Nictiz FHIR NL STU3 Zib2017
1.3.15 - CI Build

Nictiz FHIR NL STU3 Zib2017 - Local Development build (v1.3.15) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: Zib MedicationAdministration - Detailed Descriptions

Active as of 2025-09-22

Definitions for the zib-MedicationAdministration resource profile.

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

0. MedicationAdministration
Definition

Medication administration is the registration of the individual administrations of the medicine on the patient by the administrator (e.g. a nurse or patient themselves), in relation to the entered agreements.

ShortMedicationAdministration
Alternate NamesMedicatieToediening
2. MedicationAdministration.extension
SlicingThis element introduces a set of slices on MedicationAdministration.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 4. MedicationAdministration.extension:agreedDateTime
    Slice NameagreedDateTime
    Definition

    Date and time in the medication or administration agreement to which this administration pertains. Since multiple times can be indicated in one medication/administration agreement, this can be used to identify the agreed time in the event of e.g. early administration or a late administration.

    ShortAgreedDateTime
    TypeExtension(HCIM AgreedDateTime) (Extension Type: dateTime)
    Alternate NamesAfgesprokenDatumTijd
    6. MedicationAdministration.extension:doubleCheckPerformed
    Slice NamedoubleCheckPerformed
    Definition

    Was a double check performed prior to the administration? This is only legally required for certain medication.

    ShortDoubleCheckPerformed
    Control0..1
    TypeExtension(HCIM Double Check Performed) (Extension Type: boolean)
    Alternate NamesDubbeleControleUitgevoerd
    8. MedicationAdministration.extension:medicationTreatment
    Slice NamemedicationTreatment
    Definition

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

    ShortMedicational 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
    TypeExtension(HCIM MedicationTreatment) (Extension Type: Identifier)
    Alternate NamesMedicamenteuze behandeling
    10. MedicationAdministration.extension:deviatingAdministration
    Slice NamedeviatingAdministration
    Control0..1
    TypeExtension(HCIM Deviating Administration) (Complex Extension)
    12. MedicationAdministration.extension:deviatingAdministration.extension
    SlicingThis element introduces a set of slices on MedicationAdministration.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 14. MedicationAdministration.extension:deviatingAdministration.extension:deviation
      Slice Namedeviation
      16. MedicationAdministration.extension:deviatingAdministration.extension:reasonForDeviation
      Slice NamereasonForDeviation
      BindingUnless not suitable, these codes SHALL be taken from MedicatieToedieningRedenVanAfwijkenCodelijst
      (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.13.3--20171231000000)
      18. MedicationAdministration.identifier
      NoteThis is a business identifier, not a resource identifier (see discussion)
      20. MedicationAdministration.status
      Definition

      The status of the administration, as a description of the stage within the administering process. Only the status codes ‘completed’ and ‘cancelled’ apply to indivisible products (such as tablets or suppositories). For divisible products (such as infusions), doses can also be ‘suspended’ or ‘aborted’.

      When documenting this, the following interpretations are used: Active: The product is administered. Interrupted: Use has (temporarily) been interrupted, because of a side effect, for example. Later, the patient and/or doctor can decide whether or not to resume or discontinue use. Discontinued: Administration has stopped. Completed: Administration has been completed.

      Not started: The product was never administered.

      ShortMedicationAdministrationStatus
      Alternate NamesMedicatieToedieningStatus
      22. MedicationAdministration.status.extension
      SlicingThis element introduces a set of slices on MedicationAdministration.status.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 24. MedicationAdministration.status.extension:orderStatus
        Slice NameorderStatus
        Definition

        The status of the order / recommendation.

        ShortOrderStatus
        Control0..1
        TypeExtension(HCIM extension code-specification) (Extension Type: CodeableConcept)
        Alternate NamesOrderStatus
        26. MedicationAdministration.category
        Control1..?
        28. MedicationAdministration.category.coding
        SlicingThis element introduces a set of slices on MedicationAdministration.category.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ code
        • 30. MedicationAdministration.category.coding:MedicationAdministrationCode
          Slice NameMedicationAdministrationCode
          Definition

          Category SNOMED code used for indexing/retrieval of the HCIM MedicationAdministration. The SNOMED code 18629005 for this resource is stated in the Medication Process v09.

          ShortMedicationAdministrationCode
          32. MedicationAdministration.category.coding:MedicationAdministrationCode.system
          Fixed Valuehttp://snomed.info/sct
          34. MedicationAdministration.category.coding:MedicationAdministrationCode.code
          Fixed Value18629005
          36. MedicationAdministration.category.coding:MedicationAdministrationCode.display
          Default ValueAdministration of drug or medicament (procedure)
          38. MedicationAdministration.medicationReference:medicationReference
          Slice NamemedicationReference
          Definition

          The product taken or administered. This is usually medication. Food, blood products, aids and bandages do not strictly fall under the category of medication, but can be reported as well.

          In principle, this will be the prescribed product, but the administrator may substitute it by replacing the product with an equivalent product. For example: two 50mg tablets can be administered instead of one 100mg tablet.

          ShortAdministrationProduct
          TypeReference(HCIM PharmaceuticalProduct)
          Alternate NamesProduct, Geneesmiddel, Toedieningsproduct
          40. MedicationAdministration.subject
          TypeReference(nl-core-patient, Group)
          42. MedicationAdministration.supportingInformation
          Definition

          Medication or administration agreement on which this administration.is based.

          ShortRelatedAgreement / MedicationAgreement / AdministrationAgreement
          TypeReference(Resource, HCIM Dispense, HCIM PharmaceuticalProduct, HCIM DispenseRequest, HCIM AdministrationAgreement, HCIM MedicationAgreement, HCIM MedicationAdministration)
          Alternate NamesGerelateerdeAfspraak, Medicatieafspraak, Toedieningsafspraak
          44. MedicationAdministration.effective[x]
          Definition

          The date and time at which the medication was administered.

          ShortAdministrationDateTime
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Alternate NamesToedieningsDatumTijd
          46. MedicationAdministration.performer
          Definition

          Container of the Administrator concept. This container contains all data elements of the Administrator concept. The concept describes the person who administered the product. This is a professional authorised administrator, the patient themselves or the caregiver, for example.

          ShortAdministrator
          Alternate NamesToediener
          48. MedicationAdministration.performer.actor
          Comments

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

          TypeReference(nl-core-practitioner, nl-core-patient, nl-core-relatedperson, Device)
          50. MedicationAdministration.performer.actor.extension
          SlicingThis element introduces a set of slices on MedicationAdministration.performer.actor.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 52. MedicationAdministration.performer.actor.extension:practitionerRole
            Slice NamepractitionerRole
            Control0..1
            TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
            54. MedicationAdministration.performer.onBehalfOf
            TypeReference(nl-core-organization)
            56. MedicationAdministration.note
            Definition

            Comments on administering the medication.

            ShortComment
            Alternate NamesToelichting
            58. MedicationAdministration.dosage
            60. MedicationAdministration.dosage.route
            Definition

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

            ShortRouteOfAdministration
            Control1..?
            BindingUnless not suitable, these codes SHALL be taken from MedicatieToedieningToedieningswegCodelijst
            (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.13.2--20171231000000)

            MedicatieToedieningToedieningswegCodelijst

            Alternate NamesToedieningsweg
            62. MedicationAdministration.dosage.dose
            Definition

            Amount of the administered product

            ShortAdministeredAmount
            Control1..?
            BindingThe codes SHALL be taken from G-Standaard Eenhedentabel
            (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453)

            GstdTabel902

            Alternate NamesToegediendeHoeveelheid
            64. MedicationAdministration.dosage.rate[x]
            Definition

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

            For example, with an administering speed of 10ml/hour: amount = 10, dose unit = ml

            time unit = hour

            ShortAdministeringSpeed
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Alternate NamesToedieningssnelheid

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

            0. MedicationAdministration
            Definition

            Medication administration is the registration of the individual administrations of the medicine on the patient by the administrator (e.g. a nurse or patient themselves), in relation to the entered agreements.


            Describes the event of a patient consuming or otherwise being administered a medication. This may be as simple as swallowing a tablet or it may be a long running infusion. Related resources tie this event to the authorizing prescription, and the specific encounter between patient and health care practitioner.

            ShortMedicationAdministrationAdministration of medication to a patient
            Comments

            The WG will be updating the MedicationAdministration resource to adjust each affected resource to align with the workflow pattern (see workflow.html).

            Control0..*
            Alternate NamesMedicatieToediening
            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())
            mad-2: Reason not given is only permitted if NotGiven is true (reasonNotGiven.empty() or notGiven = true)
            mad-3: Reason given is only permitted if NotGiven is false (reasonCode.empty() or notGiven.empty() or notGiven = 'false')
            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())
            mad-2: Reason not given is only permitted if NotGiven is true (reasonNotGiven.empty() or notGiven = true)
            mad-3: Reason given is only permitted if NotGiven is false (reasonCode.empty() or notGiven.empty() or notGiven = 'false')
            2. MedicationAdministration.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. MedicationAdministration.extension
            Definition

            An Extension


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

            ShortExtensionAdditional Content defined by implementations
            Comments

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

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

              Date and time in the medication or administration agreement to which this administration pertains. Since multiple times can be indicated in one medication/administration agreement, this can be used to identify the agreed time in the event of e.g. early administration or a late administration.

              ShortAgreedDateTime
              Control0..*
              This element is affected by the following invariants: ele-1
              TypeExtension(HCIM AgreedDateTime) (Extension Type: dateTime)
              Alternate NamesAfgesprokenDatumTijd
              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())
              8. MedicationAdministration.extension:doubleCheckPerformed
              Slice NamedoubleCheckPerformed
              Definition

              Was a double check performed prior to the administration? This is only legally required for certain medication.

              ShortDoubleCheckPerformed
              Control0..1
              This element is affected by the following invariants: ele-1
              TypeExtension(HCIM Double Check Performed) (Extension Type: boolean)
              Alternate NamesDubbeleControleUitgevoerd
              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())
              10. MedicationAdministration.extension:medicationTreatment
              Slice NamemedicationTreatment
              Definition

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

              ShortMedicational 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())
              12. MedicationAdministration.extension:deviatingAdministration
              Slice NamedeviatingAdministration
              Definition

              Optional Extension Element - found in all resources.

              ShortOptional Extensions Element
              Control0..1
              This element is affected by the following invariants: ele-1
              TypeExtension(HCIM Deviating Administration) (Complex Extension)
              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. MedicationAdministration.extension:deviatingAdministration.extension
              Definition

              An Extension


              May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

              ShortExtensionAdditional Content defined by implementations
              Comments

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

              Control0..*
              TypeExtension
              Alternate Namesextensions, user content
              SlicingThis element introduces a set of slices on MedicationAdministration.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 16. MedicationAdministration.extension:deviatingAdministration.extension:deviation
                Slice Namedeviation
                Definition

                An Extension

                ShortExtensionAdditional Content defined by implementations
                Control0..*
                TypeExtension
                18. MedicationAdministration.extension:deviatingAdministration.extension:deviation.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 Valuedeviation
                20. MedicationAdministration.extension:deviatingAdministration.extension:deviation.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 MedicationAdministration.extension.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                • type @ $this
                • 22. MedicationAdministration.extension:deviatingAdministration.extension:deviation.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
                  24. MedicationAdministration.extension:deviatingAdministration.extension:reasonForDeviation
                  Slice NamereasonForDeviation
                  Definition

                  An Extension

                  ShortExtensionAdditional Content defined by implementations
                  Control0..*
                  TypeExtension
                  26. MedicationAdministration.extension:deviatingAdministration.extension:reasonForDeviation.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 ValuereasonForDeviation
                  28. MedicationAdministration.extension:deviatingAdministration.extension:reasonForDeviation.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 MedicationAdministration.extension.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                  • type @ $this
                  • 30. MedicationAdministration.extension:deviatingAdministration.extension:reasonForDeviation.value[x]:valueCodeableConcept
                    Slice NamevalueCodeableConcept
                    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]
                    32. MedicationAdministration.extension:deviatingAdministration.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-MedicationAdministration-DeviatingAdministration
                    34. MedicationAdministration.extension:deviatingAdministration.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..01
                    TypeChoice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, Meta
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    36. MedicationAdministration.modifierExtension
                    Definition

                    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.

                    ShortExtensions 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
                    38. MedicationAdministration.identifier
                    Definition

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

                    ShortExternal identifier
                    NoteThis is a business identifier, not a resource identifier (see discussion)
                    Control0..*
                    TypeIdentifier
                    40. MedicationAdministration.status
                    Definition

                    The status of the administration, as a description of the stage within the administering process. Only the status codes ‘completed’ and ‘cancelled’ apply to indivisible products (such as tablets or suppositories). For divisible products (such as infusions), doses can also be ‘suspended’ or ‘aborted’.

                    When documenting this, the following interpretations are used: Active: The product is administered. Interrupted: Use has (temporarily) been interrupted, because of a side effect, for example. Later, the patient and/or doctor can decide whether or not to resume or discontinue use. Discontinued: Administration has stopped. Completed: Administration has been completed.

                    Not started: The product was never administered.


                    Will generally be set to show that the administration has been completed. For some long running administrations such as infusions it is possible for an administration to be started but not completed or it may be paused while some other process is under way.

                    ShortMedicationAdministrationStatusin-progress | on-hold | completed | entered-in-error | stopped | unknown
                    Comments

                    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 MedicationAdministrationStatushttp://hl7.org/fhir/ValueSet/medication-admin-status|3.0.2
                    (required to http://hl7.org/fhir/ValueSet/medication-admin-status|3.0.2)

                    A set of codes indicating the current status of a MedicationAdministration.

                    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 NamesMedicatieToedieningStatus
                    42. MedicationAdministration.status.extension
                    Definition

                    An Extension


                    May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                    ShortExtensionAdditional Content defined by implementations
                    Comments

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

                    Control0..*
                    TypeExtension
                    Alternate Namesextensions, user content
                    SlicingThis element introduces a set of slices on MedicationAdministration.status.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ url
                    • 44. MedicationAdministration.status.extension:orderStatus
                      Slice NameorderStatus
                      Definition

                      The status of the order / recommendation.

                      ShortOrderStatus
                      Control0..1
                      This element is affected by the following invariants: ele-1
                      TypeExtension(HCIM extension code-specification) (Extension Type: CodeableConcept)
                      Alternate NamesBevat de specifieke code conform de zib, bij een FHIR-element die een verplichte koppeling heeft met een bepaalde FHIR waardelijst of een FHIR element die niet gecodeerd is gedefinieerd, terwijl de zib dit wel doet., OrderStatus
                      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())
                      46. MedicationAdministration.category
                      Definition

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

                      ShortType of medication usage
                      Control10..1
                      BindingThe codes SHOULD be taken from MedicationAdministrationCategoryhttp://hl7.org/fhir/ValueSet/medication-admin-category|3.0.2
                      (preferred to http://hl7.org/fhir/ValueSet/medication-admin-category|3.0.2)

                      A coded concept describing where the medication administered is expected to occur

                      TypeCodeableConcept
                      48. MedicationAdministration.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 MedicationAdministration.category.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ code
                      • 50. MedicationAdministration.category.coding:MedicationAdministrationCode
                        Slice NameMedicationAdministrationCode
                        Definition

                        Category SNOMED code used for indexing/retrieval of the HCIM MedicationAdministration. The SNOMED code 18629005 for this resource is stated in the Medication Process v09.


                        A reference to a code defined by a terminology system.

                        ShortMedicationAdministrationCodeCode 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.

                        52. MedicationAdministration.category.coding:MedicationAdministrationCode.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 Valuehttp://snomed.info/sct
                        54. MedicationAdministration.category.coding:MedicationAdministrationCode.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 Value18629005
                        56. MedicationAdministration.category.coding:MedicationAdministrationCode.display
                        Definition

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

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

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

                        58. MedicationAdministration.medication[x]
                        Definition

                        Identifies the medication that was 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 was administered
                        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 MedicationAdministration.medication[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                        • type @ $this
                        • 60. MedicationAdministration.medication[x]:medicationReference
                          Slice NamemedicationReference
                          Definition

                          The product taken or administered. This is usually medication. Food, blood products, aids and bandages do not strictly fall under the category of medication, but can be reported as well.

                          In principle, this will be the prescribed product, but the administrator may substitute it by replacing the product with an equivalent product. For example: two 50mg tablets can be administered instead of one 100mg tablet.


                          Identifies the medication that was 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.

                          ShortAdministrationProductWhat was administered
                          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 NamesProduct, Geneesmiddel, Toedieningsproduct
                          62. MedicationAdministration.subject
                          Definition

                          The person or animal or group receiving the medication.

                          ShortWho received medication
                          Control1..1
                          TypeReference(nl-core-patient, Group, Patient)
                          Summarytrue
                          64. MedicationAdministration.supportingInformation
                          Definition

                          Medication or administration agreement on which this administration.is based.


                          Additional information (for example, patient height and weight) that supports the administration of the medication.

                          ShortRelatedAgreement / MedicationAgreement / AdministrationAgreementAdditional information to support administration
                          Control0..*
                          TypeReference(Resource, HCIM Dispense, HCIM PharmaceuticalProduct, HCIM DispenseRequest, HCIM AdministrationAgreement, HCIM MedicationAgreement, HCIM MedicationAdministration)
                          Alternate NamesGerelateerdeAfspraak, Medicatieafspraak, Toedieningsafspraak
                          66. MedicationAdministration.effective[x]
                          Definition

                          The date and time at which the medication was administered.


                          A specific date/time or interval of time during which the administration took place (or did not take place, when the 'notGiven' attribute is true). For many administrations, such as swallowing a tablet the use of dateTime is more appropriate.

                          ShortAdministrationDateTimeStart and end time of administration
                          Control1..1
                          TypeChoice of: dateTime, Period
                          [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
                          Summarytrue
                          Alternate NamesToedieningsDatumTijd
                          68. MedicationAdministration.performer
                          Definition

                          Container of the Administrator concept. This container contains all data elements of the Administrator concept. The concept describes the person who administered the product. This is a professional authorised administrator, the patient themselves or the caregiver, for example.


                          The individual who was responsible for giving the medication to the patient.

                          ShortAdministratorWho administered substance
                          Control0..*
                          TypeBackboneElement
                          Summarytrue
                          Alternate NamesToediener
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                          ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                          70. MedicationAdministration.performer.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 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.

                          ShortExtensions 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
                          Summarytrue
                          Alternate Namesextensions, user content, modifiers
                          72. MedicationAdministration.performer.actor
                          Definition

                          The device, practitioner, etc. who performed the action.

                          ShortIndividual who was performing
                          Comments

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

                          Control1..1
                          TypeReference(nl-core-practitioner, nl-core-patient, nl-core-relatedperson, Device, Practitioner, Patient, RelatedPerson)
                          Summarytrue
                          74. MedicationAdministration.performer.actor.extension
                          Definition

                          An Extension


                          May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                          ShortExtensionAdditional Content defined by implementations
                          Comments

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

                          Control0..*
                          TypeExtension
                          Alternate Namesextensions, user content
                          SlicingThis element introduces a set of slices on MedicationAdministration.performer.actor.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 76. MedicationAdministration.performer.actor.extension:practitionerRole
                            Slice NamepractitionerRole
                            Definition

                            Optional Extension Element - found in all resources.

                            ShortOptional Extensions Element
                            Control0..1
                            TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
                            78. MedicationAdministration.performer.onBehalfOf
                            Definition

                            The organization the device or practitioner was acting on behalf of.

                            ShortOrganization organization was acting for
                            Control0..1
                            TypeReference(nl-core-organization, Organization)
                            80. MedicationAdministration.notGiven
                            Definition

                            Set this to true if the record is saying that the medication was NOT administered.

                            ShortTrue if medication not administered
                            Comments

                            This element is labeled as a modifier because it indicates that a administration didn't happen.

                            Control0..1
                            Typeboolean
                            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
                            Meaning if MissingIf this is missing, then the medication was administered
                            82. MedicationAdministration.note
                            Definition

                            Comments on administering the medication.


                            Extra information about the medication administration that is not conveyed by the other attributes.

                            ShortCommentInformation about the administration
                            Control0..*
                            TypeAnnotation
                            Alternate NamesToelichting

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

                            0. MedicationAdministration
                            Definition

                            Medication administration is the registration of the individual administrations of the medicine on the patient by the administrator (e.g. a nurse or patient themselves), in relation to the entered agreements.

                            ShortMedicationAdministration
                            Comments

                            The WG will be updating the MedicationAdministration resource to adjust each affected resource to align with the workflow pattern (see workflow.html).

                            Control0..*
                            Alternate NamesMedicatieToediening
                            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())
                            mad-2: Reason not given is only permitted if NotGiven is true (reasonNotGiven.empty() or notGiven = true)
                            mad-3: Reason given is only permitted if NotGiven is false (reasonCode.empty() or notGiven.empty() or notGiven = 'false')
                            2. MedicationAdministration.id
                            Definition

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

                            ShortLogical id of this artifact
                            Comments

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

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

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

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

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

                            ShortA set of rules under which this content was created
                            Comments

                            Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

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

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

                            The base language in which the resource is written.

                            ShortLanguage of the resource content
                            Comments

                            Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

                            Control0..1
                            BindingUnless not suitable, these codes SHALL be taken from Common Languages
                            (extensible to http://hl7.org/fhir/ValueSet/languages|3.0.2)

                            A human language.

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

                            A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

                            ShortText summary of the resource, for human interpretation
                            Comments

                            Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.

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

                            These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

                            ShortContained, inline Resources
                            Comments

                            This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.

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

                            An Extension

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

                              Date and time in the medication or administration agreement to which this administration pertains. Since multiple times can be indicated in one medication/administration agreement, this can be used to identify the agreed time in the event of e.g. early administration or a late administration.

                              ShortAgreedDateTime
                              Control0..*
                              This element is affected by the following invariants: ele-1
                              TypeExtension(HCIM AgreedDateTime) (Extension Type: dateTime)
                              Alternate NamesAfgesprokenDatumTijd
                              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. MedicationAdministration.extension:doubleCheckPerformed
                              Slice NamedoubleCheckPerformed
                              Definition

                              Was a double check performed prior to the administration? This is only legally required for certain medication.

                              ShortDoubleCheckPerformed
                              Control0..1
                              This element is affected by the following invariants: ele-1
                              TypeExtension(HCIM Double Check Performed) (Extension Type: boolean)
                              Alternate NamesDubbeleControleUitgevoerd
                              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. MedicationAdministration.extension:medicationTreatment
                              Slice NamemedicationTreatment
                              Definition

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

                              ShortMedicational 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())
                              22. MedicationAdministration.extension:deviatingAdministration
                              Slice NamedeviatingAdministration
                              Definition

                              Optional Extension Element - found in all resources.

                              ShortOptional Extensions Element
                              Control0..1
                              This element is affected by the following invariants: ele-1
                              TypeExtension(HCIM Deviating Administration) (Complex Extension)
                              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())
                              24. MedicationAdministration.extension:deviatingAdministration.id
                              Definition

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

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

                              An Extension

                              ShortExtension
                              Control0..*
                              TypeExtension
                              SlicingThis element introduces a set of slices on MedicationAdministration.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ url
                              • 28. MedicationAdministration.extension:deviatingAdministration.extension:deviation
                                Slice Namedeviation
                                Definition

                                An Extension

                                ShortExtension
                                Control0..*
                                TypeExtension
                                30. MedicationAdministration.extension:deviatingAdministration.extension:deviation.id
                                Definition

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

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

                                May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                ShortAdditional Content defined by implementations
                                Comments

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

                                Control0..*
                                TypeExtension
                                Alternate Namesextensions, user content
                                SlicingThis element introduces a set of slices on MedicationAdministration.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • value @ url
                                • 34. MedicationAdministration.extension:deviatingAdministration.extension:deviation.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 Valuedeviation
                                  36. MedicationAdministration.extension:deviatingAdministration.extension:deviation.value[x]
                                  Definition

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

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

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

                                    ShortValue of extension
                                    Control0..1
                                    Typeboolean
                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    40. MedicationAdministration.extension:deviatingAdministration.extension:reasonForDeviation
                                    Slice NamereasonForDeviation
                                    Definition

                                    An Extension

                                    ShortExtension
                                    Control0..*
                                    TypeExtension
                                    42. MedicationAdministration.extension:deviatingAdministration.extension:reasonForDeviation.id
                                    Definition

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

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

                                    May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                    ShortAdditional Content defined by implementations
                                    Comments

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

                                    Control0..*
                                    TypeExtension
                                    Alternate Namesextensions, user content
                                    SlicingThis element introduces a set of slices on MedicationAdministration.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                    • value @ url
                                    • 46. MedicationAdministration.extension:deviatingAdministration.extension:reasonForDeviation.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 ValuereasonForDeviation
                                      48. MedicationAdministration.extension:deviatingAdministration.extension:reasonForDeviation.value[x]
                                      Definition

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

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

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

                                        ShortValue of extension
                                        Control0..1
                                        TypeCodeableConcept
                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                        52. MedicationAdministration.extension:deviatingAdministration.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-MedicationAdministration-DeviatingAdministration
                                        54. MedicationAdministration.extension:deviatingAdministration.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..0
                                        TypeChoice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, Meta
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        56. MedicationAdministration.modifierExtension
                                        Definition

                                        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.

                                        ShortExtensions 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
                                        58. MedicationAdministration.identifier
                                        Definition

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

                                        ShortExternal identifier
                                        NoteThis is a business identifier, not a resource identifier (see discussion)
                                        Control0..*
                                        TypeIdentifier
                                        60. MedicationAdministration.definition
                                        Definition

                                        A protocol, guideline, orderset or other definition that was adhered to in whole or in part by this event.

                                        ShortInstantiates protocol or definition
                                        Control0..*
                                        TypeReference(PlanDefinition, ActivityDefinition)
                                        Summarytrue
                                        62. MedicationAdministration.partOf
                                        Definition

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

                                        ShortPart of referenced event
                                        Control0..*
                                        TypeReference(MedicationAdministration, Procedure)
                                        Summarytrue
                                        64. MedicationAdministration.status
                                        Definition

                                        The status of the administration, as a description of the stage within the administering process. Only the status codes ‘completed’ and ‘cancelled’ apply to indivisible products (such as tablets or suppositories). For divisible products (such as infusions), doses can also be ‘suspended’ or ‘aborted’.

                                        When documenting this, the following interpretations are used: Active: The product is administered. Interrupted: Use has (temporarily) been interrupted, because of a side effect, for example. Later, the patient and/or doctor can decide whether or not to resume or discontinue use. Discontinued: Administration has stopped. Completed: Administration has been completed.

                                        Not started: The product was never administered.

                                        ShortMedicationAdministrationStatus
                                        Comments

                                        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 MedicationAdministrationStatus
                                        (required to http://hl7.org/fhir/ValueSet/medication-admin-status|3.0.2)

                                        A set of codes indicating the current status of a MedicationAdministration.

                                        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 NamesMedicatieToedieningStatus
                                        66. MedicationAdministration.status.id
                                        Definition

                                        unique id for the element within a resource (for internal references)

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

                                        An Extension

                                        ShortExtension
                                        Control0..*
                                        TypeExtension
                                        SlicingThis element introduces a set of slices on MedicationAdministration.status.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                        • value @ url
                                        • 70. MedicationAdministration.status.extension:orderStatus
                                          Slice NameorderStatus
                                          Definition

                                          The status of the order / recommendation.

                                          ShortOrderStatus
                                          Control0..1
                                          This element is affected by the following invariants: ele-1
                                          TypeExtension(HCIM extension code-specification) (Extension Type: CodeableConcept)
                                          Alternate NamesBevat de specifieke code conform de zib, bij een FHIR-element die een verplichte koppeling heeft met een bepaalde FHIR waardelijst of een FHIR element die niet gecodeerd is gedefinieerd, terwijl de zib dit wel doet., OrderStatus
                                          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())
                                          72. MedicationAdministration.status.value
                                          Definition

                                          Primitive value for code

                                          ShortPrimitive value for code
                                          Control0..1
                                          Typecode
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          74. MedicationAdministration.category
                                          Definition

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

                                          ShortType of medication usage
                                          Control1..1
                                          BindingThe codes SHOULD be taken from MedicationAdministrationCategory
                                          (preferred to http://hl7.org/fhir/ValueSet/medication-admin-category|3.0.2)

                                          A coded concept describing where the medication administered is expected to occur

                                          TypeCodeableConcept
                                          76. MedicationAdministration.category.id
                                          Definition

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

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

                                          May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                          ShortAdditional Content defined by implementations
                                          Comments

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

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

                                              Category SNOMED code used for indexing/retrieval of the HCIM MedicationAdministration. The SNOMED code 18629005 for this resource is stated in the Medication Process v09.

                                              ShortMedicationAdministrationCode
                                              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.

                                              84. MedicationAdministration.category.coding:MedicationAdministrationCode.id
                                              Definition

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

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

                                              May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                              ShortAdditional Content defined by implementations
                                              Comments

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

                                              Control0..*
                                              TypeExtension
                                              Alternate Namesextensions, user content
                                              SlicingThis element introduces a set of slices on MedicationAdministration.category.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                              • value @ url
                                              • 88. MedicationAdministration.category.coding:MedicationAdministrationCode.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 Valuehttp://snomed.info/sct
                                                90. MedicationAdministration.category.coding:MedicationAdministrationCode.version
                                                Definition

                                                The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                ShortVersion of the system - if relevant
                                                Comments

                                                Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                NoteThis is a business version Id, not a resource version Id (see discussion)
                                                Control0..1
                                                Typestring
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                92. MedicationAdministration.category.coding:MedicationAdministrationCode.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 Value18629005
                                                94. MedicationAdministration.category.coding:MedicationAdministrationCode.display
                                                Definition

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

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

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

                                                96. MedicationAdministration.category.coding:MedicationAdministrationCode.userSelected
                                                Definition

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

                                                ShortIf this coding was chosen directly by the user
                                                Comments

                                                Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

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

                                                This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                98. MedicationAdministration.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
                                                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.

                                                100. MedicationAdministration.medication[x]
                                                Definition

                                                Identifies the medication that was 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 was administered
                                                Comments

                                                If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended.  For example if you require form or lot number, then you must reference the Medication resource. .

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

                                                  The product taken or administered. This is usually medication. Food, blood products, aids and bandages do not strictly fall under the category of medication, but can be reported as well.

                                                  In principle, this will be the prescribed product, but the administrator may substitute it by replacing the product with an equivalent product. For example: two 50mg tablets can be administered instead of one 100mg tablet.

                                                  ShortAdministrationProduct
                                                  Control1..1
                                                  TypeReference(HCIM PharmaceuticalProduct)
                                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                  Summarytrue
                                                  Alternate NamesProduct, Geneesmiddel, Toedieningsproduct
                                                  104. MedicationAdministration.subject
                                                  Definition

                                                  The person or animal or group receiving the medication.

                                                  ShortWho received medication
                                                  Control1..1
                                                  TypeReference(nl-core-patient, Group)
                                                  Summarytrue
                                                  106. MedicationAdministration.context
                                                  Definition

                                                  The visit, admission or other contact between patient and health care provider the medication administration was performed as part of.

                                                  ShortEncounter or Episode of Care administered as part of
                                                  Control0..1
                                                  TypeReference(Encounter, EpisodeOfCare)
                                                  108. MedicationAdministration.supportingInformation
                                                  Definition

                                                  Medication or administration agreement on which this administration.is based.

                                                  ShortRelatedAgreement / MedicationAgreement / AdministrationAgreement
                                                  Control0..*
                                                  TypeReference(Resource, HCIM Dispense, HCIM PharmaceuticalProduct, HCIM DispenseRequest, HCIM AdministrationAgreement, HCIM MedicationAgreement, HCIM MedicationAdministration)
                                                  Alternate NamesGerelateerdeAfspraak, Medicatieafspraak, Toedieningsafspraak
                                                  110. MedicationAdministration.effective[x]
                                                  Definition

                                                  The date and time at which the medication was administered.

                                                  ShortAdministrationDateTime
                                                  Control1..1
                                                  TypeChoice of: dateTime, Period
                                                  [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
                                                  Summarytrue
                                                  Alternate NamesToedieningsDatumTijd
                                                  112. MedicationAdministration.performer
                                                  Definition

                                                  Container of the Administrator concept. This container contains all data elements of the Administrator concept. The concept describes the person who administered the product. This is a professional authorised administrator, the patient themselves or the caregiver, for example.

                                                  ShortAdministrator
                                                  Control0..*
                                                  TypeBackboneElement
                                                  Summarytrue
                                                  Alternate NamesToediener
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                  114. MedicationAdministration.performer.id
                                                  Definition

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

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

                                                  May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                  ShortAdditional Content defined by implementations
                                                  Comments

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

                                                  Control0..*
                                                  TypeExtension
                                                  Alternate Namesextensions, user content
                                                  118. MedicationAdministration.performer.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 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.

                                                  ShortExtensions 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
                                                  Summarytrue
                                                  Alternate Namesextensions, user content, modifiers
                                                  120. MedicationAdministration.performer.actor
                                                  Definition

                                                  The device, practitioner, etc. who performed the action.

                                                  ShortIndividual who was performing
                                                  Comments

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

                                                  Control1..1
                                                  TypeReference(nl-core-practitioner, nl-core-patient, nl-core-relatedperson, Device)
                                                  Summarytrue
                                                  122. MedicationAdministration.performer.actor.id
                                                  Definition

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

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

                                                  An Extension

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

                                                    Optional Extension Element - found in all resources.

                                                    ShortOptional Extensions Element
                                                    Control0..1
                                                    TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
                                                    128. MedicationAdministration.performer.actor.reference
                                                    Definition

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

                                                    ShortLiteral reference, Relative, internal or absolute URL
                                                    Comments

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

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

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

                                                    ShortLogical reference, when literal reference is not known
                                                    Comments

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

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

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

                                                    NoteThis is a business identifier, not a resource identifier (see discussion)
                                                    Control0..1
                                                    TypeIdentifier
                                                    Summarytrue
                                                    132. MedicationAdministration.performer.actor.display
                                                    Definition

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

                                                    ShortText alternative for the resource
                                                    Comments

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

                                                    Control0..1
                                                    Typestring
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summarytrue
                                                    134. MedicationAdministration.performer.onBehalfOf
                                                    Definition

                                                    The organization the device or practitioner was acting on behalf of.

                                                    ShortOrganization organization was acting for
                                                    Control0..1
                                                    TypeReference(nl-core-organization)
                                                    136. MedicationAdministration.notGiven
                                                    Definition

                                                    Set this to true if the record is saying that the medication was NOT administered.

                                                    ShortTrue if medication not administered
                                                    Comments

                                                    This element is labeled as a modifier because it indicates that a administration didn't happen.

                                                    Control0..1
                                                    Typeboolean
                                                    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
                                                    Meaning if MissingIf this is missing, then the medication was administered
                                                    138. MedicationAdministration.reasonNotGiven
                                                    Definition

                                                    A code indicating why the administration was not performed.

                                                    ShortReason administration not performed
                                                    Control0..*
                                                    This element is affected by the following invariants: mad-2
                                                    BindingFor example codes, see SNOMED CT Reason Medication Not Given Codes
                                                    (example to http://hl7.org/fhir/ValueSet/reason-medication-not-given-codes|3.0.2)

                                                    A set of codes indicating the reason why the MedicationAdministration is negated.

                                                    TypeCodeableConcept
                                                    140. MedicationAdministration.reasonCode
                                                    Definition

                                                    A code indicating why the medication was given.

                                                    ShortReason administration performed
                                                    Control0..*
                                                    This element is affected by the following invariants: mad-3
                                                    BindingFor example codes, see Reason Medication Given Codes
                                                    (example to http://hl7.org/fhir/ValueSet/reason-medication-given-codes|3.0.2)

                                                    A set of codes indicating the reason why the MedicationAdministration was made.

                                                    TypeCodeableConcept
                                                    142. MedicationAdministration.reasonReference
                                                    Definition

                                                    Condition or observation that supports why the medication was administered.

                                                    ShortCondition or Observation that supports why the medication was administered
                                                    Comments

                                                    This is a reference to a condition that is the reason for the medication request. If only a code exists, use reasonCode.

                                                    Control0..*
                                                    TypeReference(Condition, Observation)
                                                    144. MedicationAdministration.prescription
                                                    Definition

                                                    The original request, instruction or authority to perform the administration.

                                                    ShortRequest administration performed against
                                                    Control0..1
                                                    TypeReference(MedicationRequest)
                                                    146. MedicationAdministration.device
                                                    Definition

                                                    The device used in administering the medication to the patient. For example, a particular infusion pump.

                                                    ShortDevice used to administer
                                                    Control0..*
                                                    TypeReference(Device)
                                                    148. MedicationAdministration.note
                                                    Definition

                                                    Comments on administering the medication.

                                                    ShortComment
                                                    Control0..*
                                                    TypeAnnotation
                                                    Alternate NamesToelichting
                                                    150. MedicationAdministration.dosage
                                                    Definition

                                                    Describes the medication dosage information details e.g. dose, rate, site, route, etc.

                                                    ShortDetails of how medication was taken
                                                    Control0..1
                                                    TypeBackboneElement
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                    mad-1: SHALL have at least one of dosage.dose or dosage.rate[x] (dose.exists() or rate.exists())
                                                    152. MedicationAdministration.dosage.id
                                                    Definition

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

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

                                                    May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                    ShortAdditional Content defined by implementations
                                                    Comments

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

                                                    Control0..*
                                                    TypeExtension
                                                    Alternate Namesextensions, user content
                                                    156. MedicationAdministration.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 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.

                                                    ShortExtensions 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
                                                    Summarytrue
                                                    Alternate Namesextensions, user content, modifiers
                                                    158. MedicationAdministration.dosage.text
                                                    Definition

                                                    Free text dosage can be used for cases where the dosage administered is too complex to code. When coded dosage is present, the free text dosage may still be present for display to humans.

                                                    The dosage instructions should reflect the dosage of the medication that was administered.

                                                    ShortFree text dosage instructions e.g. SIG
                                                    Control0..1
                                                    Typestring
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    160. MedicationAdministration.dosage.site
                                                    Definition

                                                    A coded specification of the anatomic site where the medication first entered the body. For example, "left arm".

                                                    ShortBody site administered to
                                                    Comments

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

                                                    Control0..1
                                                    BindingFor example codes, see SNOMED CT Anatomical Structure for Administration Site Codes
                                                    (example to http://hl7.org/fhir/ValueSet/approach-site-codes|3.0.2)

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

                                                    TypeCodeableConcept
                                                    162. MedicationAdministration.dosage.route
                                                    Definition

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

                                                    ShortRouteOfAdministration
                                                    Control1..1
                                                    BindingUnless not suitable, these codes SHALL be taken from MedicatieToedieningToedieningswegCodelijst
                                                    (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.13.2--20171231000000)

                                                    MedicatieToedieningToedieningswegCodelijst

                                                    TypeCodeableConcept
                                                    Alternate NamesToedieningsweg
                                                    164. MedicationAdministration.dosage.method
                                                    Definition

                                                    A coded value indicating the method by which the medication is intended to be or was introduced into or on the body. This attribute will most often NOT be populated. It is most commonly used for injections. For example, Slow Push, Deep IV.

                                                    ShortHow drug was administered
                                                    Comments

                                                    One of the reasons this attribute is not used often, is that the method is often pre-coordinated with the route and/or form of administration. This means the codes used in route or form may pre-coordinate the method in the route code or the form code. The implementation decision about what coding system to use for route or form code will determine how frequently the method code will be populated e.g. if route or form code pre-coordinate method code, then this attribute will not be populated often; if there is no pre-coordination then method code may be used frequently.

                                                    Control0..1
                                                    BindingFor example codes, see SNOMED CT Administration Method Codes
                                                    (example to http://hl7.org/fhir/ValueSet/administration-method-codes|3.0.2)

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

                                                    TypeCodeableConcept
                                                    166. MedicationAdministration.dosage.dose
                                                    Definition

                                                    Amount of the administered product

                                                    ShortAdministeredAmount
                                                    Comments

                                                    If the administration is not instantaneous (rate is present), this can be specified to convey the total amount administered over period of time of a single administration.

                                                    Control1..1
                                                    BindingThe codes SHALL be taken from G-Standaard Eenhedentabel
                                                    (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453)

                                                    GstdTabel902

                                                    TypeQuantity(SimpleQuantity)
                                                    Alternate NamesToegediendeHoeveelheid
                                                    168. MedicationAdministration.dosage.rate[x]
                                                    Definition

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

                                                    For example, with an administering speed of 10ml/hour: amount = 10, dose unit = ml

                                                    time unit = hour

                                                    ShortAdministeringSpeed
                                                    Comments

                                                    If the rate changes over time, and you want to capture this in MedicationAdministration, then each change should be captured as a distinct MedicationAdministration, with a specific MedicationAdministration.dosage.rate, and the date time when the rate change occurred. Typically, the MedicationAdministration.dosage.rate element is not used to convey an average rate.

                                                    Control0..1
                                                    TypeChoice of: Ratio, Quantity(SimpleQuantity)
                                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                    Alternate NamesToedieningssnelheid
                                                    170. MedicationAdministration.eventHistory
                                                    Definition

                                                    A summary of the events of interest that have occurred, such as when the administration was verified.

                                                    ShortA list of events of interest in the lifecycle
                                                    Comments

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

                                                    Control0..*
                                                    TypeReference(Provenance)