typeinteger
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Requirements

    If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. If the sequence number is different, then the Dosages are intended to be sequential.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ch-dosage-2: The sequence number must be greater than 1 ($this > 1)
    6. Dosage.text
    Definition

    Free text dosage instructions e.g. SIG.

    ShortFree text dosage instructions e.g. SIG
    Control0..01
    Typestring
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    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. Additional information about administration or preparation of the medication should be included as text.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    8. Dosage.additionalInstruction
    Definition

    Supplemental instructions to the patient on how to take the medication (e.g. "with meals" or"take half to one hour before food") or warnings for the patient about the medication (e.g. "may cause drowsiness" or "avoid exposure of skin to direct sunlight or sunlamps").

    ShortSupplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
    Comments

    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.

    Control0..0*
    BindingFor example codes, see SNOMEDCTAdditionalDosageInstructionshttp://hl7.org/fhir/ValueSet/additional-instruction-codes
    (example to http://hl7.org/fhir/ValueSet/additional-instruction-codes)

    A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".

    TypeCodeableConcept
    Is Modifierfalse
    Summarytrue
    Requirements

    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.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    10. Dosage.patientInstruction
    Definition

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

    ShortPatient or consumer oriented instructions
    Control0..01
    Typestring
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    12. Dosage.timing
    Definition

    When medication should be administered.

    ShortWhen medication should be administered
    Comments

    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.

    Control10..1
    TypeTiming
    Is Modifierfalse
    Summarytrue
    Requirements

    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.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    14. Dosage.timing.modifierExtension
    Definition

    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).

    ShortExtensions that cannot be ignored even if unrecognized
    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 Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
    Summarytrue
    Requirements

    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.

    Alternate Namesextensions, user content, modifiers
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    16. Dosage.timing.repeat
    Definition

    A set of rules that describe when the event is scheduled.

    ShortWhen the event is to occur
    Control10..1
    TypeElement
    Is Modifierfalse
    Summarytrue
    Requirements

    Many timing schedules are determined by regular repetitions.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    tim-1: if there's a duration, there needs to be duration units (duration.empty() or durationUnit.exists())
    tim-2: if there's a period, there needs to be period units (period.empty() or periodUnit.exists())
    tim-4: duration SHALL be a non-negative value (duration.exists() implies duration >= 0)
    tim-5: period SHALL be a non-negative value (period.exists() implies period >= 0)
    tim-6: If there's a periodMax, there must be a period (periodMax.empty() or period.exists())
    tim-7: If there's a durationMax, there must be a duration (durationMax.empty() or duration.exists())
    tim-8: If there's a countMax, there must be a count (countMax.empty() or count.exists())
    tim-9: 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())))
    tim-10: If there's a timeOfDay, there cannot be a when, or vice versa (timeOfDay.empty() or when.empty())
    tim-1: if there's a duration, there needs to be duration units (duration.empty() or durationUnit.exists())
    tim-2: if there's a period, there needs to be period units (period.empty() or periodUnit.exists())
    tim-4: duration SHALL be a non-negative value (duration.exists() implies duration >= 0)
    tim-5: period SHALL be a non-negative value (period.exists() implies period >= 0)
    tim-6: If there's a periodMax, there must be a period (periodMax.empty() or period.exists())
    tim-7: If there's a durationMax, there must be a duration (durationMax.empty() or duration.exists())
    tim-8: If there's a countMax, there must be a count (countMax.empty() or count.exists())
    tim-9: 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())))
    tim-10: If there's a timeOfDay, there cannot be a when, or vice versa (timeOfDay.empty() or when.empty())
    18. Dosage.timing.repeat.bounds[x]
    Definition

    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.

    ShortLength/Range of lengths, or (Start and/or end) limits
    Control0..1
    TypeChoice of: Duration, Range, Period
    [x] NoteSee Choice of Data Types for further information about how to use [x]
    Is Modifierfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    SlicingThis element introduces a set of slices on Dosage.timing.repeat.bounds[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • type @ $this
    • 20. Dosage.timing.repeat.bounds[x]:boundsPeriod
      Slice NameboundsPeriod
      Definition

      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.

      ShortLength/Range of lengths, or (Start and/or end) limits
      Control0..01
      TypePeriod, Duration, Range
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      22. Dosage.timing.repeat.when
      Definition

      An approximate time period during the day, potentially linked to an event of daily living that indicates when the action should occur.

      ShortCode for time period of occurrence
      Comments

      When more than one event is listed, the event is tied to the union of the specified events.

      Control10..*
      BindingThe codes SHALL be taken from EventTiminghttp://hl7.org/fhir/ValueSet/event-timing|4.0.1
      (required to http://hl7.org/fhir/ValueSet/event-timing|4.0.1)

      Real world event relating to the schedule.

      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Requirements

      Timings are frequently determined by occurrences such as waking, eating and sleep.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ch-emed-event-timing: For the representation of the time of administration according to the 1-1-1-1 scheme, the values MORN-NOON-EVE-NIGHT are highly recommended. ($this='MORN' or $this='NOON' or $this='EVE' or $this='NIGHT')
      24. 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..01
      BindingFor example codes, see SNOMEDCTMedicationAsNeededReasonCodeshttp://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.

      TypeChoice of: boolean, CodeableConcept
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      26. Dosage.site
      Definition

      Body site to administer to.

      ShortBody site to administer to
      Comments

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

      Control0..01
      BindingFor example codes, see SNOMEDCTAnatomicalStructureForAdministrationSiteCodeshttp://hl7.org/fhir/ValueSet/approach-site-codes
      (example to http://hl7.org/fhir/ValueSet/approach-site-codes)

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

      TypeCodeableConcept
      Is Modifierfalse
      Summarytrue
      Requirements

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

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      28. Dosage.route
      Definition

      How drug should enter body.

      ShortHow drug should enter body
      Control0..01
      BindingThe codes SHOULD be taken from For example codes, see EDQM - RouteOfAdministrationhttp://hl7.org/fhir/ValueSet/route-codes
      (preferred to http://fhir.ch/ig/ch-term/ValueSet/edqm-routeofadministration)
      TypeCodeableConcept
      Is Modifierfalse
      Summarytrue
      Requirements

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

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      30. Dosage.method
      Definition

      Technique for administering medication.

      ShortTechnique for administering medication
      Comments

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

      Control0..01
      BindingThe codes SHOULD be taken from For example codes, see EDQM - Administration Methodhttp://hl7.org/fhir/ValueSet/administration-method-codes
      (preferred to http://fhir.ch/ig/ch-term/ValueSet/edqm-administrationmethod)
      TypeCodeableConcept
      Is Modifierfalse
      Summarytrue
      Requirements

      A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      32. Dosage.doseAndRate
      Definition

      The amount of medication administered.

      ShortAmount of medication administered
      Control10..1*
      TypeElement
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      34. Dosage.doseAndRate.dose[x]
      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.

      Control10..1
      TypeChoice of: Range(CH Core Range with EMED Units), Quantity(CH Core Quantity with EMED Units, SimpleQuantity)
      [x] NoteSee Choice of Data Types for further information about how to use [x]
      Is Modifierfalse
      Must Supporttrue
      Must Support TypesNo must-support rules about the choice of types/profiles
      Summarytrue
      Requirements

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

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      36. Dosage.maxDosePerPeriod
      Definition

      Upper limit on medication per unit of time.

      ShortUpper limit on medication per unit of time
      Comments

      This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".

      Control0..01
      TypeRatio
      Is Modifierfalse
      Summarytrue
      Requirements

      The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      38. Dosage.maxDosePerAdministration
      Definition

      Upper limit on medication per administration.

      ShortUpper limit on medication per administration
      Comments

      This is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg.

      Control0..01
      TypeQuantity(SimpleQuantity)
      Is Modifierfalse
      Summarytrue
      Requirements

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

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      40. Dosage.maxDosePerLifetime
      Definition

      Upper limit on medication per lifetime of the patient.

      ShortUpper limit on medication per lifetime of the patient
      Control0..01
      TypeQuantity(SimpleQuantity)
      Is Modifierfalse
      Summarytrue
      Requirements

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

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

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

      0. Dosage
      Definition

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

      ShortCH EMED Dosage Split (MedicationStatement / MedicationDispense / MedicationRequest)
      Control0..*
      Is Modifierfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      2. Dosage.id
      Definition

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

      ShortUnique id for inter-element referencing
      Control0..1
      Typestring
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      4. Dosage.extension
      Definition

      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.

      ShortAdditional content defined by implementations
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      SlicingThis element introduces a set of slices on Dosage.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 6. Dosage.modifierExtension
        Definition

        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).

        ShortExtensions that cannot be ignored even if unrecognized
        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 Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        Requirements

        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.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        8. Dosage.sequence
        Definition

        Indicates the order in which the dosage instructions should be applied or interpreted.

        ShortThe order of the dosage instructions
        Control1..1
        Typeinteger
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. If the sequence number is different, then the Dosages are intended to be sequential.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ch-dosage-2: The sequence number must be greater than 1 ($this > 1)
        10. Dosage.text
        Definition

        Free text dosage instructions e.g. SIG.

        ShortFree text dosage instructions e.g. SIG
        Control0..0
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        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. Additional information about administration or preparation of the medication should be included as text.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        12. Dosage.additionalInstruction
        Definition

        Supplemental instructions to the patient on how to take the medication (e.g. "with meals" or"take half to one hour before food") or warnings for the patient about the medication (e.g. "may cause drowsiness" or "avoid exposure of skin to direct sunlight or sunlamps").

        ShortSupplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
        Comments

        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.

        Control0..0
        BindingFor example codes, see SNOMEDCTAdditionalDosageInstructions
        (example to http://hl7.org/fhir/ValueSet/additional-instruction-codes)

        A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".

        TypeCodeableConcept
        Is Modifierfalse
        Summarytrue
        Requirements

        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.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        14. Dosage.patientInstruction
        Definition

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

        ShortPatient or consumer oriented instructions
        Control0..0
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        16. Dosage.timing
        Definition

        When medication should be administered.

        ShortWhen medication should be administered
        Comments

        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.

        Control1..1
        TypeTiming
        Is Modifierfalse
        Summarytrue
        Requirements

        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.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        18. Dosage.timing.id
        Definition

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

        ShortUnique id for inter-element referencing
        Control0..1
        Typestring
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        20. Dosage.timing.extension
        Definition

        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.

        ShortAdditional content defined by implementations
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        SlicingThis element introduces a set of slices on Dosage.timing.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 22. Dosage.timing.modifierExtension
          Definition

          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).

          ShortExtensions that cannot be ignored even if unrecognized
          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 Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
          Summarytrue
          Requirements

          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.

          Alternate Namesextensions, user content, modifiers
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          24. Dosage.timing.event
          Definition

          Identifies specific times when the event occurs.

          ShortWhen the event occurs
          Control0..*
          TypedateTime
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          In a Medication Administration Record, for instance, you need to take a general specification, and turn it into a precise specification.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          26. Dosage.timing.repeat
          Definition

          A set of rules that describe when the event is scheduled.

          ShortWhen the event is to occur
          Control1..1
          TypeElement
          Is Modifierfalse
          Summarytrue
          Requirements

          Many timing schedules are determined by regular repetitions.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          tim-1: if there's a duration, there needs to be duration units (duration.empty() or durationUnit.exists())
          tim-2: if there's a period, there needs to be period units (period.empty() or periodUnit.exists())
          tim-4: duration SHALL be a non-negative value (duration.exists() implies duration >= 0)
          tim-5: period SHALL be a non-negative value (period.exists() implies period >= 0)
          tim-6: If there's a periodMax, there must be a period (periodMax.empty() or period.exists())
          tim-7: If there's a durationMax, there must be a duration (durationMax.empty() or duration.exists())
          tim-8: If there's a countMax, there must be a count (countMax.empty() or count.exists())
          tim-9: 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())))
          tim-10: If there's a timeOfDay, there cannot be a when, or vice versa (timeOfDay.empty() or when.empty())
          28. Dosage.timing.repeat.id
          Definition

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

          ShortUnique id for inter-element referencing
          Control0..1
          Typestring
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          30. Dosage.timing.repeat.extension
          Definition

          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.

          ShortAdditional content defined by implementations
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Alternate Namesextensions, user content
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          SlicingThis element introduces a set of slices on Dosage.timing.repeat.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 32. Dosage.timing.repeat.bounds[x]
            Definition

            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.

            ShortLength/Range of lengths, or (Start and/or end) limits
            Control0..1
            TypeChoice of: Duration, Range, Period
            [x] NoteSee Choice of Data Types for further information about how to use [x]
            Is Modifierfalse
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            SlicingThis element introduces a set of slices on Dosage.timing.repeat.bounds[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • type @ $this
            • 34. Dosage.timing.repeat.bounds[x]:boundsPeriod
              Slice NameboundsPeriod
              Definition

              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.

              ShortLength/Range of lengths, or (Start and/or end) limits
              Control0..0
              TypePeriod
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              36. Dosage.timing.repeat.count
              Definition

              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.

              ShortNumber of times to repeat
              Comments

              If you have both bounds and count, then this should be understood as within the bounds period, until count times happens.

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

              Repetitions may be limited by end time or total occurrences.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              38. Dosage.timing.repeat.countMax
              Definition

              If present, indicates that the count is a range - so to perform the action between [count] and [countMax] times.

              ShortMaximum number of times to repeat
              Control0..1
              TypepositiveInt
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              40. Dosage.timing.repeat.duration
              Definition

              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.

              ShortHow long when it happens
              Comments

              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).

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

              Some activities are not instantaneous and need to be maintained for a period of time.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              42. Dosage.timing.repeat.durationMax
              Definition

              If present, indicates that the duration is a range - so to perform the action between [duration] and [durationMax] time length.

              ShortHow long when it happens (Max)
              Comments

              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).

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

              Some activities are not instantaneous and need to be maintained for a period of time.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              44. Dosage.timing.repeat.durationUnit
              Definition

              The units of time for the duration, in UCUM units.

              Shorts | min | h | d | wk | mo | a - unit of time (UCUM)
              Control0..1
              BindingThe codes SHALL be taken from UnitsOfTime
              (required to http://hl7.org/fhir/ValueSet/units-of-time|4.0.1)

              A unit of time (units from UCUM).

              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              46. Dosage.timing.repeat.frequency
              Definition

              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.

              ShortEvent occurs frequency times per period
              Control0..1
              TypepositiveInt
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Meaning if MissingIf no frequency is stated, the assumption is that the event occurs once per period, but systems SHOULD always be specific about this
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              48. Dosage.timing.repeat.frequencyMax
              Definition

              If present, indicates that the frequency is a range - so to repeat between [frequency] and [frequencyMax] times within the period or period range.

              ShortEvent occurs up to frequencyMax times per period
              Control0..1
              TypepositiveInt
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              50. Dosage.timing.repeat.period
              Definition

              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.

              ShortEvent occurs frequency times per period
              Control0..1
              Typedecimal
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              52. Dosage.timing.repeat.periodMax
              Definition

              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.

              ShortUpper limit of period (3-4 hours)
              Control0..1
              Typedecimal
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              54. Dosage.timing.repeat.periodUnit
              Definition

              The units of time for the period in UCUM units.

              Shorts | min | h | d | wk | mo | a - unit of time (UCUM)
              Control0..1
              BindingThe codes SHALL be taken from UnitsOfTime
              (required to http://hl7.org/fhir/ValueSet/units-of-time|4.0.1)

              A unit of time (units from UCUM).

              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              56. Dosage.timing.repeat.dayOfWeek
              Definition

              If one or more days of week is provided, then the action happens only on the specified day(s).

              Shortmon | tue | wed | thu | fri | sat | sun
              Comments

              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.

              Control0..*
              BindingThe codes SHALL be taken from DaysOfWeek
              (required to http://hl7.org/fhir/ValueSet/days-of-week|4.0.1)
              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              58. Dosage.timing.repeat.timeOfDay
              Definition

              Specified time of day for action to take place.

              ShortTime of day for action
              Comments

              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.

              Control0..*
              Typetime
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              60. Dosage.timing.repeat.when
              Definition

              An approximate time period during the day, potentially linked to an event of daily living that indicates when the action should occur.

              ShortCode for time period of occurrence
              Comments

              When more than one event is listed, the event is tied to the union of the specified events.

              Control1..*
              BindingThe codes SHALL be taken from EventTiming
              (required to http://hl7.org/fhir/ValueSet/event-timing|4.0.1)

              Real world event relating to the schedule.

              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Requirements

              Timings are frequently determined by occurrences such as waking, eating and sleep.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ch-emed-event-timing: For the representation of the time of administration according to the 1-1-1-1 scheme, the values MORN-NOON-EVE-NIGHT are highly recommended. ($this='MORN' or $this='NOON' or $this='EVE' or $this='NIGHT')
              62. Dosage.timing.repeat.offset
              Definition

              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.

              ShortMinutes from event (before or after)
              Control0..1
              TypeunsignedInt
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              64. Dosage.timing.code
              Definition

              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).

              ShortBID | TID | QID | AM | PM | QD | QOD | +
              Comments

              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).

              Control0..1
              BindingThe codes SHOULD be taken from TimingAbbreviation
              (preferred to http://hl7.org/fhir/ValueSet/timing-abbreviation)

              Code for a known / defined timing pattern.

              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              66. 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..0
              BindingFor example codes, see SNOMEDCTMedicationAsNeededReasonCodes
              (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.

              TypeChoice of: boolean, CodeableConcept
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              68. Dosage.site
              Definition

              Body site to administer to.

              ShortBody site to administer to
              Comments

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

              Control0..0
              BindingFor example codes, see SNOMEDCTAnatomicalStructureForAdministrationSiteCodes
              (example to http://hl7.org/fhir/ValueSet/approach-site-codes)

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

              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Requirements

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

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              70. Dosage.route
              Definition

              How drug should enter body.

              ShortHow drug should enter body
              Control0..0
              BindingThe codes SHOULD be taken from EDQM - RouteOfAdministration
              (preferred to http://fhir.ch/ig/ch-term/ValueSet/edqm-routeofadministration)
              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Requirements

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

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              72. Dosage.method
              Definition

              Technique for administering medication.

              ShortTechnique for administering medication
              Comments

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

              Control0..0
              BindingThe codes SHOULD be taken from EDQM - Administration Method
              (preferred to http://fhir.ch/ig/ch-term/ValueSet/edqm-administrationmethod)
              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Requirements

              A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              74. Dosage.doseAndRate
              Definition

              The amount of medication administered.

              ShortAmount of medication administered
              Control1..1
              TypeElement
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              76. Dosage.doseAndRate.id
              Definition

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

              ShortUnique id for inter-element referencing
              Control0..1
              Typestring
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              78. Dosage.doseAndRate.extension
              Definition

              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.

              ShortAdditional content defined by implementations
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Alternate Namesextensions, user content
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              SlicingThis element introduces a set of slices on Dosage.doseAndRate.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 80. Dosage.doseAndRate.type
                Definition

                The kind of dose or rate specified, for example, ordered or calculated.

                ShortThe kind of dose or rate specified
                Control0..1
                BindingFor example codes, see DoseAndRateType
                (example to http://hl7.org/fhir/ValueSet/dose-rate-type)

                The kind of dose or rate specified.

                TypeCodeableConcept
                Is Modifierfalse
                Summarytrue
                Requirements

                If the type is not populated, assume to be "ordered".

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                82. Dosage.doseAndRate.dose[x]
                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.

                Control1..1
                TypeChoice of: Range(CH Core Range with EMED Units), Quantity(CH Core Quantity with EMED Units)
                [x] NoteSee Choice of Data Types for further information about how to use [x]
                Is Modifierfalse
                Must Supporttrue
                Must Support TypesNo must-support rules about the choice of types/profiles
                Summarytrue
                Requirements

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

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                84. Dosage.doseAndRate.rate[x]
                Definition

                Amount of medication per unit of time.

                ShortAmount of medication per unit of time
                Comments

                It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate.

                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.

                Control0..1
                TypeChoice of: Ratio, Range, Quantity(SimpleQuantity)
                [x] NoteSee Choice of Data Types for further information about how to use [x]
                Is Modifierfalse
                Summarytrue
                Requirements

                Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                86. Dosage.maxDosePerPeriod
                Definition

                Upper limit on medication per unit of time.

                ShortUpper limit on medication per unit of time
                Comments

                This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".

                Control0..0
                TypeRatio
                Is Modifierfalse
                Summarytrue
                Requirements

                The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                88. Dosage.maxDosePerAdministration
                Definition

                Upper limit on medication per administration.

                ShortUpper limit on medication per administration
                Comments

                This is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg.

                Control0..0
                TypeQuantity(SimpleQuantity)
                Is Modifierfalse
                Summarytrue
                Requirements

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

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                90. Dosage.maxDosePerLifetime
                Definition

                Upper limit on medication per lifetime of the patient.

                ShortUpper limit on medication per lifetime of the patient
                Control0..0
                TypeQuantity(SimpleQuantity)
                Is Modifierfalse
                Summarytrue
                Requirements

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

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))