MedicationRequest

Overview

The MedicationRequest resource provides orders for all medications along with administration instructions for a patient in both the inpatient and outpatient setting (orders/prescriptions filled by a pharmacy and discharge medication orders). This resource also includes a patient’s historical or documented home medications reported by the patient, significant other or another provider.

If the MedicationRequest represents a prescription (something the patient takes at home), the start, stop, and other data may not be a representation of when the medication was taken. For example, the system may not know if the patient ever filled or took the prescribed medication, or when the prescription was filled. Documented historical/past/home medications are commonly captured when taking the patient’s medical history.

The following fields are returned if valued:

Terminology Bindings

MedicationRequest.status
  • Description
    • The current state of the medication request.
  • Details: MedicationRequest Status
    System: https://hl7.org/fhir/CodeSystem/medicationrequest-status

MedicationRequest.statusReason
MedicationRequest.category
MedicationRequest.priority
  • Description
    • Medication Request Priority
  • Details: Request Priority
    System: https://hl7.org/fhir/request-priority

MedicationRequest.medication[x]
  • Description
    • A code that defines the medication
  • Details: RxNorm
    System: https://www.nlm.nih.gov/research/umls/rxnorm

  • Details: Millennium Medication Order Synonym
    System: https://fhir.cerner.com/<EHR source id>/synonym

MedicationRequest.reasonCode
  • Description
    • Reason why medication is/was taken
  • Details: SNOMED CT
    System: http://snomed.info/sct

  • Details: ICD-9
    System: https://hl7.org/fhir/sid/icd-9

  • Details: ICD-10
    System: https://hl7.org/fhir/sid/icd-10

MedicationRequest.dosageInstruction.timing.code
  • Description
    • Code for a known/defined timing pattern
  • Details: TimingAbbreviation
    System: https://hl7.org/fhir/r4/v3/GTSAbbreviation/cs.html

  • Details: SNOMED CT
    System: http://snomed.info/sct

  • Details: Millennium Frequency
    System: https://fhir.cerner.com/<EHR source id>/codeSet/4003

MedicationRequest.dosageInstruction.asNeeded[x]
  • Description
    • Indicates whether the Medication is only taken when needed or the preconditions for taking the medication.
  • Details: SNOMED CT
    System: http://snomed.info/sct

  • Details: Millennium Reason for Medication
    System: https://fhir.cerner.com/<EHR source id>/codeSet/4005

MedicationRequest.dosageInstruction.site
  • Description
    • The anatomic site where the medication first enters the body.
  • Details: SNOMED CT
    System: http://snomed.info/sct

  • Details: Millennium Bodysite
    System: https://fhir.cerner.com/<EHR source id>/codeSet/1028

MedicationRequest.dosageInstruction.route
  • Description
    • Route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
  • Details: SNOMED CT
    System: http://snomed.info/sct

  • Details: Millennium Routes
    System: https://fhir.cerner.com/<EHR source id>/codeSet/4001

Contained Medication Bindings

Medication.code
  • Description
    • A code that defines the medication
  • Details: RxNorm
    System: https://www.nlm.nih.gov/research/umls/rxnorm

Medication.form

Extensions

All URLs for Swedish extensions are defined as http://electronichealth.se/fhir/StructureDefinition/{id}

ID Value[x] Type Description
NLLPrescriptionFormat Coding Current prescription format
NLLRegistrationBasis Coding Format for prescription registration
NLLDosePackaging valueBoolean Dose dispensed prescription

Custom Extensions

Search for MedicationRequests that meet supplied query parameters:

GET /MedicationRequest?:parameters

Implementation Notes

We are currently always returning a value of “Order” in the intent field. We recommend using the reported field to determine if a medication is an authorization or a medication reported by a patient. In the future, we will support “Plan” and “Order” in accordance with the US Core Profile pending changes.

Authorization Types

Parameters

Name Required? Type Description
_id This, or patient token The logical resource id associated with the resource. Example: 12345
patient This, or _id reference The specific patient to return MedicationRequests for. Example: 12345
status N token The status of the medication, may be a list separated by commas. Example: active,completed
-timing-boundsPeriod N token The date-time which should fall within the dosageInstruction.timing.repeat.boundsPeriod the medication should be given to the patient. Must be prefixed by ge. Example: ge2014-05-19T20:54:02.000Z
_lastUpdated N date An explicit or implied date-time range within which the most recent clinically relevant update was made to the medication. Must include a time, and must be prefixed by ge or le. Example: ge2014-05-19T20:54:02.000Z
_count N number The maximum number of results to include in a page. Example: 50

Headers

Accept: application/fhir+json
Authorization: <OAuth2 Bearer Token>

Example

Request

GET https://fhir-open.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/MedicationRequest?patient=12742400

Response

Status: 200 OK
{
  "resourceType": "Bundle",
  "id": "b630105a-2ec0-4877-8f8c-3b26b53cacd9",
  "type": "searchset",
  "link": [
    {
      "relation": "self",
      "url": "https://fhir-open.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/MedicationRequest?patient=1316024"
    }
  ],
  "entry": [
    {
      "fullUrl": "https://fhir-open.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/MedicationRequest/313757847",
      "resource": {
        "resourceType": "MedicationRequest",
        "id": "313757847",
        "meta": {
          "versionId": "3",
          "lastUpdated": "2020-07-21T01:00:49.000Z"
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\\"http://www.w3.org/1999/xhtml\\"><p><b>Medication Request</b></p>\\\n          <p><b>Status</b>: Active</p>\\\n          <p><b>Intent</b>: Order</p>\\\n          <p><b>Medication</b>: lisinopril-hydroCHLOROthiazide\n          (lisinopril-hydroCHLOROthiazide 10 mg-12.5 mg oral tablet)</p>\\\n          <p><b>Dosage Instructions</b>: 1 tab, Oral, Daily</p>\\\n          <p><b>Patient</b>: PETERS, TIM A</p><p><b>Authored On</b>: Nov 21, 2020  8:59 P.M. UTC</p></div>"
        },
        "extension": [
          {
            "valueCoding": {
              "system": "http://electronichealth.se/fhir/ValueSet/prescription-format",
              "code": "ELECTRONIC",
              "display": "Electronic"
            },
            "url": "http://electronichealth.se/fhir/StructureDefinition/NLLPrescriptionFormat"
          },
          {
            "valueCoding": {
              "system": "http://ehalsomyndigheten.se/fhir/ValueSet/registration-basis-codes",
              "code": "ELECTRONIC",
              "display": "Electronic"
            },
            "url": "http://electronichealth.se/fhir/StructureDefinition/NLLRegistrationBasis"
          }
        ],
        "status": "active",
        "intent": "order",
        "category": [
          {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                "code": "inpatient",
                "display": "Inpatient",
                "userSelected": false
              }
            ]
          }
        ],
        "reportedBoolean": false,
        "medicationCodeableConcept": {
          "coding": [
            {
              "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
              "code": "830261",
              "display": "Hepatitis B Surface Antigen Vaccine 0.04 MG/ML Injectable Suspension",
              "userSelected": false
            },
            {
              "system": "https://fhir.cerner.com/ec2458f2-1e24-41c8-b71b-0e701af7583d/synonym",
              "code": "19953289",
              "display": "hepatitis B adult vaccine dialysis 40 mcg/mL intramuscular suspension",
              "userSelected": true
            }
          ],
          "text": "hepatitis B adult vaccine (hepatitis B adult vaccine dialysis 40 mcg/mL intramuscular suspension)"
        },
        "subject": {
          "reference": "Patient/12724066",
          "display": "SMART, NANCY"
        },
        "encounter": {
          "reference": "Encounter/97953477"
        },
        "authoredOn": "2020-07-06T15:37:13.000-05:00",
        "requester": {
          "reference": "Practitioner/2",
          "display": "CERNER, CERNER CERNER"
        },
        "courseOfTherapyType": {
          "coding": [
            {
              "system": "https://fhir.cerner.com/ec2458f2-1e24-41c8-b71b-0e701af7583d/codeSet/4009",
              "code": "2337",
              "display": "Physician Stop",
              "userSelected": true
            },
            {
              "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-course-of-therapy",
              "code": "acute",
              "display": "Short course (acute) therapy",
              "userSelected": false
            }
          ],
          "text": "Physician Stop"
        },
        "dosageInstruction": [
          {
            "extension": [
              {
                "valueString": "40 mcg = 1 mL, IM, Once, First Dose: 12/07/16 16:00:00 CST",
                "url": "https://fhir-ehr.cerner.com/r4/StructureDefinition/clinical-instruction"
              }
            ],
            "text": "40 mcg = 1 mL, IM, Once",
            "patientInstruction": "1 Milliliters Intramuscular (in a muscle) once. Refills: 0.",
            "timing": {
              "repeat": {
                "boundsPeriod": {
                  "start": "2020-07-06T16:00:00.000-05:00",
                  "end": "2020-07-06T16:00:00.000-05:00"
                }
              },
              "code": {
                "coding": [
                  {
                    "system": "https://fhir.cerner.com/ec2458f2-1e24-41c8-b71b-0e701af7583d/codeSet/4003",
                    "code": "696531",
                    "display": "Once",
                    "userSelected": true
                  }
                ],
                "text": "Once"
              }
            },
            "route": {
              "coding": [
                {
                  "system": "https://fhir.cerner.com/ec2458f2-1e24-41c8-b71b-0e701af7583d/codeSet/4001",
                  "code": "318167",
                  "display": "IM",
                  "userSelected": true
                },
                {
                  "system": "http://snomed.info/sct",
                  "code": "78421000",
                  "display": "Intramuscular route (qualifier value)",
                  "userSelected": false
                }
              ],
              "text": "IM"
            },
            "doseAndRate": [
              {
                "doseQuantity": {
                  "value": 1.0,
                  "unit": "mL",
                  "system": "http://unitsofmeasure.org",
                  "code": "mL"
                }
              }
            ]
          }
        ],
        "dispenseRequest": {
          "extension": [
            {
              "valueBoolean": false,
              "url": "http://electronichealth.se/fhir/StructureDefinition/NLLDosePackaging"
            }
          ],
          "validityPeriod": {
            "start": "2020-07-06T15:37:13.000-05:00"
          }
        }
      }
    }
  ]
}

Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.

Patient Authorization Request

GET https://fhir-ehr.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/MedicationRequest?patient=12742400

Response

Status: 200 OK
{
  "resourceType": "Bundle",
  "id": "40d441d8-d53c-4bd6-b20e-d0c1af3244a3",
  "type": "searchset",
  "link": [
    {
      "relation": "self",
      "url": "https://fhir-ehr.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/MedicationRequest?patient=12724065"
    },
    {
      "relation": "next",
      "url": "https://fhir-ehr.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/MedicationRequest?patient=12724065&-pageContext=T3BlblBsYXRmb3JtRmhpckNvbnRleHQ9dHJ1ZSZwYWdlQ29udGV4dD02MDY4MDUwXzYwNjgwNTFfMTI3MjQwNjVfMTI5MjMwOV8xJmNvbmNlcHQ9Y2hhcnRlZA%3D%3D&-pageDirection=NEXT"
    }
  ],
  "entry": [
    {
      "fullUrl": "https://fhir-ehr.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/MedicationRequest/314010287",
      "resource": {
        "resourceType": "MedicationRequest",
        "id": "314010287",
        "meta": {
          "versionId": "0",
          "lastUpdated": "2020-07-14T14:45:37.000Z"
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\\"http://www.w3.org/1999/xhtml\\"><p><b>Medication Request</b></p>\\\n        <p><b>Status</b>: Active</p><p><b>Intent</b>: Order</p>\\\n        <p><b>Medication</b>: acetaminophen (acetaminophen 325 mg oral capsule)</p>\\\n        <p><b>Dosage Instructions</b>: 650 mg = 2 cap, Oral, every 4 hr,\n         PRN: as needed for pain, 90 cap, 0 Refill(s)</p>\\\n        <p><b>Patient</b>: SMART, WILMA</p><p><b>Authored On</b>: Jul 14, 2020  2:45 P.M. UTC</p></div>"
        },
        "extension": [
          {
            "valueCoding": {
              "system": "http://electronichealth.se/fhir/ValueSet/prescription-format",
              "code": "ELECTRONIC",
              "display": "Electronic"
            },
            "url": "http://electronichealth.se/fhir/StructureDefinition/NLLPrescriptionFormat"
          },
          {
            "valueCoding": {
              "system": "http://ehalsomyndigheten.se/fhir/ValueSet/registration-basis-codes",
              "code": "ELECTRONIC",
              "display": "Electronic"
            },
            "url": "http://electronichealth.se/fhir/StructureDefinition/NLLRegistrationBasis"
          }
        ],
        "status": "active",
        "intent": "order",
        "category": [
          {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                "code": "community",
                "display": "Community",
                "userSelected": false
              }
            ]
          },
          {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                "code": "discharge",
                "display": "Discharge",
                "userSelected": false
              }
            ]
          }
        ],
        "reportedBoolean": false,
        "medicationCodeableConcept": {
          "coding": [
            {
              "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
              "code": "198436",
              "display": "Acetaminophen 325 MG Oral Capsule"
            },
            {
              "system": "https://fhir.cerner.com/ec2458f2-1e24-41c8-b71b-0e701af7583d/synonym",
              "code": "276230589",
              "display": "acetaminophen 325 mg oral capsule"
            }
          ],
          "text": "acetaminophen (acetaminophen 325 mg oral capsule)"
        },
        "subject": {
          "reference": "Patient/12724065",
          "display": "SMART, WILMA"
        },
        "encounter": {
          "reference": "Encounter/97953483"
        },
        "authoredOn": "2020-07-14T09:45:15.000-05:00",
        "requester": {
          "reference": "Practitioner/12732044",
          "display": "PWMedActionPlan, Physician - Primary Care"
        },
        "courseOfTherapyType": {
          "coding": [
            {
              "system": "https://fhir.cerner.com/ec2458f2-1e24-41c8-b71b-0e701af7583d/codeSet/4009",
              "code": "2338",
              "display": "Soft Stop"
            },
            {
              "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-course-of-therapy",
              "code": "continuous",
              "display": "Continuous long term therapy"
            }
          ],
          "text": "Maintenance"
        },
        "dosageInstruction": [
          {
            "text": "650 mg = 2 cap, Oral, every 4 hr, PRN: as needed for pain, 90 cap, 0 Refill(s)",
            "patientInstruction": "2 Capsules Oral (given by mouth) every 4 hours as needed as needed for pain.\n           Refills: 0.",
            "timing": {
              "repeat": {
                "boundsPeriod": {
                  "start": "2020-07-14T09:45:00.000-05:00"
                }
              },
              "code": {
                "coding": [
                  {
                    "system": "https://fhir.cerner.com/ec2458f2-1e24-41c8-b71b-0e701af7583d/codeSet/4003",
                    "code": "696547",
                    "display": "every 4 hr"
                  },
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-GTSAbbreviation",
                    "code": "Q4H",
                    "display": "Q4H"
                  },
                  {
                    "system": "http://snomed.info/sct",
                    "code": "225756002",
                    "display": "Every four hours (qualifier value)"
                  }
                ],
                "text": "every 4 hr"
              }
            },
            "asNeededCodeableConcept": {
              "text": "as needed for pain"
            },
            "route": {
              "coding": [
                {
                  "system": "https://fhir.cerner.com/ec2458f2-1e24-41c8-b71b-0e701af7583d/codeSet/4001",
                  "code": "318185",
                  "display": "Oral",
                  "userSelected": true
                },
                {
                  "system": "http://snomed.info/sct",
                  "code": "26643006",
                  "display": "Oral route (qualifier value)",
                  "userSelected": false
                }
              ],
              "text": "Oral"
            },
            "doseAndRate": [
              {
                "doseQuantity": {
                  "value": 2,
                  "unit": "cap",
                  "system": "http://unitsofmeasure.org",
                  "code": "{Capsule}"
                }
              }
            ]
          }
        ],
        "dispenseRequest": {
          "extension": [
            {
              "valueBoolean": false,
              "url": "http://electronichealth.se/fhir/StructureDefinition/NLLDosePackaging"
            }
          ],
          "validityPeriod": {
            "start": "2020-07-14T09:45:15.000-05:00"
          },
          "numberOfRepeatsAllowed": 0,
          "quantity": {
            "value": 90,
            "unit": "cap",
            "system": "http://unitsofmeasure.org",
            "code": "{Capsule}"
          }
        },
        "substitution": {
          "allowedBoolean": true
        }
      }
    }
  ]
}

Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.

Errors

The common errors and OperationOutcomes may be returned.

Retrieve by id

List an individual MedicationRequest by its id:

GET /MedicationRequest/:id

Implementation Notes

We are currently always returning a value of “Order” in the intent field. We recommend using the reported field to determine if a medication is an authorization or a medication reported by a patient. In the future, we will support “Plan” and “Order” in accordance with the US Core Profile pending changes.

Authorization Types

Headers

Accept: application/json+fhir
Authorization: <OAuth2 Bearer Token>

Example

Request

GET https://fhir-open.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/MedicationRequest/56770371

Response

Status: 200 OK
{
  "fullUrl": "https://fhir-open.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/MedicationRequest/313757847",
  "resource": {
    "resourceType": "MedicationRequest",
    "id": "313757847",
    "meta": {
      "versionId": "3",
      "lastUpdated": "2020-07-21T01:00:49.000Z"
    },
    "text": {
      "status": "generated",
      "div": "<div xmlns=\\"http://www.w3.org/1999/xhtml\\"><p><b>Medication Request</b></p>\\\n          <p><b>Status</b>: Active</p>\\\n          <p><b>Intent</b>: Order</p>\\\n          <p><b>Medication</b>: lisinopril-hydroCHLOROthiazide\n          (lisinopril-hydroCHLOROthiazide 10 mg-12.5 mg oral tablet)</p>\\\n          <p><b>Dosage Instructions</b>: 1 tab, Oral, Daily</p>\\\n          <p><b>Patient</b>: PETERS, TIM A</p><p><b>Authored On</b>: Nov 21, 2020  8:59 P.M. UTC</p></div>"
    },
    "extension": [
      {
        "valueCoding": {
          "system": "http://electronichealth.se/fhir/ValueSet/prescription-format",
          "code": "ELECTRONIC",
          "display": "Electronic"
        },
        "url": "http://electronichealth.se/fhir/StructureDefinition/NLLPrescriptionFormat"
      },
      {
        "valueCoding": {
          "system": "http://ehalsomyndigheten.se/fhir/ValueSet/registration-basis-codes",
          "code": "ELECTRONIC",
          "display": "Electronic"
        },
        "url": "http://electronichealth.se/fhir/StructureDefinition/NLLRegistrationBasis"
      }
    ],
    "status": "active",
    "intent": "order",
    "category": [
      {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
            "code": "inpatient",
            "display": "Inpatient",
            "userSelected": false
          }
        ]
      }
    ],
    "reportedBoolean": false,
    "medicationCodeableConcept": {
      "coding": [
        {
          "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
          "code": "830261",
          "display": "Hepatitis B Surface Antigen Vaccine 0.04 MG/ML Injectable Suspension",
          "userSelected": false
        },
        {
          "system": "https://fhir.cerner.com/ec2458f2-1e24-41c8-b71b-0e701af7583d/synonym",
          "code": "19953289",
          "display": "hepatitis B adult vaccine dialysis 40 mcg/mL intramuscular suspension",
          "userSelected": true
        }
      ],
      "text": "hepatitis B adult vaccine (hepatitis B adult vaccine dialysis 40 mcg/mL intramuscular suspension)"
    },
    "subject": {
      "reference": "Patient/12724066",
      "display": "SMART, NANCY"
    },
    "encounter": {
      "reference": "Encounter/97953477"
    },
    "authoredOn": "2020-07-06T15:37:13.000-05:00",
    "requester": {
      "reference": "Practitioner/2",
      "display": "CERNER, CERNER CERNER"
    },
    "courseOfTherapyType": {
      "coding": [
        {
          "system": "https://fhir.cerner.com/ec2458f2-1e24-41c8-b71b-0e701af7583d/codeSet/4009",
          "code": "2337",
          "display": "Physician Stop",
          "userSelected": true
        },
        {
          "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-course-of-therapy",
          "code": "acute",
          "display": "Short course (acute) therapy",
          "userSelected": false
        }
      ],
      "text": "Physician Stop"
    },
    "dosageInstruction": [
      {
        "extension": [
          {
            "valueString": "40 mcg = 1 mL, IM, Once, First Dose: 12/07/16 16:00:00 CST",
            "url": "https://fhir-ehr.cerner.com/r4/StructureDefinition/clinical-instruction"
          }
        ],
        "text": "40 mcg = 1 mL, IM, Once",
        "patientInstruction": "1 Milliliters Intramuscular (in a muscle) once. Refills: 0.",
        "timing": {
          "repeat": {
            "boundsPeriod": {
              "start": "2020-07-06T16:00:00.000-05:00",
              "end": "2020-07-06T16:00:00.000-05:00"
            }
          },
          "code": {
            "coding": [
              {
                "system": "https://fhir.cerner.com/ec2458f2-1e24-41c8-b71b-0e701af7583d/codeSet/4003",
                "code": "696531",
                "display": "Once",
                "userSelected": true
              }
            ],
            "text": "Once"
          }
        },
        "route": {
          "coding": [
            {
              "system": "https://fhir.cerner.com/ec2458f2-1e24-41c8-b71b-0e701af7583d/codeSet/4001",
              "code": "318167",
              "display": "IM",
              "userSelected": true
            },
            {
              "system": "http://snomed.info/sct",
              "code": "78421000",
              "display": "Intramuscular route (qualifier value)",
              "userSelected": false
            }
          ],
          "text": "IM"
        },
        "doseAndRate": [
          {
            "doseQuantity": {
              "value": 1.0,
              "unit": "mL",
              "system": "http://unitsofmeasure.org",
              "code": "mL"
            }
          }
        ]
      }
    ],
    "dispenseRequest": {
      "extension": [
        {
          "valueBoolean": false,
          "url": "http://electronichealth.se/fhir/StructureDefinition/NLLDosePackaging"
        }
      ],
      "validityPeriod": {
        "start": "2020-07-06T15:37:13.000-05:00"
      }
    }
  }
}

Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.

Patient Authorization Request For Active Status

GET https://fhir-ehr.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/MedicationRequest/314010287

Response

Status: 200 OK
{
  "resourceType": "MedicationRequest",
  "id": "314010287",
  "meta": {
    "versionId": "0",
    "lastUpdated": "2020-07-14T14:45:37.000Z"
  },
  "text": {
    "status": "generated",
    "div": "<div xmlns=\\"http://www.w3.org/1999/xhtml\\"><p><b>Medication Request</b></p>\\\n        <p><b>Status</b>: Active</p><p><b>Intent</b>: Order</p>\\\n        <p><b>Medication</b>: acetaminophen (acetaminophen 325 mg oral capsule)</p>\\\n        <p><b>Dosage Instructions</b>: 650 mg = 2 cap, Oral, every 4 hr,\n         PRN: as needed for pain, 90 cap, 0 Refill(s)</p>\\\n        <p><b>Patient</b>: SMART, WILMA</p><p><b>Authored On</b>: Jul 14, 2020  2:45 P.M. UTC</p></div>"
  },
  "extension": [
    {
      "valueCoding": {
        "system": "http://electronichealth.se/fhir/ValueSet/prescription-format",
        "code": "ELECTRONIC",
        "display": "Electronic"
      },
      "url": "http://electronichealth.se/fhir/StructureDefinition/NLLPrescriptionFormat"
    },
    {
      "valueCoding": {
        "system": "http://ehalsomyndigheten.se/fhir/ValueSet/registration-basis-codes",
        "code": "ELECTRONIC",
        "display": "Electronic"
      },
      "url": "http://electronichealth.se/fhir/StructureDefinition/NLLRegistrationBasis"
    }
  ],
  "status": "active",
  "intent": "order",
  "category": [
    {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
          "code": "community",
          "display": "Community",
          "userSelected": false
        }
      ]
    },
    {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
          "code": "discharge",
          "display": "Discharge",
          "userSelected": false
        }
      ]
    }
  ],
  "reportedBoolean": false,
  "medicationCodeableConcept": {
    "coding": [
      {
        "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
        "code": "198436",
        "display": "Acetaminophen 325 MG Oral Capsule"
      },
      {
        "system": "https://fhir.cerner.com/ec2458f2-1e24-41c8-b71b-0e701af7583d/synonym",
        "code": "276230589",
        "display": "acetaminophen 325 mg oral capsule"
      }
    ],
    "text": "acetaminophen (acetaminophen 325 mg oral capsule)"
  },
  "subject": {
    "reference": "Patient/12724065",
    "display": "SMART, WILMA"
  },
  "encounter": {
    "reference": "Encounter/97953483"
  },
  "authoredOn": "2020-07-14T09:45:15.000-05:00",
  "requester": {
    "reference": "Practitioner/12732044",
    "display": "PWMedActionPlan, Physician - Primary Care"
  },
  "courseOfTherapyType": {
    "coding": [
      {
        "system": "https://fhir.cerner.com/ec2458f2-1e24-41c8-b71b-0e701af7583d/codeSet/4009",
        "code": "2338",
        "display": "Soft Stop"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-course-of-therapy",
        "code": "continuous",
        "display": "Continuous long term therapy"
      }
    ],
    "text": "Maintenance"
  },
  "dosageInstruction": [
    {
      "text": "650 mg = 2 cap, Oral, every 4 hr, PRN: as needed for pain, 90 cap, 0 Refill(s)",
      "patientInstruction": "2 Capsules Oral (given by mouth) every 4 hours as needed as needed for pain.\n           Refills: 0.",
      "timing": {
        "repeat": {
          "boundsPeriod": {
            "start": "2020-07-14T09:45:00.000-05:00"
          }
        },
        "code": {
          "coding": [
            {
              "system": "https://fhir.cerner.com/ec2458f2-1e24-41c8-b71b-0e701af7583d/codeSet/4003",
              "code": "696547",
              "display": "every 4 hr"
            },
            {
              "system": "http://terminology.hl7.org/CodeSystem/v3-GTSAbbreviation",
              "code": "Q4H",
              "display": "Q4H"
            },
            {
              "system": "http://snomed.info/sct",
              "code": "225756002",
              "display": "Every four hours (qualifier value)"
            }
          ],
          "text": "every 4 hr"
        }
      },
      "asNeededCodeableConcept": {
        "text": "as needed for pain"
      },
      "route": {
        "coding": [
          {
            "system": "https://fhir.cerner.com/ec2458f2-1e24-41c8-b71b-0e701af7583d/codeSet/4001",
            "code": "318185",
            "display": "Oral",
            "userSelected": true
          },
          {
            "system": "http://snomed.info/sct",
            "code": "26643006",
            "display": "Oral route (qualifier value)",
            "userSelected": false
          }
        ],
        "text": "Oral"
      },
      "doseAndRate": [
        {
          "doseQuantity": {
            "value": 2,
            "unit": "cap",
            "system": "http://unitsofmeasure.org",
            "code": "{Capsule}"
          }
        }
      ]
    }
  ],
  "dispenseRequest": {
    "extension": [
      {
        "valueBoolean": false,
        "url": "http://electronichealth.se/fhir/StructureDefinition/NLLDosePackaging"
      }
    ],
    "validityPeriod": {
      "start": "2020-07-14T09:45:15.000-05:00"
    },
    "numberOfRepeatsAllowed": 0,
    "quantity": {
      "value": 90,
      "unit": "cap",
      "system": "http://unitsofmeasure.org",
      "code": "{Capsule}"
    }
  },
  "substitution": {
    "allowedBoolean": true
  }
}

Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.

Patient Authorization Request For Entered in Error Status

GET https://fhir-ehr.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/MedicationRequest/261542609

Response

Status: 200 OK
{
  "resourceType": "MedicationRequest",
  "id": "261542609",
  "meta": {
    "versionId": "4",
    "lastUpdated": "2020-12-09T05:29:49.000Z"
  },
  "text": {
    "status": "generated",
    "div": "<div xmlns=\\"http://www.w3.org/1999/xhtml\\"><p><b>Medication Request</b></p>\\\n        <p><b>Status</b>: Entered in Error</p><p><b>Intent</b>: Order</p>/\n        <p><b>Medication</b>: Error</p><p><b>Patient</b>: MARSTON, JACK</p></div>"
  },
  "extension": [
    {
      "valueCoding": {
        "system": "http://electronichealth.se/fhir/ValueSet/prescription-format",
        "code": "ELECTRONIC",
        "display": "Electronic"
      },
      "url": "http://electronichealth.se/fhir/StructureDefinition/NLLPrescriptionFormat"
    },
    {
      "valueCoding": {
        "system": "http://ehalsomyndigheten.se/fhir/ValueSet/registration-basis-codes",
        "code": "ELECTRONIC",
        "display": "Electronic"
      },
      "url": "http://electronichealth.se/fhir/StructureDefinition/NLLRegistrationBasis"
    }
  ],
  "status": "entered-in-error",
  "intent": "order",
  "medicationCodeableConcept": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/data-absent-reason",
        "code": "error",
        "display": "Error"
      }
    ],
    "text": "Error"
  },
  "subject": {
    "reference": "Patient/166045489",
    "display": "MARSTON, JACK"
  }
}

Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.

Errors

The common errors and OperationOutcomes may be returned.

Create

Create an individual MedicationRequest.

POST /MedicationRequest

Authorization Types

Headers

Authorization: <OAuth2 Bearer Token>
Content-Type: application/fhir+json

Body Fields

Name Required Type
resourceType Yes string
  • Description
    • The type of the FHIR resource.
  • Example
    • {
        "resourceType": "MedicationRequest"
      }
      
  • Notes
    • resourceType must be MedicationRequest
status Yes code
  • Description
    • The current state of the medication request.
  • Example
    • {
        "status": "active"
      }
      
  • Notes
    • When creating a new MedicationRequest, the status must be active
intent Yes code
  • Description
    • Whether the request is a proposal, plan, or an original order.
  • Example
    • {
        "intent": "order"
      }
      
  • Notes
      • When creating a MedicationRequest, the intent must be order or plan.
      • When read back, the created MedicationRequest will always have an intent of order. The reported field can be used to determine if a medication is an authorization or a medication reported by a patient. In the future, MedicationRequests with intents of order and plan will be supported in accordance with pending changes to the US Core Profile.
doNotPerform No boolean
  • Description
    • Indicates whether or not the provider is asking for the medication request not to occur.
  • Example
    • {
        "doNotPerform": false
      }
      
  • Notes
    • If provided, must be set to false.
reported[x] Yes boolean
  • Description
    • Indicates if this record was captured as a secondary 'reported' record rather than as an original primary source-of-truth record.
  • Example
    • {
        "reportedBoolean": true
      }
      
  • Notes
    • Must be of type boolean and must be set to true.
medication[x] Yes CodeableConcept
  • Description
    • A code that defines the medication
  • Example
    • {
        "medicationCodeableConcept": {
          "coding": [
            {
              "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
              "code": "352362"
            }
          ],
          "text": "Acetaminophen"
        }
      }
      
  • Notes
    • Must be of type CodeableConcept. text and/or one coding with a system and code must be provided.
subject Yes Reference (Patient|Group)
  • Description
    • A link to a resource representing the person or set of individuals to whom the medication will be given.
  • Example
    • {
        "subject": {
          "reference": "Patient/12742400"
        }
      }
      
  • Notes
encounter No Reference (Encounter)
  • Description
    • The Encounter this medication request was created or to which the creation of this record is tightly associated.
  • Example
    • {
        "encounter": {
          "reference": "Encounter/1621910"
        }
      }
      
note No Annotation
  • Description
    • Information about the medication request.
  • Example
    • {
        "note": [
          {
            "authorString": "Leslie Knope",
            "time": "2020-03-03T20:07:53Z",
            "text": "Patient has had medication in past."
          }
        ]
      }
      
dosageInstruction No Dosage
  • Description
    • Indicates how the medication is to be used by the patient.
  • Notes
    • Can only be provided once.
dosageInstruction.text No string
  • Description
    • The free text dosage instructions.
  • Example
    • {
        "dosageInstruction": [
          {
            "text": "5 mL, Oral, Daily."
          }
        ]
      }
      
dosageInstruction.additionalInstruction No string
  • Description
    • The supplemental instruction or warnings to the patient.
  • Example
    • {
        "dosageInstruction": [
          {
            "additionalInstruction": [
              {
                "text": "Take with food."
              }
            ]
          }
        ]
      }
      
  • Notes
    • If provided, can only be provided once. text is only supported.
dosageInstruction.timing No Timing
  • Description
    • When the medication should be administered.
dosageInstruction.timing.repeat No Element
  • Description
    • When the event is to occur.
dosageInstruction.timing.repeat.bounds[x] No Period
  • Description
    • The outer bounds for start and/or end limits of the timing schedule.
  • Example
    • {
        "dosageInstruction": [
          {
            "timing": {
              "repeat": {
                "boundsPeriod": {
                  "start": "2020-03-03T20:07:53Z",
                  "end": "2021-03-03T20:07:53Z"
                }
              }
            }
          }
        ]
      }
      
  • Notes
    • If provided, must be of type Period. If an end is given a start must be provided.
dosageInstruction.timing.repeat.count No positiveInt
  • Description
    • The number of times to repeat.
  • Example
    • {
        "dosageInstruction": [
          {
            "timing": {
              "repeat": {
                "count": 1
              }
            }
          }
        ]
      }
      
dosageInstruction.timing.repeat.duration No decimal
  • Description
    • How long when it happens.
  • Example
    • {
        "dosageInstruction": [
          {
            "timing": {
              "repeat": {
                "duration": 1,
                "durationUnit": "d"
              }
            }
          }
        ]
      }
      
  • Notes
    • If provided, durationUnit must be provided.
dosageInstruction.timing.repeat.durationUnit No code
  • Description
    • The units of time for the duration.
  • Example
    • {
        "dosageInstruction": [
          {
            "timing": {
              "repeat": {
                "duration": 5,
                "durationUnit": "h"
              }
            }
          }
        ]
      }
      
  • Notes
    • If provided, duration must be provided.
dosageInstruction.timing.code No CodeableConcept
  • Description
    • Code for a known/defined timing pattern
  • Example
    • {
        "dosageInstruction": [
          {
            "timing": {
              "code": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-GTSAbbreviation",
                    "code": "BID"
                  }
                ]
              }
            }
          }
        ]
      }
      
  • Notes
      • If provided, only the coding field is supported.
      • When the coding field is provided, system and code must be provided together.
dosageInstruction.asNeeded[x] No boolean | CodeableConcept
  • Description
    • Indicates whether the Medication is only taken when needed or the preconditions for taking the medication.
  • Example
    • {
        "dosageInstruction": [
          {
            "asNeededBoolean": true
          }
        ]
      }
      
  • Example
    • {
        "dosageInstruction": [
          {
            "asNeededCodeableConcept": {
              "coding": [
                {
                  "system": "http://snomed.info/sct",
                  "code": "25064002"
                }
              ],
              "text": "For headaches"
            }
          }
        ]
      }
      
  • Notes
    • When providing the asNeededCodeableConcept field, and the coding field is provided, system and code must be provided together.
dosageInstruction.site No CodeableConcept
  • Description
    • The anatomic site where the medication first enters the body.
  • Example
    • {
        "dosageInstruction": [
          {
            "site": {
              "coding": [
                {
                  "system": "http://snomed.info/sct",
                  "code": "368208006"
                }
              ]
            }
          }
        ]
      }
      
  • Notes
      • If provided, only the coding field is supported.
      • When the coding field is provided, system and code must be provided together.
dosageInstruction.route No CodeableConcept
  • Description
    • Route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
  • Example
    • {
        "dosageInstruction": [
          {
            "route": {
              "coding": [
                {
                  "system": "http://snomed.info/sct",
                  "code": "41974700"
                }
              ]
            }
          }
        ]
      }
      
  • Notes
      • If provided, only the coding field is supported.
      • When the coding field is provided, system and code must be provided together.
dosageInstruction.doseAndRate No Element
  • Description
    • How drug should enter body.
  • Notes
    • Can only be provided once.
dosageInstruction.doseAndRate.dose[x] No SimpleQuantity
  • Description
    • Amount of medication per dose.
  • Example
    • {
        "dosageInstruction": [
          {
            "doseAndRate": [
              {
                "doseQuantity": {
                  "value": 5,
                  "unit": "tabs",
                  "system": "http://unitsofmeasure.org",
                  "code": "tbl"
                }
              }
            ]
          }
        ]
      }
      
  • Notes
    • Must be of type SimpleQuantity. Must contain the system and code fields if either are provided.
dispenseRequest No BackboneElement
  • Description
    • Medication supply authorization.
dispenseRequest.numberOfRepeatsAllowed No unsignedInt
  • Description
    • Number of refills authorized.
  • Example
    • {
        "dispenseRequest": {
          "numberOfRepeatsAllowed": 5
        }
      }
      
dispenseRequest.quantity No SimpleQuantity
  • Description
    • Amount of medication to supply per dispense.
  • Example
    • {
        "dispenseRequest": {
          "quantity": {
            "value": 12,
            "system": "http://unitsofmeasure.org",
            "code": "tbl"
          }
        }
      }
      
  • Notes
      • Must contain the system and code fields if either are provided.
      • The unit field is not supported.
substitution No BackboneElement
  • Description
    • Any restrictions on medication substitution.
substitution.allowed[x] No boolean
  • Description
    • Whether substitution is allowed or not.
  • Example
    • {
        "substitution": {
          "allowedBoolean": true
        }
      }
      
  • Notes

Example

Request

POST https://fhir-ehr-code.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/MedicationRequest

Body

{
  "resourceType": "MedicationRequest",
  "status": "active",
  "intent": "order",
  "doNotPerform": false,
  "reportedBoolean": true,
  "medicationCodeableConcept": {
    "coding": [
      {
        "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
        "code": "352362"
      }
    ],
    "text": "Acetaminophen"
  },
  "subject": {
    "reference": "Patient/12742400"
  },
  "encounter": {
    "reference": "Encounter/97953530"
  },
  "note": [
    {
      "authorString": "Leslie Knope",
      "time": "2020-03-03T20:07:53Z",
      "text": "Patient has had medication in past."
    }
  ],
  "dosageInstruction": [
    {
      "text": "5 mL, Oral, Daily.",
      "additionalInstruction": [
        {
          "text": "Take with food."
        }
      ],
      "timing": {
        "repeat": {
          "boundsPeriod": {
            "start": "2020-02-25T23:19:10Z",
            "end": "2021-02-27T23:19:10Z"
          },
          "count": 1,
          "duration": 1.0,
          "durationUnit": "d"
        },
        "code": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/v3-GTSAbbreviation",
              "code": "BID"
            }
          ]
        }
      },
      "asNeededBoolean": true,
      "site": {
        "coding": [
          {
            "system": "http://snomed.info/sct",
            "code": "368208006"
          }
        ]
      },
      "route": {
        "coding": [
          {
            "system": "http://snomed.info/sct",
            "code": "41974700"
          }
        ]
      },
      "doseAndRate": [
        {
          "doseQuantity": {
            "value": 23.0,
            "unit": "tabs",
            "system": "http://unitsofmeasure.org",
            "code": "tbl"
          }
        }
      ]
    }
  ],
  "dispenseRequest": {
    "numberOfRepeatsAllowed": 5,
    "quantity": {
      "value": 10.0,
      "system": "http://unitsofmeasure.org",
      "code": "tbl"
    }
  },
  "substitution": {
    "allowedBoolean": true
  }
}

Response

Status: 201 Created
Cache-Control: no-cache
Content-Length: 0
Content-Type: application/fhir+json
Date: Wed, 27 Mar 2019 15:59:33 GMT
Etag: W/"0"
Last-Modified: Wed, 27 Mar 2019 15:59:30 GMT
Location: https://fhir-ehr-code.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/MedicationRequest/4595905
Vary: Origin
X-Request-Id: 1638e30e497b93ff4383b2ff0eaeea68

Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.

Errors

The common errors and OperationOutcomes may be returned.

Patch

Patch an existing medication request.

PATCH /MedicationRequest/:id

Implementation Notes

Authorization Types

Headers

Authorization: <OAuth2 Bearer Token>
Accept: application/fhir+json
Content-Type: application/json-patch+json
If-Match: W/"<Current version of the MedicationRequest resource>"

Patch Operations

Path Operation Value Type
/status replace code
  • Description
    • The status of the MedicationRequest
  • Example
    • {
        "op": "replace",
        "path": "/status",
        "value":  "stopped"
      }
      
  • Notes
      • Only the statuses of stopped and cancelled are supported.
        • The stopped status indicates the medication was stopped prior to all scheduled administrations occurring.
        • The cancelled status indicates that the first instance was never administered.
      • The dosageInstruction.timing.repeat.boundsPeriod.start field should be used to determine if the stopped or cancelled status is most appropriate. If the field is in the past, then the stopped status should be used, otherwise the cancelled status should be used.
      • Using stopped when the cancelled status is most appropriate will result in the status being updated to cancelled.
      • Using cancelled when the stopped status is most appropriate will result in the status being updated to stopped.

Example

Request

PATCH https://fhir-ehr.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/MedicationRequest/1621910

Body

[
  {
    "op": "replace",
    "path": "/status",
    "value": "stopped"
  }
]

Response

Status: 200 OK
Cache-Control: no-cache
Content-Length: 0
Content-Type: text/html
Date: Tue, 26 Mar 2019 15:42:29 GMT
Etag: W/"10"
Last-Modified: Tue, 26 Mar 2019 15:42:27 GMT
Vary: Origin
X-Request-Id: 47306a14c8a2c3afd4ab85aa9594101d

The ETag response header indicates the current If-Match version to use on subsequent updates.

Errors

The common errors and OperationOutcomes may be returned.