FHIR IG analytics
| Package | nictiz.fhir.nl.stu3.zib2017 |
| Resource Type | StructureDefinition |
| Id | zib-InstructionsForUse.json |
| FHIR Version | R3 |
| Source | https://simplifier.net/resolve?scope=nictiz.fhir.nl.stu3.zib2017@2.3.2&canonical=http://nictiz.nl/fhir/StructureDefinition/zib-InstructionsForUse |
| URL | http://nictiz.nl/fhir/StructureDefinition/zib-InstructionsForUse |
| Version | 2.0.5 |
| Status | active |
| Name | Zib InstructionsForUse |
| Title | HCIM InstructionsForUse |
| Realm | nl |
| Authority | hl7 |
| Description | This profile is based on the Dutch Health and Care Information model (Dutch: Zorginformatiebouwsteen or ZIB) InstructionsForUse version 1.1, year 2017. Instructions for the use or administration of the medication, e.g. dose and route of administration. In the event of medication use, this is the pattern of use established by the patient or which the patient followed. |
| Purpose | InstructionsForUse gives an insight into the manner a drug is to be used. |
| Copyright | CC0 |
| Type | Dosage |
| Kind | complex-type |
Resources that use this resource
Resources that this resource uses
Narrative
No narrative content found in resource
Source1
{
"resourceType": "StructureDefinition",
"id": "zib-InstructionsForUse",
"url": "http://nictiz.nl/fhir/StructureDefinition/zib-InstructionsForUse",
"version": "2.0.5",
"name": "Zib InstructionsForUse",
"title": "HCIM InstructionsForUse",
"status": "active",
"publisher": "Nictiz",
"contact": [
{
"name": "Nictiz",
"telecom": [
{
"system": "url",
"value": "https://www.nictiz.nl",
"use": "work"
}
]
}
],
"description": "This profile is based on the Dutch Health and Care Information model (Dutch: Zorginformatiebouwsteen or ZIB) InstructionsForUse version 1.1, year 2017. Instructions for the use or administration of the medication, e.g. dose and route of administration. In the event of medication use, this is the pattern of use established by the patient or which the patient followed.",
"purpose": "InstructionsForUse gives an insight into the manner a drug is to be used.",
"copyright": "CC0",
"fhirVersion": "3.0.2",
"mapping": [
{
"identity": "hcim-instructionsforuse-v1.1-2017EN",
"uri": "https://zibs.nl/wiki/InstructionsForUse-v1.1(2017EN)",
"name": "HCIM InstructionsForUse-v1.1(2017EN)"
}
],
"kind": "complex-type",
"abstract": false,
"type": "Dosage",
"baseDefinition": "http://hl7.org/fhir/StructureDefinition/Dosage",
"derivation": "constraint",
"snapshot": {
"element": [
{
"id": "Dosage",
"path": "Dosage",
"short": "InstructionsForUse",
"definition": "Instructions for the use of the medication, e.g. dose and route of administration. In the event of medication use, this is the pattern of use established by the patient or which the patient followed",
"comment": "The wiki page https://informatiestandaarden.nictiz.nl/wiki/mp:V9.0_Voorbeelden_doseringen provides dosage instruction examples. These examples consists of functional data and their representation in FHIR and CDA.",
"alias": [
"Gebruiksinstructie"
],
"min": 0,
"max": "*",
"base": {
"path": "Element",
"min": 0,
"max": "*"
},
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "Element"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "rim",
"map": ".outboundRelationship[typeCode=COMP].target[classCode=SBADM, moodCode=INT]"
},
{
"identity": "hcim-instructionsforuse-v1.1-2017EN",
"map": "NL-CM:9.12.22504",
"comment": "InstructionsForUse"
}
]
},
{
"id": "Dosage.id",
"path": "Dosage.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "Dosage.extension",
"path": "Dosage.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"rules": "open"
},
"short": "Additional Content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "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.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "Dosage.sequence",
"path": "Dosage.sequence",
"short": "SequenceNumber",
"definition": "This indicates the sequence of the dosing instructions within the medication agreement.",
"requirements": "If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. If the sequence number is different, then the Dosages are intended to be sequential.",
"alias": [
"Volgnummer"
],
"min": 0,
"max": "1",
"base": {
"path": "Dosage.sequence",
"min": 0,
"max": "1"
},
"type": [
{
"code": "integer"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": ".text"
},
{
"identity": "hcim-instructionsforuse-v1.1-2017EN",
"map": "NL-CM:9.12.22503",
"comment": "SequenceNumber"
}
]
},
{
"id": "Dosage.text",
"path": "Dosage.text",
"short": "Description",
"definition": "Textual description of the complete instructions for use including the period of use.",
"requirements": "Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing.",
"alias": [
"Omschrijving"
],
"min": 0,
"max": "1",
"base": {
"path": "Dosage.text",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": ".text"
},
{
"identity": "hcim-instructionsforuse-v1.1-2017EN",
"map": "NL-CM:9.12.9581",
"comment": "Description"
}
]
},
{
"id": "Dosage.additionalInstruction",
"path": "Dosage.additionalInstruction",
"short": "AdditionalInstructions",
"definition": "The additional instructions contain extra information on the use of or considerations for the current prescription. This can also include all instructions for use. The text can come from the original 'paper' medication prescription, but can also be generated from the coded information. This concept may contain more information than what is structurally coded in the information below, but may not conflict with it. The instructions may not conflict with other components of the request for administration. The instructions can also refer to an existing protocol. The G standard contains many texts that can support this attribute, in for example G standard table 362, which contains texts from the general practitioners’ standard WCIA table 25. If desired, these texts can be used to structure this concept.",
"requirements": "Additional instruction such as \"Swallow with plenty of water\" which may or may not be coded.",
"alias": [
"AanvullendeInstructie"
],
"min": 0,
"max": "*",
"base": {
"path": "Dosage.additionalInstruction",
"min": 0,
"max": "*"
},
"type": [
{
"code": "CodeableConcept"
}
],
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "AdditionalInstruction"
}
],
"strength": "extensible",
"description": "A coded concept identifying additional instructions such as \"take with water\" or \"avoid operating heavy machinery\".",
"valueSetReference": {
"reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.9--20160407000000",
"display": "AanvullendeGebruiksinstructie"
}
},
"mapping": [
{
"identity": "rim",
"map": ".text"
},
{
"identity": "hcim-instructionsforuse-v1.1-2017EN",
"map": "NL-CM:9.12.19944",
"comment": "AdditionalInstructions"
}
]
},
{
"id": "Dosage.patientInstruction",
"path": "Dosage.patientInstruction",
"short": "Patient or consumer oriented instructions",
"definition": "Instructions in terms that are understood by the patient or consumer.",
"min": 0,
"max": "1",
"base": {
"path": "Dosage.patientInstruction",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": ".text"
}
]
},
{
"id": "Dosage.timing",
"path": "Dosage.timing",
"short": "AdministeringSchedule",
"definition": "Specifications of the times at which the medication is to be administered. This is indicated as follows: Time(s) (16:00) or indications (“before meals”) at which the medication is to be taken each day. A specific number of times the medication is to be taken each day (“3x a day“), indicated with the frequency A time interval between consecutive doses (“Every 2 hours”, “every 3 days”), indicated with the word Interval. Combined periods with an interval and duration (“1 daily for three out of four weeks: the pill schedule”) If a certain medication is not to be taken daily, the aforementioned can be combined with daily indications: One or more week days on which the medication is to be administered (e.g. “Monday, Wednesday, Friday”) ”3x a week”, “2x a month”. The specified administration “infinite” is automatically to be repeated until: The end date and time has been reached The total administration duration has been reached (14 days) A specific amount of administrations has been reached (“20 doses”, “one-time only”), to be entered in the NumberOfDoses concept.",
"comment": "A timing schedule can be either a list of events - intervals on which the event occurs, or a single event with repeating criteria or just repeating criteria with no actual event. When both event and a repeating specification are provided, the list of events should be understood as an interpretation of the information in the repeat structure.",
"requirements": "The timing schedule for giving the medication to the patient. The Schedule data type allows many different expressions. For example: \"Every 8 hours\"; \"Three times a day\"; \"1/2 an hour before breakfast for 10 days from 23-Dec 2011:\"; \"15 Oct 2013, 17 Oct 2013 and 1 Nov 2013\". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.",
"alias": [
"Toedieningsschema"
],
"min": 0,
"max": "1",
"base": {
"path": "Dosage.timing",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Timing",
"profile": "http://nictiz.nl/fhir/StructureDefinition/zib-AdministrationSchedule"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "Element"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": ".effectiveTime"
},
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "N/A"
},
{
"identity": "rim",
"map": "QSET<TS> (GTS)"
},
{
"identity": "hcim-instructionsforuse-v1.1-2017EN",
"map": "NL-CM:9.12.19948",
"comment": "AdministeringSchedule"
}
]
},
{
"id": "Dosage.asNeeded[x]:asNeededCodeableConcept",
"path": "Dosage.asNeededCodeableConcept",
"sliceName": "asNeededCodeableConcept",
"short": "AsNeeded",
"definition": "As needed means that the dose is only to be administered under certain conditions.",
"comment": "Using the term 'as needed' or a specific reason (eg 'in case of pain') to use medication leads to ambiguity. It is not always clear whether the whole dose is 'as needed' or only part of the dose. For example: 1x daily 1-2 tablets as needed. This can mean: 1 tablet fixed per day and 1 tablet as needed or, as needed, a maximum of 2 tablets.As needed medication is not included in GDS. In the first situation, 1 tablet comes in the GDS (drug dispensing systems) and 1 tablet is delivered separately. In the second situation there is only separate delivery.The system must make sufficiently clear whether the entire instruction or part of the dose is necessary. The HCIM supports both options described above.",
"alias": [
"Zo nodig",
"Criterium"
],
"min": 0,
"max": "1",
"base": {
"path": "Dosage.asNeeded[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "MedicationAsNeededReason"
}
],
"strength": "extensible",
"description": "ZonodigCriteriumCodelijst",
"valueSetReference": {
"reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.12.4--20171231000000",
"display": "ZonodigCriteriumCodelijst"
}
},
"mapping": [
{
"identity": "rim",
"map": ".outboundRelationship[typeCode=PRCN].target[classCode=OBS, moodCode=EVN, code=\"as needed\"].value=boolean or codable concept"
},
{
"identity": "hcim-instructionsforuse-v1.1-2017EN",
"map": "NL-CM:9.12.22512",
"comment": "AsNeeded"
},
{
"identity": "hcim-instructionsforuse-v1.1-2017EN",
"map": "NL-CM:9.12.19945",
"comment": "Condition"
}
]
},
{
"id": "Dosage.site",
"path": "Dosage.site",
"short": "Body site to administer to",
"definition": "Body site to administer to.",
"comment": "If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [body-site-instance](extension-body-site-instance.html). May be a summary code, or a reference to a very precise definition of the location, or both.",
"requirements": "A coded specification of the anatomic site where the medication first enters the body.",
"min": 0,
"max": "1",
"base": {
"path": "Dosage.site",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "MedicationAdministrationSite"
}
],
"strength": "example",
"description": "A coded concept describing the site location the medicine enters into or onto the body.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/approach-site-codes"
}
},
"mapping": [
{
"identity": "rim",
"map": ".approachSiteCode"
}
]
},
{
"id": "Dosage.route",
"path": "Dosage.route",
"short": "RouteOfAdministration",
"definition": "The route through which the medication is administered (oral, nasal, intravenous, etc.)",
"requirements": "A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.",
"alias": [
"Toedieningsweg"
],
"min": 0,
"max": "1",
"base": {
"path": "Dosage.route",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"example": [
{
"label": "Example of RouteOfAdministration",
"valueCodeableConcept": {
"coding": [
{
"system": "urn:oid:2.16.840.1.113883.2.4.4.9",
"code": "oraal",
"display": "Oraal"
}
]
}
}
],
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "RouteOfAdministration"
}
],
"strength": "extensible",
"description": "ToedieningswegCodelijst",
"valueSetReference": {
"reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.12.1--20171231000000",
"display": "ToedieningswegCodelijst"
}
},
"mapping": [
{
"identity": "rim",
"map": ".routeCode"
},
{
"identity": "hcim-instructionsforuse-v1.1-2017EN",
"map": "NL-CM:9.12.19941",
"comment": "RouteOfAdministration"
}
]
},
{
"id": "Dosage.method",
"path": "Dosage.method",
"short": "Technique for administering medication",
"definition": "Technique for administering medication.",
"comment": "Terminologies used often pre-coordinate this term with the route and or form of administration.",
"requirements": "A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV.",
"min": 0,
"max": "1",
"base": {
"path": "Dosage.method",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "MedicationAdministrationMethod"
}
],
"strength": "example",
"description": "A coded concept describing the technique by which the medicine is administered.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/administration-method-codes"
}
},
"mapping": [
{
"identity": "rim",
"map": ".doseQuantity"
}
]
},
{
"id": "Dosage.dose[x]",
"path": "Dosage.dose[x]",
"slicing": {
"discriminator": [
{
"type": "type",
"path": "$this"
}
],
"rules": "open"
},
"short": "Dose",
"definition": "The dose indicates the dose amount per administration. \n \nThe dosage is described in the unit accompanying the product; usually, this is just a number of units or doses. Liquids and other divisible products will usually include a unit of volume (preferably \"ml\"). \n \nIn many cases, the prescriber will want to indicate the dose in units of weight of the active ingredient. \n \nIf only the ingredient is included and not the product, then the amount of that ingredient will be given. Paracetamol 1000mg is equivalent to 2 Paracetamol 500mg tablets or units. \n \nThe dosage is sometimes given as a calculation, in which the patient’s body weight or body surface area is used as a parameter. The calculation is however no more than an aid in reaching a decision. \n \nIn the event of constant administration, sometimes the dose is given in addition to the administration speed (infusion rate) (e.g. 20ml in a syringe or 500ml in a bag), but it is often also omitted. \n \nA general dosage recommendation such as ‘Use according to protocol’ or ‘See instructions’ can be sufficient. In that case, no dose is given.",
"comment": "Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.",
"requirements": "The amount of therapeutic or other substance given at one administration event.",
"alias": [
"Keerdosis"
],
"min": 0,
"max": "1",
"base": {
"path": "Dosage.dose[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Range"
},
{
"code": "Quantity",
"profile": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": ".doseQuantity"
},
{
"identity": "hcim-instructionsforuse-v1.1-2017EN",
"map": "NL-CM:9.12.19940",
"comment": "Dose"
}
]
},
{
"id": "Dosage.dose[x]:doseQuantity",
"path": "Dosage.dose[x]",
"sliceName": "doseQuantity",
"short": "A fixed quantity (no comparator)",
"definition": "The comparator is not used on a SimpleQuantity",
"comment": "The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.",
"requirements": "The amount of therapeutic or other substance given at one administration event.",
"min": 0,
"max": "1",
"base": {
"path": "Dosage.dose[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Quantity",
"profile": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() | (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "Element"
},
{
"key": "qty-3",
"severity": "error",
"human": "If a code for the unit is present, the system SHALL also be present",
"expression": "code.empty() or system.exists()",
"xpath": "not(exists(f:code)) or exists(f:system)",
"source": "Quantity"
},
{
"key": "sqty-1",
"severity": "error",
"human": "The comparator is not used on a SimpleQuantity",
"expression": "comparator.empty()",
"xpath": "not(exists(f:comparator))",
"source": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
}
],
"isSummary": true,
"binding": {
"strength": "required",
"description": "GstdTabel902",
"valueSetReference": {
"reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453",
"display": "GstdTabel902"
}
},
"mapping": [
{
"identity": "rim",
"map": ".doseQuantity"
},
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "SN (see also Range) or CQ"
},
{
"identity": "rim",
"map": "PQ, IVL<PQ>, MO, CO, depending on the values"
}
]
},
{
"id": "Dosage.dose[x]:doseRange",
"path": "Dosage.dose[x]",
"sliceName": "doseRange",
"short": "Amount of medication per dose",
"definition": "Amount of medication per dose.",
"comment": "Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.",
"requirements": "The amount of therapeutic or other substance given at one administration event.",
"min": 0,
"max": "1",
"base": {
"path": "Dosage.dose[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Range"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": ".doseQuantity"
}
]
},
{
"id": "Dosage.dose[x]:doseRange.id",
"path": "Dosage.dose[x].id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "Dosage.dose[x]:doseRange.extension",
"path": "Dosage.dose[x].extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"rules": "open"
},
"short": "Additional Content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "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.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "Dosage.dose[x]:doseRange.low",
"path": "Dosage.dose[x].low",
"short": "Low limit",
"definition": "The low limit. The boundary is inclusive.",
"comment": "If the low element is missing, the low boundary is not known.",
"min": 0,
"max": "1",
"base": {
"path": "Range.low",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Quantity",
"profile": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
}
],
"condition": [
"rng-2"
],
"isSummary": true,
"binding": {
"strength": "required",
"description": "GstdTabel902",
"valueSetReference": {
"reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453",
"display": "GstdTabel902"
}
},
"mapping": [
{
"identity": "v2",
"map": "NR.1"
},
{
"identity": "rim",
"map": "./low"
}
]
},
{
"id": "Dosage.dose[x]:doseRange.high",
"path": "Dosage.dose[x].high",
"short": "High limit",
"definition": "The high limit. The boundary is inclusive.",
"comment": "If the high element is missing, the high boundary is not known.",
"min": 0,
"max": "1",
"base": {
"path": "Range.high",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Quantity",
"profile": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
}
],
"condition": [
"rng-2"
],
"isSummary": true,
"binding": {
"strength": "required",
"description": "GstdTabel902",
"valueSetReference": {
"reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453",
"display": "GstdTabel902"
}
},
"mapping": [
{
"identity": "v2",
"map": "NR.2"
},
{
"identity": "rim",
"map": "./high"
}
]
},
{
"id": "Dosage.maxDosePerPeriod",
"path": "Dosage.maxDosePerPeriod",
"short": "MaximumDose",
"definition": "A maximum dose indicates the maximum duration a product can be used with an ‘as needed’ prescription.\r\n\r\nFor example:\r\n- Max 6 units per day\r\n- Max 200ml per week",
"comment": "This is intended for use as an adjunct to the dosage when there is an upper cap. For example \"2 tablets every 4 hours to a maximum of 8/day\".",
"requirements": "The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours.",
"alias": [
"Maximale dosering",
"Maximale dosis (per dag enz.)"
],
"min": 0,
"max": "1",
"base": {
"path": "Dosage.maxDosePerPeriod",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Ratio"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": ".maxDoseQuantity"
},
{
"identity": "hcim-instructionsforuse-v1.1-2017EN",
"map": "NL-CM:9.12.19946",
"comment": "MaximumDose"
}
]
},
{
"id": "Dosage.maxDosePerPeriod.id",
"path": "Dosage.maxDosePerPeriod.id",
"representation": [
"xmlAttr"
],
"short": "xml:id (or equivalent in JSON)",
"definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "Dosage.maxDosePerPeriod.extension",
"path": "Dosage.maxDosePerPeriod.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"rules": "open"
},
"short": "Additional Content defined by implementations",
"definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "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.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "Dosage.maxDosePerPeriod.numerator",
"path": "Dosage.maxDosePerPeriod.numerator",
"short": "Numerator value",
"definition": "The value of the numerator.",
"min": 0,
"max": "1",
"base": {
"path": "Ratio.numerator",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Quantity"
}
],
"isSummary": true,
"binding": {
"strength": "required",
"description": "GstdTabel902",
"valueSetReference": {
"reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453",
"display": "GstdTabel902"
}
},
"mapping": [
{
"identity": "rim",
"map": ".numerator"
}
]
},
{
"id": "Dosage.maxDosePerPeriod.denominator",
"path": "Dosage.maxDosePerPeriod.denominator",
"short": "Denominator value",
"definition": "The value of the denominator.",
"min": 0,
"max": "1",
"base": {
"path": "Ratio.denominator",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Quantity"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": ".denominator"
}
]
},
{
"id": "Dosage.maxDosePerAdministration",
"path": "Dosage.maxDosePerAdministration",
"short": "Upper limit on medication per administration",
"definition": "Upper limit on medication per administration.",
"comment": "This is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg.",
"requirements": "The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.",
"min": 0,
"max": "1",
"base": {
"path": "Dosage.maxDosePerAdministration",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Quantity",
"profile": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "not supported"
}
]
},
{
"id": "Dosage.maxDosePerLifetime",
"path": "Dosage.maxDosePerLifetime",
"short": "Upper limit on medication per lifetime of the patient",
"definition": "Upper limit on medication per lifetime of the patient.",
"requirements": "The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.",
"min": 0,
"max": "1",
"base": {
"path": "Dosage.maxDosePerLifetime",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Quantity",
"profile": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "not supported"
}
]
},
{
"id": "Dosage.rate[x]",
"path": "Dosage.rate[x]",
"short": "AdministeringSpeed",
"definition": "The administering speed is used in slow administration of liquid. In practice, the measuring unit is almost always ml/hour. Entering an interval (such as 0-10 ml/hour) is also a commonly used option. For example, with an administering speed of 10ml/hour: amount = 10, dose unit = ml time unit = hour",
"comment": "It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate.",
"requirements": "Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.",
"alias": [
"Toedieningssnelheid",
"Inloopsnelheid"
],
"min": 0,
"max": "1",
"base": {
"path": "Dosage.rate[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Ratio"
},
{
"code": "Range"
},
{
"code": "Quantity",
"profile": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
}
],
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": ".rateQuantity"
},
{
"identity": "hcim-instructionsforuse-v1.1-2017EN",
"map": "NL-CM:9.12.19942",
"comment": "AdministeringSpeed"
}
]
}
]
},
"differential": {
"element": [
{
"id": "Dosage",
"path": "Dosage",
"short": "InstructionsForUse",
"definition": "Instructions for the use of the medication, e.g. dose and route of administration. In the event of medication use, this is the pattern of use established by the patient or which the patient followed",
"comment": "The wiki page https://informatiestandaarden.nictiz.nl/wiki/mp:V9.0_Voorbeelden_doseringen provides dosage instruction examples. These examples consists of functional data and their representation in FHIR and CDA.",
"alias": [
"Gebruiksinstructie"
],
"mapping": [
{
"identity": "hcim-instructionsforuse-v1.1-2017EN",
"map": "NL-CM:9.12.22504",
"comment": "InstructionsForUse"
}
]
},
{
"id": "Dosage.sequence",
"path": "Dosage.sequence",
"short": "SequenceNumber",
"definition": "This indicates the sequence of the dosing instructions within the medication agreement.",
"alias": [
"Volgnummer"
],
"mapping": [
{
"identity": "hcim-instructionsforuse-v1.1-2017EN",
"map": "NL-CM:9.12.22503",
"comment": "SequenceNumber"
}
]
},
{
"id": "Dosage.text",
"path": "Dosage.text",
"short": "Description",
"definition": "Textual description of the complete instructions for use including the period of use.",
"alias": [
"Omschrijving"
],
"mapping": [
{
"identity": "hcim-instructionsforuse-v1.1-2017EN",
"map": "NL-CM:9.12.9581",
"comment": "Description"
}
]
},
{
"id": "Dosage.additionalInstruction",
"path": "Dosage.additionalInstruction",
"short": "AdditionalInstructions",
"definition": "The additional instructions contain extra information on the use of or considerations for the current prescription. This can also include all instructions for use. The text can come from the original 'paper' medication prescription, but can also be generated from the coded information. This concept may contain more information than what is structurally coded in the information below, but may not conflict with it. The instructions may not conflict with other components of the request for administration. The instructions can also refer to an existing protocol. The G standard contains many texts that can support this attribute, in for example G standard table 362, which contains texts from the general practitioners’ standard WCIA table 25. If desired, these texts can be used to structure this concept.",
"alias": [
"AanvullendeInstructie"
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "AdditionalInstruction"
}
],
"strength": "extensible",
"valueSetReference": {
"reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.9--20160407000000",
"display": "AanvullendeGebruiksinstructie"
}
},
"mapping": [
{
"identity": "hcim-instructionsforuse-v1.1-2017EN",
"map": "NL-CM:9.12.19944",
"comment": "AdditionalInstructions"
}
]
},
{
"id": "Dosage.timing",
"path": "Dosage.timing",
"definition": "Specifications of the times at which the medication is to be administered. This is indicated as follows: Time(s) (16:00) or indications (“before meals”) at which the medication is to be taken each day. A specific number of times the medication is to be taken each day (“3x a day“), indicated with the frequency A time interval between consecutive doses (“Every 2 hours”, “every 3 days”), indicated with the word Interval. Combined periods with an interval and duration (“1 daily for three out of four weeks: the pill schedule”) If a certain medication is not to be taken daily, the aforementioned can be combined with daily indications: One or more week days on which the medication is to be administered (e.g. “Monday, Wednesday, Friday”) ”3x a week”, “2x a month”. The specified administration “infinite” is automatically to be repeated until: The end date and time has been reached The total administration duration has been reached (14 days) A specific amount of administrations has been reached (“20 doses”, “one-time only”), to be entered in the NumberOfDoses concept.",
"type": [
{
"code": "Timing",
"profile": "http://nictiz.nl/fhir/StructureDefinition/zib-AdministrationSchedule"
}
]
},
{
"id": "Dosage.asNeeded[x]:asNeededCodeableConcept",
"path": "Dosage.asNeededCodeableConcept",
"sliceName": "asNeededCodeableConcept",
"short": "AsNeeded",
"definition": "As needed means that the dose is only to be administered under certain conditions.",
"comment": "Using the term 'as needed' or a specific reason (eg 'in case of pain') to use medication leads to ambiguity. It is not always clear whether the whole dose is 'as needed' or only part of the dose. For example: 1x daily 1-2 tablets as needed. This can mean: 1 tablet fixed per day and 1 tablet as needed or, as needed, a maximum of 2 tablets.As needed medication is not included in GDS. In the first situation, 1 tablet comes in the GDS (drug dispensing systems) and 1 tablet is delivered separately. In the second situation there is only separate delivery.The system must make sufficiently clear whether the entire instruction or part of the dose is necessary. The HCIM supports both options described above.",
"alias": [
"Zo nodig",
"Criterium"
],
"type": [
{
"code": "CodeableConcept"
}
],
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "MedicationAsNeededReason"
}
],
"strength": "extensible",
"description": "ZonodigCriteriumCodelijst",
"valueSetReference": {
"reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.12.4--20171231000000",
"display": "ZonodigCriteriumCodelijst"
}
},
"mapping": [
{
"identity": "hcim-instructionsforuse-v1.1-2017EN",
"map": "NL-CM:9.12.22512",
"comment": "AsNeeded"
},
{
"identity": "hcim-instructionsforuse-v1.1-2017EN",
"map": "NL-CM:9.12.19945",
"comment": "Condition"
}
]
},
{
"id": "Dosage.route",
"path": "Dosage.route",
"short": "RouteOfAdministration",
"definition": "The route through which the medication is administered (oral, nasal, intravenous, etc.)",
"alias": [
"Toedieningsweg"
],
"example": [
{
"label": "Example of RouteOfAdministration",
"valueCodeableConcept": {
"coding": [
{
"system": "urn:oid:2.16.840.1.113883.2.4.4.9",
"code": "oraal",
"display": "Oraal"
}
]
}
}
],
"binding": {
"strength": "extensible",
"description": "ToedieningswegCodelijst",
"valueSetReference": {
"reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.12.1--20171231000000",
"display": "ToedieningswegCodelijst"
}
},
"mapping": [
{
"identity": "hcim-instructionsforuse-v1.1-2017EN",
"map": "NL-CM:9.12.19941",
"comment": "RouteOfAdministration"
}
]
},
{
"id": "Dosage.dose[x]",
"path": "Dosage.dose[x]",
"slicing": {
"discriminator": [
{
"type": "type",
"path": "$this"
}
],
"rules": "open"
},
"short": "Dose",
"definition": "The dose indicates the dose amount per administration. \n \nThe dosage is described in the unit accompanying the product; usually, this is just a number of units or doses. Liquids and other divisible products will usually include a unit of volume (preferably \"ml\"). \n \nIn many cases, the prescriber will want to indicate the dose in units of weight of the active ingredient. \n \nIf only the ingredient is included and not the product, then the amount of that ingredient will be given. Paracetamol 1000mg is equivalent to 2 Paracetamol 500mg tablets or units. \n \nThe dosage is sometimes given as a calculation, in which the patient’s body weight or body surface area is used as a parameter. The calculation is however no more than an aid in reaching a decision. \n \nIn the event of constant administration, sometimes the dose is given in addition to the administration speed (infusion rate) (e.g. 20ml in a syringe or 500ml in a bag), but it is often also omitted. \n \nA general dosage recommendation such as ‘Use according to protocol’ or ‘See instructions’ can be sufficient. In that case, no dose is given.",
"alias": [
"Keerdosis"
],
"mapping": [
{
"identity": "hcim-instructionsforuse-v1.1-2017EN",
"map": "NL-CM:9.12.19940",
"comment": "Dose"
}
]
},
{
"id": "Dosage.dose[x]:doseQuantity",
"path": "Dosage.dose[x]",
"sliceName": "doseQuantity",
"type": [
{
"code": "Quantity",
"profile": "http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
}
],
"binding": {
"strength": "required",
"description": "GstdTabel902",
"valueSetReference": {
"reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453",
"display": "GstdTabel902"
}
}
},
{
"id": "Dosage.dose[x]:doseRange",
"path": "Dosage.dose[x]",
"sliceName": "doseRange",
"type": [
{
"code": "Range"
}
]
},
{
"id": "Dosage.dose[x]:doseRange.low",
"path": "Dosage.dose[x].low",
"binding": {
"strength": "required",
"description": "GstdTabel902",
"valueSetReference": {
"reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453",
"display": "GstdTabel902"
}
}
},
{
"id": "Dosage.dose[x]:doseRange.high",
"path": "Dosage.dose[x].high",
"binding": {
"strength": "required",
"description": "GstdTabel902",
"valueSetReference": {
"reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453",
"display": "GstdTabel902"
}
}
},
{
"id": "Dosage.maxDosePerPeriod",
"path": "Dosage.maxDosePerPeriod",
"short": "MaximumDose",
"definition": "A maximum dose indicates the maximum duration a product can be used with an ‘as needed’ prescription.\r\n\r\nFor example:\r\n- Max 6 units per day\r\n- Max 200ml per week",
"alias": [
"Maximale dosering",
"Maximale dosis (per dag enz.)"
],
"mapping": [
{
"identity": "hcim-instructionsforuse-v1.1-2017EN",
"map": "NL-CM:9.12.19946",
"comment": "MaximumDose"
}
]
},
{
"id": "Dosage.maxDosePerPeriod.numerator",
"path": "Dosage.maxDosePerPeriod.numerator",
"binding": {
"strength": "required",
"description": "GstdTabel902",
"valueSetReference": {
"reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453",
"display": "GstdTabel902"
}
}
},
{
"id": "Dosage.rate[x]",
"path": "Dosage.rate[x]",
"short": "AdministeringSpeed",
"definition": "The administering speed is used in slow administration of liquid. In practice, the measuring unit is almost always ml/hour. Entering an interval (such as 0-10 ml/hour) is also a commonly used option. For example, with an administering speed of 10ml/hour: amount = 10, dose unit = ml time unit = hour",
"alias": [
"Toedieningssnelheid",
"Inloopsnelheid"
],
"mapping": [
{
"identity": "hcim-instructionsforuse-v1.1-2017EN",
"map": "NL-CM:9.12.19942",
"comment": "AdministeringSpeed"
}
]
}
]
}
}
FHIR
FHIRsmith