FHIR IG Statistics: StructureDefinition/ISiKMedikationsVerabreichung

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{
  "resourceType": "StructureDefinition",
  "id": "ISiKMedikationsVerabreichung",
  "url": "https://gematik.de/fhir/isik/v3/Medikation/StructureDefinition/ISiKMedikationsVerabreichung",
  "version": "3.0.6",
  "name": "ISiKMedikationsVerabreichung",
  "status": "active",
  "experimental": false,
  "date": "2025-07-29",
  "publisher": "gematik GmbH",
  "description": "Dieses Profil ermöglicht die Abbildung der Verabreichung von Medikamenten für einen Patienten in ISiK Szenarien. \n\nHinweis zur Auswahl des Profils: In Abgrenzung zu ISiKMedikationsInformation (MedicationStatement) wird mittels des vorliegenden Profils die Verabreichung eines Medikaments an einen Patienten mit einer Zeitpunkt-genauen Angabe abgebildet (.effectiveDateTime oder .effectivePeriod auf Sekundenebene gemäß der [FHIR-Core Vorgabe](https://hl7.org/fhir/R4/datatypes.html#dateTime)). D. h. die lediglich Datums-genaue Angabe  ist im vorliegenden Profil nicht erlaubt. \nDas Profil ISiKMedikationsInformation (MedicationStatement) kann ebenfalls für  die Abbildung der Verabreichung von Medikamenten für einen Patienten verwendet werden, wenn keine Zeitpunkt-genauen Angaben zur Verabreichung vorliegen, sondern lediglich Datums-genaue Angaben (einschließlich Granularität Jahr, Monat oder Tag).\n\nBegründung zur Profil- und Nutzungsdifferenzierung:\nHandelt es sich bei Erfassung um eine medizinische Verabreichungsdokumentation, dann ist ein genauer Zeitstempel zwingend. Die medizinische Verabreichungsdokumentation muss durch medizinisches Personal erfolgen. Angaben von Patienten und Angehörigen sind grundsätzlich keine medizinische Verabreichungsdokumentation und daher als MedicationStatement zu erfassen(['report that such a sequence (or at least a part of it) did take place'](https://hl7.org/fhir/R4/medicationstatement.html)). ",
  "fhirVersion": "4.0.1",
  "kind": "resource",
  "abstract": false,
  "type": "MedicationAdministration",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/MedicationAdministration",
  "derivation": "constraint",
  "differential": {
    "element": [
      {
        "id": "MedicationAdministration.status",
        "path": "MedicationAdministration.status",
        "short": "Status der Verabreichungsinformation",
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.medication[x]",
        "path": "MedicationAdministration.medication[x]",
        "slicing": {
          "discriminator": [
            {
              "type": "type",
              "path": "$this"
            }
          ],
          "ordered": false,
          "rules": "open"
        }
      },
      {
        "id": "MedicationAdministration.medication[x]:medicationCodeableConcept",
        "path": "MedicationAdministration.medication[x]",
        "sliceName": "medicationCodeableConcept",
        "short": "Medikament in codierter Form oder ggf. als Freitext",
        "comment": "kann verwendet werden, wenn keine detaillierten Informationen zum Medikament (z.B. Rezepturen) existieren.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.medication[x]:medicationCodeableConcept.coding",
        "path": "MedicationAdministration.medication[x].coding",
        "slicing": {
          "discriminator": [
            {
              "type": "pattern",
              "path": "$this"
            }
          ],
          "rules": "open"
        },
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.medication[x]:medicationCodeableConcept.coding:PZN",
        "path": "MedicationAdministration.medication[x].coding",
        "sliceName": "PZN",
        "comment": "Mehrfachcodierung ist zulässig, da für ein abstraktes Medikament auch mehrere PZN-Codes existieren können, z. B. existieren für Aspirin 3 verschiedene Packungsgrößen.",
        "min": 0,
        "max": "*",
        "patternCoding": {
          "system": "http://fhir.de/CodeSystem/ifa/pzn"
        },
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.medication[x]:medicationCodeableConcept.coding:PZN.system",
        "path": "MedicationAdministration.medication[x].coding.system",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.medication[x]:medicationCodeableConcept.coding:PZN.code",
        "path": "MedicationAdministration.medication[x].coding.code",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.medication[x]:medicationCodeableConcept.coding:PZN.display",
        "path": "MedicationAdministration.medication[x].coding.display",
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.medication[x]:medicationCodeableConcept.coding:ATC-DE",
        "path": "MedicationAdministration.medication[x].coding",
        "sliceName": "ATC-DE",
        "comment": "Mehrfachcodierung ist zulässig, da für ein abstraktes Medikament auch mehrere ATC-Codes existieren können, z. B. existieren für Aspirin 4 verschiedene Codes, je nachdem wofür das Medikament angewendet wird.",
        "min": 0,
        "max": "*",
        "patternCoding": {
          "system": "http://fhir.de/CodeSystem/bfarm/atc"
        },
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.medication[x]:medicationCodeableConcept.coding:ATC-DE.system",
        "path": "MedicationAdministration.medication[x].coding.system",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.medication[x]:medicationCodeableConcept.coding:ATC-DE.code",
        "path": "MedicationAdministration.medication[x].coding.code",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.medication[x]:medicationCodeableConcept.coding:ATC-DE.display",
        "path": "MedicationAdministration.medication[x].coding.display",
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.medication[x]:medicationCodeableConcept.coding:WG14",
        "path": "MedicationAdministration.medication[x].coding",
        "sliceName": "WG14",
        "min": 0,
        "max": "1",
        "patternCoding": {
          "system": "http://fhir.de/CodeSystem/abdata/wg14"
        },
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.medication[x]:medicationCodeableConcept.coding:WG14.system",
        "path": "MedicationAdministration.medication[x].coding.system",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.medication[x]:medicationCodeableConcept.coding:WG14.code",
        "path": "MedicationAdministration.medication[x].coding.code",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.medication[x]:medicationCodeableConcept.coding:WG14.display",
        "path": "MedicationAdministration.medication[x].coding.display",
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.medication[x]:medicationCodeableConcept.text",
        "path": "MedicationAdministration.medication[x].text",
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.medication[x]:medicationReference",
        "path": "MedicationAdministration.medication[x]",
        "sliceName": "medicationReference",
        "short": "Referenz auf das Medikament (Medication-Ressource)",
        "comment": "wird verwendet, wenn detaillierte Informationen zum Medikament vorliegen",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Medication"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.medication[x]:medicationReference.reference",
        "path": "MedicationAdministration.medication[x].reference",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.subject",
        "path": "MedicationAdministration.subject",
        "short": "Referenz auf den Patienten",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Patient"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.subject.reference",
        "path": "MedicationAdministration.subject.reference",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.context",
        "path": "MedicationAdministration.context",
        "short": "Referenz auf den Abteilungskontakt",
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.context.reference",
        "path": "MedicationAdministration.context.reference",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.effective[x]",
        "path": "MedicationAdministration.effective[x]",
        "slicing": {
          "discriminator": [
            {
              "type": "type",
              "path": "$this"
            }
          ],
          "ordered": false,
          "rules": "open"
        }
      },
      {
        "id": "MedicationAdministration.effective[x]:effectiveDateTime",
        "path": "MedicationAdministration.effective[x]",
        "sliceName": "effectiveDateTime",
        "short": "Zeitpunkt der Verabreichung",
        "comment": "Begründung des Must-Support: Basisinformation\n\n  Festlegung zur Nutzung: eine Zeitpunkt-genaue Angabe (.effectiveDateTime oder .effectivePeriod auf Sekundenebene gemäß der [FHIR-Core Vorgabe](https://hl7.org/fhir/R4/datatypes.html#dateTime)) MUSS hier seitens eines bestätigungsrelevanten Systems unterstützt werden.\n\n  Für grobgranularere Angaben (z.B. nur Jahr, Monat oder Tag) SOLL das Profil ISiKMedikationsInformation (MedicationStatement) verwendet werden.\n  ",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "dateTime"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.effective[x]:effectivePeriod",
        "path": "MedicationAdministration.effective[x]",
        "sliceName": "effectivePeriod",
        "short": "Zeitraum der Verabreichung",
        "comment": "Begründung des Must-Support: Basisinformation\n\n  Festlegung zur Nutzung: eine Zeitpunkt-genaue Angabe (.effectiveDateTime oder .effectivePeriod auf Sekundenebene gemäß der [FHIR-Core Vorgabe](https://hl7.org/fhir/R4/datatypes.html#dateTime)) MUSS hier seitens eines bestätigungsrelevanten Systems unterstützt werden.\n  Für grobgranularere Angaben (z.B. nur Jahr, Monat oder Tag) SOLL das Profil ISiKMedikationsInformation (MedicationStatement) verwendet werden.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Period"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.effective[x]:effectivePeriod.start",
        "path": "MedicationAdministration.effective[x].start",
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.effective[x]:effectivePeriod.end",
        "path": "MedicationAdministration.effective[x].end",
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.performer",
        "path": "MedicationAdministration.performer",
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.performer.actor",
        "path": "MedicationAdministration.performer.actor",
        "short": "Referenz auf die verabreichende Person",
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.performer.actor.reference",
        "path": "MedicationAdministration.performer.actor.reference",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.reasonReference",
        "path": "MedicationAdministration.reasonReference",
        "short": "Grund der Medikation (Referenz)",
        "comment": "Festlegung zum MS: Die Elemente .reasonCode und .reasonReference MÜSSEN nach OR-Logik in der Ausgabe verwendet werden, d.h. nur eines MUSS geliefert werden können. Ein System KANN demnach statt .reasonReference auch .reasonCode in der Ausgabe verwenden. .reasonReference MUSS aber weiterhin interpretiert werden können.\n\n  Begründung zu Must-Support: Konsolidierung mit MII.",
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.reasonReference.reference",
        "path": "MedicationAdministration.reasonReference.reference",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.note",
        "path": "MedicationAdministration.note",
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.note.text",
        "path": "MedicationAdministration.note.text",
        "short": "Freitext-Notiz",
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage",
        "path": "MedicationAdministration.dosage",
        "short": "Dosierungsangaben",
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.text",
        "path": "MedicationAdministration.dosage.text",
        "short": "Freitext-Dosierungsangabe",
        "comment": "Festlegung zum Must-Support: Die Verarbeitung MUSS unterstützt werden, indem empfangende Systeme  die Freitext-Dosierungsinformation entweder direkt in der Textform persistieren, ODER die Informationen in eine alternative (strukturierte) Form umwandeln (ggf. unter Einwirkung geeigneter Nutzer). Im letzteren Fall KANN auf eine Persistierung in Textform verzichtet werden, um Inkonsistenzen zu vermeiden.\n\n    Ein System KANN jedoch strukturierte Dosierungsinformationen in Freitext-Dosierungsinformationen umwandeln, um sie in einem Dokument oder einer Benutzeroberfläche anzuzeigen - dabei ist auf Konsistenzwahrung zu allen strukturierten Elementen zu achten.\n\n    Hinweis: Diese Festlegung folgt und spezifiziert folgende MS-Festlegung aus dem [ISiK Basismodul](https://simplifier.net/guide/isik-basis-401/Einfuehrung/UebergreifendeFestlegungen/UebergreifendeFestlegungen_Must-Support-Flags.page.md?version=current): 'Systeme KÖNNEN es darüber hinaus ermöglichen, dass die jeweiligen Informationen vom Anwender ergänzt oder editiert werden.' \n\n    Zum Beispiel kann die textuelle Information '1L Infusion mit Rate 50ml/h' in eine entsprechende, strukturierte Form überführt werden - d.h. in die Angabe von 'dose' und 'rateQuantity'.",
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.site",
        "path": "MedicationAdministration.dosage.site",
        "short": "Körperstelle der Verabreichung",
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.site.coding",
        "path": "MedicationAdministration.dosage.site.coding",
        "slicing": {
          "discriminator": [
            {
              "type": "pattern",
              "path": "$this"
            }
          ],
          "rules": "open"
        },
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.site.coding:SNOMED-CT",
        "path": "MedicationAdministration.dosage.site.coding",
        "sliceName": "SNOMED-CT",
        "min": 0,
        "max": "1",
        "patternCoding": {
          "system": "http://snomed.info/sct"
        },
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.site.coding:SNOMED-CT.system",
        "path": "MedicationAdministration.dosage.site.coding.system",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.site.coding:SNOMED-CT.code",
        "path": "MedicationAdministration.dosage.site.coding.code",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.site.coding:SNOMED-CT.display",
        "path": "MedicationAdministration.dosage.site.coding.display",
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.site.text",
        "path": "MedicationAdministration.dosage.site.text",
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.route",
        "path": "MedicationAdministration.dosage.route",
        "short": "Route",
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.route.coding",
        "path": "MedicationAdministration.dosage.route.coding",
        "slicing": {
          "discriminator": [
            {
              "type": "pattern",
              "path": "$this"
            }
          ],
          "rules": "open"
        },
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.route.coding:EDQM",
        "path": "MedicationAdministration.dosage.route.coding",
        "sliceName": "EDQM",
        "min": 0,
        "max": "1",
        "patternCoding": {
          "system": "http://standardterms.edqm.eu"
        },
        "mustSupport": true,
        "binding": {
          "strength": "required",
          "valueSet": "http://hl7.org/fhir/uv/ips/ValueSet/medicine-route-of-administration"
        }
      },
      {
        "id": "MedicationAdministration.dosage.route.coding:EDQM.system",
        "path": "MedicationAdministration.dosage.route.coding.system",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.route.coding:EDQM.code",
        "path": "MedicationAdministration.dosage.route.coding.code",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.route.coding:EDQM.display",
        "path": "MedicationAdministration.dosage.route.coding.display",
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.route.coding:SNOMED-CT",
        "path": "MedicationAdministration.dosage.route.coding",
        "sliceName": "SNOMED-CT",
        "min": 0,
        "max": "1",
        "patternCoding": {
          "system": "http://snomed.info/sct"
        },
        "mustSupport": true,
        "binding": {
          "strength": "required",
          "valueSet": "https://gematik.de/fhir/isik/v3/Medikation/ValueSet/SctRouteOfAdministration"
        }
      },
      {
        "id": "MedicationAdministration.dosage.route.coding:SNOMED-CT.system",
        "path": "MedicationAdministration.dosage.route.coding.system",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.route.coding:SNOMED-CT.code",
        "path": "MedicationAdministration.dosage.route.coding.code",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.route.coding:SNOMED-CT.display",
        "path": "MedicationAdministration.dosage.route.coding.display",
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.route.text",
        "path": "MedicationAdministration.dosage.route.text",
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.dose",
        "path": "MedicationAdministration.dosage.dose",
        "short": "verabreichte Dosis",
        "patternQuantity": {
          "system": "http://unitsofmeasure.org"
        },
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.dose.value",
        "path": "MedicationAdministration.dosage.dose.value",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.dose.unit",
        "path": "MedicationAdministration.dosage.dose.unit",
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.dose.system",
        "path": "MedicationAdministration.dosage.dose.system",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.dose.code",
        "path": "MedicationAdministration.dosage.dose.code",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.rate[x]",
        "path": "MedicationAdministration.dosage.rate[x]",
        "slicing": {
          "discriminator": [
            {
              "type": "type",
              "path": "$this"
            }
          ],
          "ordered": false,
          "rules": "open"
        }
      },
      {
        "id": "MedicationAdministration.dosage.rate[x]:rateRatio",
        "path": "MedicationAdministration.dosage.rate[x]",
        "sliceName": "rateRatio",
        "short": "Verabreichungs-Rate (Verhältnis)",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Ratio"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.rate[x]:rateRatio.numerator",
        "path": "MedicationAdministration.dosage.rate[x].numerator",
        "patternQuantity": {
          "system": "http://unitsofmeasure.org"
        },
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.rate[x]:rateRatio.numerator.value",
        "path": "MedicationAdministration.dosage.rate[x].numerator.value",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.rate[x]:rateRatio.numerator.unit",
        "path": "MedicationAdministration.dosage.rate[x].numerator.unit",
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.rate[x]:rateRatio.numerator.system",
        "path": "MedicationAdministration.dosage.rate[x].numerator.system",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.rate[x]:rateRatio.numerator.code",
        "path": "MedicationAdministration.dosage.rate[x].numerator.code",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.rate[x]:rateRatio.denominator",
        "path": "MedicationAdministration.dosage.rate[x].denominator",
        "patternQuantity": {
          "system": "http://unitsofmeasure.org"
        },
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.rate[x]:rateRatio.denominator.value",
        "path": "MedicationAdministration.dosage.rate[x].denominator.value",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.rate[x]:rateRatio.denominator.unit",
        "path": "MedicationAdministration.dosage.rate[x].denominator.unit",
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.rate[x]:rateRatio.denominator.system",
        "path": "MedicationAdministration.dosage.rate[x].denominator.system",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.rate[x]:rateRatio.denominator.code",
        "path": "MedicationAdministration.dosage.rate[x].denominator.code",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.rate[x]:rateQuantity",
        "path": "MedicationAdministration.dosage.rate[x]",
        "sliceName": "rateQuantity",
        "short": "Verabreichungs-Rate",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Quantity",
            "profile": [
              "http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
            ]
          }
        ],
        "patternQuantity": {
          "system": "http://unitsofmeasure.org"
        },
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.rate[x]:rateQuantity.value",
        "path": "MedicationAdministration.dosage.rate[x].value",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.rate[x]:rateQuantity.unit",
        "path": "MedicationAdministration.dosage.rate[x].unit",
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.rate[x]:rateQuantity.system",
        "path": "MedicationAdministration.dosage.rate[x].system",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationAdministration.dosage.rate[x]:rateQuantity.code",
        "path": "MedicationAdministration.dosage.rate[x].code",
        "min": 1,
        "mustSupport": true
      }
    ]
  }
}