Narrativa gerada: StructureDefinition br-core-medicationstatement Nome Bandeiras Card. Tipo Descrição e condicionalismos MedicationStatement MedicationStatement #xD; id 0..1 id Identificador lógico deste artefato #xD; meta 0..1 Meta Metadados sobre o recurso #xD; implicitRules 0..1 uri Um conjunto de regras sob as quais este conteúdo foi criado #xD; language 0..1 code Idioma do recurso #xD; text 0..1 Narrative Resumo do texto do recurso em linguagem natural #xD; contained 0..* Resource Recursos contidos no recurso #xD; extension 0..* Extension Extensões adicionais que não fazem parte do modelo base #xD; modifierExtension 0..* Extension Extensões adicionais que não podem ser ignoradas, mesmo que não reconhecidas #xD; identifier 0..* Identifier Identificadores externos para este recurso #xD; basedOn 0..* Reference(br-core-medicationrequest | BRCoreCarePlan | BRCoreServiceRequest) Referência ao pedido ou ao plano de tratamento que gerou este recurso #xD; partOf 0..* Reference(br-core-medicationadministration | br-core-medicationdispense | br-core-medicationstatement | BRCoreProcedure | BRCoreObservation) Referência ao evento do qual este recurso faz parte #xD; status 1..1 code Status atual do recurso: active | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken #xD; statusReason 0..* CodeableConcept Motivo do status atual #xD; category 0..1 CodeableConcept Um conceito codificado identificando onde se espera que o medicamento incluído neste recurso seja administrado #xD; Fatias para medication[x] 1..1 CodeableConcept, Reference(Medication) Qual medicamento foi tomado Fatia: Não ordenado, Aberto por type:$this #xD; medication[x]:medicationReference 0..1 Reference(br-core-medication) Referência ao medicamento #xD; subject 1..1 Reference(BRCorePatient) Referência que utiliza o medicamento #xD; id 0..1 string Identificador único para referência cruzada #xD; extension 0..* Extension Extensões adicionais que não fazem parte do modelo de dados básico #xD; reference 0..1 string Referência literal. URL relativa, interna ou externa #xD; type 0..1 uri Tipo de recurso ao qual a referência é feita #xD; identifier 0..1 Identifier Referência lógica, quando a referência literal não é conhecida #xD; display 0..1 string Texto alternativo para o recurso #xD; context 0..1 Reference(br-core-encounter | EpisodeOfCare) Referência ao atendimento ou ao cuidado de associado a este recurso #xD; Fatias para effective[x] 0..1 dateTime, Period Data ou intervalo de tempo na qual o medicamento foi ou será administrado Fatia: Não ordenado, Aberto por type:$this #xD; effective[x]:effectiveDateTime 0..1 dateTime Data na qual o medicamento foi ou será administrado #xD; effective[x]:effectivePeriod 0..1 Period Intervalo de tempo no qual o medicamento foi ou será administrado #xD; dateAsserted 0..1 dateTime Data de registro deste recurso #xD; informationSource 0..1 Reference(BRCorePatient | BRCorePractitioner | BRCorePractitionerRole | BRCoreRelatedPerson | BRCoreOrganization) Referência à pessoa ou organização que forneceu as informações sobre este recurso #xD; derivedFrom 0..* Reference(Resource) Referência à um recurso com informações adicionais #xD; reasonCode 0..* CodeableConcept Motivo pelo qual o medicamento foi ou será administrado #xD; reasonReference 0..* Reference(BRCoreCondition | BRCoreObservation | BRCoreDiagnosticReport) Referência à condição ou observação associado a este recurso #xD; note 0..* Annotation Informações adicionais sobre essa declaração #xD; dosage 0..* Dosage Dosagem dos medicamentos #xD; id 0..1 string Identificador único para referência cruzada #xD; extension 0..* Extension Extensões adicionais que não fazem parte do modelo de dados básico #xD; modifierExtension 0..* Extension Extensões adicionais que não podem ser ignoradas, mesmo que não reconhecidas #xD; sequence 0..1 integer A ordem das instruções de dosagem #xD; text 0..1 string Instruções de dosagem em texto livre #xD; additionalInstruction 0..* CodeableConcept Informações auxiliares ou advertências ao paciente #xD; patientInstruction 0..1 string Instruções orientadas ao paciente ou consumidor #xD; timing 0..1 Timing Quando o medicamento deve ser administrado #xD; asNeeded[x] 0..1 boolean, CodeableConcept Tomar "conforme necessário" (para x) #xD; site 0..1 CodeableConcept Local no corpo onde deve ser administrado o medicamento Vínculo: SNOMEDCTBodyStructures (required) #xD; route 0..1 CodeableConcept Via de administração Vínculo: Medicine Route of Administration - IPS (required) #xD; method 0..1 CodeableConcept Método de administração #xD; doseAndRate 0..* Element Quantidade de medicamento administrado #xD; id 0..1 string Identificador único para referência cruzada #xD; extension 0..* Extension Extensões adicionais que não fazem parte do modelo de dados básico #xD; type 0..1 CodeableConcept O tipo de dose especificado #xD; dose[x] 0..1 Range, SimpleQuantity Quantidade de medicamento por dose #xD; rate[x] 0..1 Ratio, Range, SimpleQuantity Quantidade de medicamento por unidade de tempo #xD; maxDosePerPeriod 0..1 Ratio Limite máximo de medicamento por unidade de tempo #xD; maxDosePerAdministration 0..1 SimpleQuantity Limite máximo de medicamento por administração #xD; maxDosePerLifetime 0..1 SimpleQuantity Limite máximo de medicamento por tempo de vida do paciente #xD; Documentação para este formato
Um registro de um medicamento que está sendo consumido por um paciente. Um recurso [br-core-medicationstatement](https://saude.gov.br/fhir/StructureDefiniton/medicationstatement.html) indica que o paciente pode estar tomando o medicamento agora ou tomou o medicamento no passado ou tomará o medicamento no futuro. A fonte dessas informações pode ser o paciente, outra pessoa significativa (como um membro da família ou cônjuge) ou um clínico. Um cenário comum em que essas informações são capturadas é durante o processo de obtenção do histórico durante uma visita ou internação do paciente. As informações sobre medicamentos podem vir de fontes como a memória do paciente, de um frasco de prescrição ou de uma lista de medicamentos que o paciente, o clínico ou outra parte mantém. A principal diferença entre um recurso [br-core-medicationstatement](https://saude.gov.br/fhir/StructureDefiniton/medicationstatement.html) e um [br-core-medicationadministration](https://saude.gov.br/fhir/StructureDefiniton/medicationadministration.html) é que o último contém informações completas sobre a administração e é baseada em informações reais sobre a administração e da pessoa que administrou o medicamento. Um [br-core-medicationstatement](https://saude.gov.br/fhir/StructureDefiniton/medicationstatement.html#MedicationStatement) é frequentemente, se não sempre, menos específico. Não há data/hora obrigatória em que o medicamento foi administrado; na verdade, sabe-se apenas que uma fonte relatou que o paciente está tomando esse medicamento, onde detalhes como hora, quantidade ou taxa ou mesmo o produto do medicamento podem estar incompletos, ausentes ou menos precisos. Conforme dito anteriormente, as informações do [br-core-medicationstatement](https://saude.gov.br/fhir/StructureDefiniton/medicationstatement.html#MedicationStatement) podem vir da memória do paciente, de um frasco de prescrição ou de uma lista de medicamentos que o paciente, o clínico ou outra parte mantém. A administração de medicamentos é mais formal e não deixa de ter informações detalhadas.
Record of medication being taken by a patient
A record of a medication that is being consumed by a patient. A MedicationStatement may indicate that the patient may be taking the medication now or has taken the medication in the past or will be taking the medication in the future. The source of this information can be the patient, significant other (such as a family member or spouse), or a clinician. A common scenario where this information is captured is during the history taking process during a patient visit or stay. The medication information may come from sources such as the patient's memory, from a prescription bottle, or from a list of medications the patient, clinician or other party maintains. The primary difference between a medication statement and a medication administration is that the medication administration has complete administration information and is based on actual administration information from the person who administered the medication. A medication statement is often, if not always, less specific. There is no required date/time when the medication was administered, in fact we only know that a source has reported the patient is taking this medication, where details such as time, quantity, or rate or even medication product may be incomplete or missing or less precise. As stated earlier, the medication statement information may come from the patient's memory, from a prescription bottle or from a list of medications the patient, clinician or other party maintains. Medication administration is more formal and is not missing detailed information.
When interpreting a medicationStatement, the value of the status and NotTaken needed to be considered: MedicationStatement.status + MedicationStatement.wasNotTaken Status=Active + NotTaken=T = Not currently taking Status=Completed + NotTaken=T = Not taken in the past Status=Intended + NotTaken=T = No intention of taking Status=Active + NotTaken=F = Taking, but not as prescribed Status=Active + NotTaken=F = Taking Status=Intended +NotTaken= F = Will be taking (not started) Status=Completed + NotTaken=F = Taken in past Status=In Error + NotTaken=N/A = In Error.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
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()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
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()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Um conjunto de regras sob as quais este conteúdo foi criado
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.
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
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).
Resumo do texto do recurso em linguagem natural
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.
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.
Extensões adicionais que não fazem parte do modelo base
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
Extensões adicionais que não podem ser ignoradas, mesmo que não reconhecidas
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Identificadores externos para este recurso
This is a business identifier, not a resource identifier.
Referência ao pedido ou ao plano de tratamento que gerou este recurso
Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.
.outboundRelationship[typeCode=FLFS].target[classCode=SBADM or PROC or PCPR or OBS, moodCode=RQO orPLAN or PRP]
Referência ao evento do qual este recurso faz parte
This should not be used when indicating which resource a MedicationStatement has been derived from. If that is the use case, then MedicationStatement.derivedFrom should be used.
.outboundRelationship[typeCode=COMP]/target[classCode=SPLY or SBADM or PROC or OBS,moodCode=EVN]
Status atual do recurso: active | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken
MedicationStatement is a statement at a point in time. The status is only representative at the point when it was asserted. The value set for MedicationStatement.status contains codes that assert the status of the use of the medication by the patient (for example, stopped or on hold) as well as codes that assert the status of the medication statement itself (for example, entered in error). This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
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
A coded concept indicating the current status of a MedicationStatement.
This is generally only used for "exception" statuses such as "not-taken", "on-hold", "cancelled" or "entered-in-error". The reason for performing the event at all is captured in reasonCode, not here.
A coded concept indicating the reason for the status of the statement.
.inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde
Um conceito codificado identificando onde se espera que o medicamento incluído neste recurso seja administrado
A coded concept identifying where the medication included in the MedicationStatement is expected to be consumed or administered.
.inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="type of medication usage"].value
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.
A coded concept identifying the substance or product being taken.
.participation[typeCode=CSM].role[classCode=ADMM or MANU]
Identificador único para referência cruzada
Extensions are always sliced by (at least) url
Extensões adicionais que não fazem parte do modelo de dados básico
Referência literal. URL relativa, interna ou externa
Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
Tipo de recurso ao qual a referência é feita
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
Aa resource (or, for logical models, the URI of the logical model).
Referência lógica, quando a referência literal não é conhecida
When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
Referência ao atendimento ou ao cuidado de associado a este recurso
.inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code="type of encounter or episode"]
Data ou intervalo de tempo na qual o medicamento foi ou será administrado
This attribute reflects the period over which the patient consumed the medication and is expected to be populated on the majority of Medication Statements. If the medication is still being taken at the time the statement is recorded, the "end" date will be omitted. The date/time attribute supports a variety of dates - year, year/month and exact date. If something more than this is required, this should be conveyed as text.
Data na qual o medicamento foi ou será administrado
Intervalo de tempo no qual o medicamento foi ou será administrado
Referência à pessoa ou organização que forneceu as informações sobre este recurso
.participation[typeCode=INF].role[classCode=PAT, or codes for Practioner or Related Person (if PAT is the informer, then syntax for self-reported =true)
Referência à um recurso com informações adicionais
Likely references would be to MedicationRequest, MedicationDispense, Claim, Observation or QuestionnaireAnswers. The most common use cases for deriving a MedicationStatement comes from creating a MedicationStatement from a MedicationRequest or from a lab observation or a claim. it should be noted that the amount of information that is available varies from the type resource that you derive the MedicationStatement from.
Motivo pelo qual o medicamento foi ou será administrado
This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonForUseReference.
A coded concept identifying why the medication is being taken.
Referência à condição ou observação associado a este recurso
This is a reference to a condition that is the reason why the medication is being/was taken. If only a code exists, use reasonForUseCode.
.outboundRelationship[typeCode=RSON]/target[classCode=OBS,moodCode=EVN, code="reason for use"].value
Informações adicionais sobre essa declaração
The dates included in the dosage on a Medication Statement reflect the dates for a given dose. For example, "from November 1, 2016 to November 3, 2016, take one tablet daily and from November 4, 2016 to November 7, 2016, take two tablets daily." It is expected that this specificity may only be populated where the patient brings in their labeled container or where the Medication Statement is derived from a MedicationRequest.
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
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.
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. Additional information about administration or preparation of the medication should be included as text.
Informações auxiliares ou advertências ao paciente
Information about administration or preparation of the medication (e.g. "infuse as rapidly as possibly via intraperitoneal port" or "immediately following drug x") should be populated in dosage.text.
Additional instruction is intended to be coded, but where no code exists, the element could include text. For example, "Swallow with plenty of water" which might or might not be coded.
A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
Instruções orientadas ao paciente ou consumidor
Quando o medicamento deve ser administrado
This attribute might not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.
The timing schedule for giving the medication to the patient. This 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.
Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not "prn" or "as needed".
A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.
.outboundRelationship[typeCode=PRCN].target[classCode=OBS, moodCode=EVN, code="as needed"].value=boolean or codable concept
Local no corpo onde deve ser administrado o medicamento
If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [bodySite](http://hl7.org/fhir/R4/extension-bodysite.html). May be a summary code, or a reference to a very precise definition of the location, or both.
A coded specification of the anatomic site where the medication first enters the body.
A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.
Terminologies used often pre-coordinate this term with the route and or form of administration.
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.
A coded concept describing the technique by which the medicine is administered.
If the type is not populated, assume to be "ordered".
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.
The amount of therapeutic or other substance given at one administration event.
Quantidade de medicamento por unidade de tempo
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. It is possible to specify a rate over time (for example, 100 ml/hour) using either the rateRatio and rateQuantity. The rateQuantity approach requires systems to have the capability to parse UCUM grammer where ml/hour is included rather than a specific ratio where the time is specified as the denominator. Where a rate such as 500ml over 2 hours is specified, the use of rateRatio may be more semantically correct than specifying using a rateQuantity of 250 mg/hour.
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.
Limite máximo de medicamento por unidade de tempo
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".
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.
Limite máximo de medicamento por administração
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.
The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.
Limite máximo de medicamento por tempo de vida do paciente
The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.