FHIR Osiris Implementation Guide
2.1.0 - ci-build

FHIR Osiris Implementation Guide - Local Development build (v2.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: ImagingInjection - Detailed Descriptions

Draft as of 2024-03-21

Definitions for the onco-imagingstudy-injection resource profile.

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

0. MedicationAdministration
2. MedicationAdministration.medication[x]
TypeReference(Imaging Study Injection Contrast), CodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
4. MedicationAdministration.effective[x]
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
SlicingThis element introduces a set of slices on MedicationAdministration.effective[x]. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • type @ $this
  • 6. MedicationAdministration.effective[x]:effectiveDateTime
    Slice NameeffectiveDateTime
    Definition

    Actual injection time for radiopharmaceutical. Actual time of administration of the radiopharmaceutical to the patient for imaging purposes. Dicom Tag (0018,1072). This variable is mandatory only if the series is PT.

    ShortActual injection time for radiopharmaceutical
    Control0..1
    TypedateTime
    [x] NoteSee Choice of Data Types for further information about how to use [x]
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    8. MedicationAdministration.effective[x]:effectivePeriod
    Slice NameeffectivePeriod
    Control0..1
    TypePeriod
    [x] NoteSee Choice of Data Types for further information about how to use [x]
    10. MedicationAdministration.effective[x]:effectivePeriod.start
    Definition

    Start of the injection for contrast agents. Dicom Tag (0018,1042)

    ShortStart of the injection for contrast agents
    12. MedicationAdministration.effective[x]:effectivePeriod.end
    Definition

    End of the injection for contrast agents. Dicom Tag (0018,1043)

    ShortEnd of the injection for contrast agents
    14. MedicationAdministration.dosage
    Definition

    This variable is mandatory only if the series is PT.

    Must Supporttrue
    16. MedicationAdministration.dosage.route
    ShortAdministration route of contrast agent.
    18. MedicationAdministration.dosage.route.coding
    20. MedicationAdministration.dosage.route.coding.code
    Pattern Value47625008
    22. MedicationAdministration.dosage.route.coding.display
    Pattern ValueIntravenous use
    24. MedicationAdministration.dosage.dose
    Definition

    Radiopharmaceutical dose administered to the patient, measured in megabecquerels (Mbq) at the time the radiopharmaceutical treatment was started. Dicom Tag (0018,1074)

    ShortRadiopharmaceutical dose
    Must Supporttrue

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

    0. MedicationAdministration
    Definition

    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.

    ShortAdministration of medication to a patient
    Control0..*
    Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.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 or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
    dom-6: A resource should have narrative for robust management (text.`div`.exists())
    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
    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. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

    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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

    Control0..1
    This element is affected by the following invariants: ele-1
    Typeuri
    Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    4. 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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer 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.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

    ShortExtensions that cannot be ignored
    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..*
    This element is affected by the following invariants: ele-1
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
    Standards StatusNormative (from Trial Use)
    Requirements

    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

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

      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.

      Shortin-progress | not-done | 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
      This element is affected by the following invariants: ele-1
      BindingThe codes SHALL be taken from MedicationAdministration Status Codeshttp://hl7.org/fhir/ValueSet/medication-admin-status|4.0.1
      (required to http://hl7.org/fhir/ValueSet/medication-admin-status|4.0.1)

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

      Typecode
      Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      8. 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
      This element is affected by the following invariants: ele-1
      TypeReference(Imaging Study Injection Contrast, Medication), CodeableConcept
      [x] NoteSee Choice of Data Types for further information about how to use [x]
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      10. MedicationAdministration.subject
      Definition

      The person or animal or group receiving the medication.

      ShortWho received medication
      Comments

      References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

      Control1..1
      This element is affected by the following invariants: ele-1
      TypeReference(Patient, Group)
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))
      12. MedicationAdministration.effective[x]
      Definition

      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.

      ShortStart and end time of administration
      Control1..1
      This element is affected by the following invariants: ele-1
      TypeChoice of: dateTime, Period
      [x] NoteSee Choice of Data Types for further information about how to use [x]
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Must Support TypesNo must-support rules about the choice of types/profiles
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      SlicingThis element introduces a set of slices on MedicationAdministration.effective[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
      • type @ $this
      • 14. MedicationAdministration.effective[x]:effectiveDateTime
        Slice NameeffectiveDateTime
        Definition

        Actual injection time for radiopharmaceutical. Actual time of administration of the radiopharmaceutical to the patient for imaging purposes. Dicom Tag (0018,1072). This variable is mandatory only if the series is PT.


        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.

        ShortActual injection time for radiopharmaceuticalStart and end time of administration
        Control01..1
        This element is affected by the following invariants: ele-1
        TypedateTime, Period
        [x] NoteSee Choice of Data Types for further information about how to use [x]
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        16. MedicationAdministration.effective[x]:effectivePeriod
        Slice NameeffectivePeriod
        Definition

        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.

        ShortStart and end time of administration
        Control01..1
        This element is affected by the following invariants: ele-1
        TypePeriod, dateTime
        [x] NoteSee Choice of Data Types for further information about how to use [x]
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        18. MedicationAdministration.effective[x]:effectivePeriod.start
        Definition

        Start of the injection for contrast agents. Dicom Tag (0018,1042)


        The start of the period. The boundary is inclusive.

        ShortStart of the injection for contrast agentsStarting time with inclusive boundary
        Comments

        If the low element is missing, the meaning is that the low boundary is not known.

        Control0..1
        This element is affected by the following invariants: ele-1, per-1
        TypedateTime
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        20. MedicationAdministration.effective[x]:effectivePeriod.end
        Definition

        End of the injection for contrast agents. Dicom Tag (0018,1043)


        The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

        ShortEnd of the injection for contrast agentsEnd time with inclusive boundary, if not ongoing
        Comments

        The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.

        Control0..1
        This element is affected by the following invariants: ele-1, per-1
        TypedateTime
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        22. MedicationAdministration.dosage
        Definition

        This variable is mandatory only if the series is PT.


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

        ShortDetails of how medication was taken
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeBackboneElement
        Must Supporttrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        mad-1: SHALL have at least one of dosage.dose or dosage.rate[x] (dose.exists() or rate.exists())
        24. 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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

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

        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

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

        A code specifying the route or physiological path of administration of a therapeutic agent into or onto the patient. For example, topical, intravenous, etc.

        ShortAdministration route of contrast agent.Path of substance into body
        Comments

        Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

        Control0..1
        This element is affected by the following invariants: ele-1
        BindingFor example codes, see SNOMEDCTRouteCodeshttp://hl7.org/fhir/ValueSet/route-codes
        (example to http://hl7.org/fhir/ValueSet/route-codes)

        A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

        TypeCodeableConcept
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        28. MedicationAdministration.dosage.dose
        Definition

        Radiopharmaceutical dose administered to the patient, measured in megabecquerels (Mbq) at the time the radiopharmaceutical treatment was started. Dicom Tag (0018,1074)


        The amount of the medication given at one administration event. Use this value when the administration is essentially an instantaneous event such as a swallowing a tablet or giving an injection.

        ShortRadiopharmaceutical doseAmount of medication per dose
        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.

        Control0..1
        This element is affected by the following invariants: ele-1
        TypeQuantity(SimpleQuantity)
        Is Modifierfalse
        Must Supporttrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        qty-3: If a code for the unit is present, the system SHALL also be present (code.empty() or system.exists())
        sqty-1: The comparator is not used on a SimpleQuantity (comparator.empty())

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

        0. MedicationAdministration
        Definition

        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.

        ShortAdministration of medication to a patient
        Control0..*
        Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.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 or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
        dom-6: A resource should have narrative for robust management (text.`div`.exists())
        dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
        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
        Summarytrue
        4. MedicationAdministration.meta
        Definition

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

        ShortMetadata about the resource
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeMeta
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        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. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

        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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

        Control0..1
        This element is affected by the following invariants: ele-1
        Typeuri
        Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        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
        This element is affected by the following invariants: ele-1
        BindingThe codes SHOULD be taken from CommonLanguages
        (preferred to http://hl7.org/fhir/ValueSet/languages)

        A human language.

        Additional BindingsPurpose
        AllLanguagesMax Binding
        Typecode
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        10. MedicationAdministration.text
        Definition

        A human-readable narrative that contains a summary of the resource and can 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 information is added later.

        Control0..1
        This element is affected by the following invariants: ele-1
        TypeNarrative
        Alternate Namesnarrative, html, xhtml, display
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

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

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

        ShortAdditional content defined by implementations
        Comments

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

        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension
        Standards StatusNormative (from Trial Use)
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        SlicingThis element introduces a set of slices on MedicationAdministration.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 16. 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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer 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.

          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

          ShortExtensions that cannot be ignored
          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..*
          This element is affected by the following invariants: ele-1
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
          Standards StatusNormative (from Trial Use)
          Requirements

          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

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

            Identifiers associated with this Medication Administration that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server.

            ShortExternal identifier
            Comments

            This is a business identifier, not a resource identifier.

            NoteThis is a business identifier, not a resource identifier (see discussion)
            Control0..*
            This element is affected by the following invariants: ele-1
            TypeIdentifier
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            20. MedicationAdministration.instantiates
            Definition

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

            ShortInstantiates protocol or definition
            Comments

            see http://en.wikipedia.org/wiki/Uniform_resource_identifier

            Control0..*
            This element is affected by the following invariants: ele-1
            Typeuri
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            22. MedicationAdministration.partOf
            Definition

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

            ShortPart of referenced event
            Comments

            References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

            Control0..*
            This element is affected by the following invariants: ele-1
            TypeReference(MedicationAdministration, Procedure)
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))
            24. MedicationAdministration.status
            Definition

            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.

            Shortin-progress | not-done | 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
            This element is affected by the following invariants: ele-1
            BindingThe codes SHALL be taken from MedicationAdministration Status Codes
            (required to http://hl7.org/fhir/ValueSet/medication-admin-status|4.0.1)

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

            Typecode
            Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            26. MedicationAdministration.statusReason
            Definition

            A code indicating why the administration was not performed.

            ShortReason administration not performed
            Comments

            Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

            Control0..*
            This element is affected by the following invariants: ele-1
            BindingFor example codes, see SNOMEDCTReasonMedicationNotGivenCodes
            (example to http://hl7.org/fhir/ValueSet/reason-medication-not-given-codes)

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

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

            Indicates where the medication is expected to be consumed or administered.

            ShortType of medication usage
            Comments

            Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

            Control0..1
            This element is affected by the following invariants: ele-1
            BindingThe codes SHOULD be taken from MedicationAdministration Category Codes
            (preferred to http://hl7.org/fhir/ValueSet/medication-admin-category)

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

            TypeCodeableConcept
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            30. 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
            This element is affected by the following invariants: ele-1
            TypeReference(Imaging Study Injection Contrast)
            [x] NoteSee Choice of Data Types for further information about how to use [x]
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            32. MedicationAdministration.subject
            Definition

            The person or animal or group receiving the medication.

            ShortWho received medication
            Comments

            References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

            Control1..1
            This element is affected by the following invariants: ele-1
            TypeReference(Patient, Group)
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))
            34. MedicationAdministration.context
            Definition

            The visit, admission, or other contact between patient and health care provider during which the medication administration was performed.

            ShortEncounter or Episode of Care administered as part of
            Comments

            References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

            Control0..1
            This element is affected by the following invariants: ele-1
            TypeReference(Encounter, EpisodeOfCare)
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))
            36. MedicationAdministration.supportingInformation
            Definition

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

            ShortAdditional information to support administration
            Comments

            References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

            Control0..*
            This element is affected by the following invariants: ele-1
            TypeReference(Resource)
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))
            38. MedicationAdministration.effective[x]
            Definition

            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.

            ShortStart and end time of administration
            Control1..1
            This element is affected by the following invariants: ele-1
            TypeChoice of: dateTime, Period
            [x] NoteSee Choice of Data Types for further information about how to use [x]
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Must Support TypesNo must-support rules about the choice of types/profiles
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            SlicingThis element introduces a set of slices on MedicationAdministration.effective[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
            • type @ $this
            • 40. MedicationAdministration.effective[x]:effectiveDateTime
              Slice NameeffectiveDateTime
              Definition

              Actual injection time for radiopharmaceutical. Actual time of administration of the radiopharmaceutical to the patient for imaging purposes. Dicom Tag (0018,1072). This variable is mandatory only if the series is PT.

              ShortActual injection time for radiopharmaceutical
              Control0..1
              This element is affected by the following invariants: ele-1
              TypedateTime
              [x] NoteSee Choice of Data Types for further information about how to use [x]
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              42. MedicationAdministration.effective[x]:effectivePeriod
              Slice NameeffectivePeriod
              Definition

              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.

              ShortStart and end time of administration
              Control0..1
              This element is affected by the following invariants: ele-1
              TypePeriod
              [x] NoteSee Choice of Data Types for further information about how to use [x]
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              44. MedicationAdministration.effective[x]:effectivePeriod.id
              Definition

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

              ShortUnique id for inter-element referencing
              Control0..1
              Typestring
              XML FormatIn the XML format, this property is represented as an attribute.
              46. MedicationAdministration.effective[x]:effectivePeriod.extension
              Definition

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

              ShortAdditional content defined by implementations
              Comments

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

              Control0..*
              This element is affected by the following invariants: ele-1
              TypeExtension
              Standards StatusNormative (from Trial Use)
              Alternate Namesextensions, user content
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              SlicingThis element introduces a set of slices on MedicationAdministration.effective[x].extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 48. MedicationAdministration.effective[x]:effectivePeriod.start
                Definition

                Start of the injection for contrast agents. Dicom Tag (0018,1042)

                ShortStart of the injection for contrast agents
                Comments

                If the low element is missing, the meaning is that the low boundary is not known.

                Control0..1
                This element is affected by the following invariants: ele-1, per-1
                TypedateTime
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                50. MedicationAdministration.effective[x]:effectivePeriod.end
                Definition

                End of the injection for contrast agents. Dicom Tag (0018,1043)

                ShortEnd of the injection for contrast agents
                Comments

                The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.

                Control0..1
                This element is affected by the following invariants: ele-1, per-1
                TypedateTime
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                52. MedicationAdministration.performer
                Definition

                Indicates who or what performed the medication administration and how they were involved.

                ShortWho performed the medication administration and what they did
                Control0..*
                This element is affected by the following invariants: ele-1
                TypeBackboneElement
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                54. 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.

                ShortUnique id for inter-element referencing
                Control0..1
                Typestring
                XML FormatIn the XML format, this property is represented as an attribute.
                56. MedicationAdministration.performer.extension
                Definition

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

                ShortAdditional content defined by implementations
                Comments

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

                Control0..*
                This element is affected by the following invariants: ele-1
                TypeExtension
                Standards StatusNormative (from Trial Use)
                Alternate Namesextensions, user content
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                SlicingThis element introduces a set of slices on MedicationAdministration.performer.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 58. 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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  ShortExtensions that cannot be ignored even if unrecognized
                  Comments

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

                  Control0..*
                  This element is affected by the following invariants: ele-1
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

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

                  Distinguishes the type of involvement of the performer in the medication administration.

                  ShortType of performance
                  Comments

                  Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

                  Control0..1
                  This element is affected by the following invariants: ele-1
                  BindingFor example codes, see MedicationAdministration Performer Function Codes
                  (example to http://hl7.org/fhir/ValueSet/med-admin-perform-function)

                  A code describing the role an individual played in administering the medication.

                  TypeCodeableConcept
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  62. MedicationAdministration.performer.actor
                  Definition

                  Indicates who or what performed the medication administration.

                  ShortWho performed the medication administration
                  Comments

                  References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

                  Control1..1
                  This element is affected by the following invariants: ele-1
                  TypeReference(Practitioner, PractitionerRole, Patient, RelatedPerson, Device)
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))
                  64. MedicationAdministration.reasonCode
                  Definition

                  A code indicating why the medication was given.

                  ShortReason administration performed
                  Comments

                  Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

                  Control0..*
                  This element is affected by the following invariants: ele-1
                  BindingFor example codes, see ReasonMedicationGivenCodes
                  (example to http://hl7.org/fhir/ValueSet/reason-medication-given-codes)

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

                  TypeCodeableConcept
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  66. 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..*
                  This element is affected by the following invariants: ele-1
                  TypeReference(Condition, Observation, DiagnosticReport)
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))
                  68. MedicationAdministration.request
                  Definition

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

                  ShortRequest administration performed against
                  Comments

                  This is a reference to the MedicationRequest where the intent is either order or instance-order. It should not reference MedicationRequests where the intent is any other value.

                  Control0..1
                  This element is affected by the following invariants: ele-1
                  TypeReference(MedicationRequest)
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))
                  70. MedicationAdministration.device
                  Definition

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

                  ShortDevice used to administer
                  Comments

                  References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

                  Control0..*
                  This element is affected by the following invariants: ele-1
                  TypeReference(Device)
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))
                  72. MedicationAdministration.note
                  Definition

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

                  ShortInformation about the administration
                  Comments

                  For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).

                  Control0..*
                  This element is affected by the following invariants: ele-1
                  TypeAnnotation
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  74. MedicationAdministration.dosage
                  Definition

                  This variable is mandatory only if the series is PT.

                  ShortDetails of how medication was taken
                  Control0..1
                  This element is affected by the following invariants: ele-1
                  TypeBackboneElement
                  Must Supporttrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  mad-1: SHALL have at least one of dosage.dose or dosage.rate[x] (dose.exists() or rate.exists())
                  76. 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.

                  ShortUnique id for inter-element referencing
                  Control0..1
                  Typestring
                  XML FormatIn the XML format, this property is represented as an attribute.
                  78. MedicationAdministration.dosage.extension
                  Definition

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

                  ShortAdditional content defined by implementations
                  Comments

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

                  Control0..*
                  This element is affected by the following invariants: ele-1
                  TypeExtension
                  Standards StatusNormative (from Trial Use)
                  Alternate Namesextensions, user content
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  SlicingThis element introduces a set of slices on MedicationAdministration.dosage.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 80. 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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

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

                    Control0..*
                    This element is affected by the following invariants: ele-1
                    TypeExtension
                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                    Summarytrue
                    Requirements

                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                    Alternate Namesextensions, user content, modifiers
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    82. 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
                    Comments

                    Note that FHIR strings SHALL NOT exceed 1MB in size

                    Control0..1
                    This element is affected by the following invariants: ele-1
                    Typestring
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    84. 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 bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.

                    Control0..1
                    This element is affected by the following invariants: ele-1
                    BindingFor example codes, see SNOMEDCTAnatomicalStructureForAdministrationSiteCodes
                    (example to http://hl7.org/fhir/ValueSet/approach-site-codes)

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

                    TypeCodeableConcept
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    86. MedicationAdministration.dosage.route
                    Definition

                    A code specifying the route or physiological path of administration of a therapeutic agent into or onto the patient. For example, topical, intravenous, etc.

                    ShortAdministration route of contrast agent.
                    Comments

                    Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

                    Control0..1
                    This element is affected by the following invariants: ele-1
                    BindingFor example codes, see SNOMEDCTRouteCodes
                    (example to http://hl7.org/fhir/ValueSet/route-codes)

                    A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

                    TypeCodeableConcept
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    88. MedicationAdministration.dosage.route.id
                    Definition

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

                    ShortUnique id for inter-element referencing
                    Control0..1
                    Typestring
                    XML FormatIn the XML format, this property is represented as an attribute.
                    90. MedicationAdministration.dosage.route.extension
                    Definition

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

                    ShortAdditional content defined by implementations
                    Comments

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

                    Control0..*
                    This element is affected by the following invariants: ele-1
                    TypeExtension
                    Standards StatusNormative (from Trial Use)
                    Alternate Namesextensions, user content
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    SlicingThis element introduces a set of slices on MedicationAdministration.dosage.route.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                    • value @ url
                    • 92. MedicationAdministration.dosage.route.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..*
                      This element is affected by the following invariants: ele-1
                      TypeCoding
                      Summarytrue
                      Requirements

                      Allows for alternative encodings within a code system, and translations to other code systems.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      94. MedicationAdministration.dosage.route.coding.id
                      Definition

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

                      ShortUnique id for inter-element referencing
                      Control0..1
                      Typestring
                      XML FormatIn the XML format, this property is represented as an attribute.
                      96. MedicationAdministration.dosage.route.coding.extension
                      Definition

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

                      ShortAdditional content defined by implementations
                      Comments

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

                      Control0..*
                      This element is affected by the following invariants: ele-1
                      TypeExtension
                      Standards StatusNormative (from Trial Use)
                      Alternate Namesextensions, user content
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      SlicingThis element introduces a set of slices on MedicationAdministration.dosage.route.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 98. MedicationAdministration.dosage.route.coding.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 reference to some definition that establishes the system clearly and unambiguously.

                        Control0..1
                        This element is affected by the following invariants: ele-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.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        100. MedicationAdministration.dosage.route.coding.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 versionId, not a resource version id (see discussion)
                        Control0..1
                        This element is affected by the following invariants: ele-1
                        Typestring
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        102. MedicationAdministration.dosage.route.coding.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
                        Comments

                        Note that FHIR strings SHALL NOT exceed 1MB in size

                        Control0..1
                        This element is affected by the following invariants: ele-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.

                        Pattern Value47625008
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        104. MedicationAdministration.dosage.route.coding.display
                        Definition

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

                        ShortRepresentation defined by the system
                        Comments

                        Note that FHIR strings SHALL NOT exceed 1MB in size

                        Control0..1
                        This element is affected by the following invariants: ele-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.

                        Pattern ValueIntravenous use
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        106. MedicationAdministration.dosage.route.coding.userSelected
                        Definition

                        Indicates that this coding was chosen by a user directly - e.g. 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
                        This element is affected by the following invariants: ele-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.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        108. MedicationAdministration.dosage.route.text
                        Definition

                        A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                        ShortPlain text representation of the concept
                        Comments

                        Very often the text is the same as a displayName of one of the codings.

                        Control0..1
                        This element is affected by the following invariants: ele-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.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        110. 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
                        This element is affected by the following invariants: ele-1
                        BindingFor example codes, see SNOMEDCTAdministrationMethodCodes
                        (example to http://hl7.org/fhir/ValueSet/administration-method-codes)

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

                        TypeCodeableConcept
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        112. MedicationAdministration.dosage.dose
                        Definition

                        Radiopharmaceutical dose administered to the patient, measured in megabecquerels (Mbq) at the time the radiopharmaceutical treatment was started. Dicom Tag (0018,1074)

                        ShortRadiopharmaceutical dose
                        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.

                        Control0..1
                        This element is affected by the following invariants: ele-1
                        TypeQuantity(SimpleQuantity)
                        Is Modifierfalse
                        Must Supporttrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        qty-3: If a code for the unit is present, the system SHALL also be present (code.empty() or system.exists())
                        sqty-1: The comparator is not used on a SimpleQuantity (comparator.empty())
                        114. MedicationAdministration.dosage.rate[x]
                        Definition

                        Identifies the speed with which the medication was or will be introduced into the patient. Typically, the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time, e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours.

                        ShortDose quantity per unit of time
                        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
                        This element is affected by the following invariants: ele-1
                        TypeChoice of: Ratio, Quantity(SimpleQuantity)
                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        116. 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 might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.

                        Control0..*
                        This element is affected by the following invariants: ele-1
                        TypeReference(Provenance)
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ref-1: SHALL have a contained resource if a local reference is provided (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')))