Introduction

This profile is used to represent de-identified MedicationStatement information. The de-identification process has to remove all data elements not explicitly identified as “SUPPORTED” in the profile.

The HHS De-identification Guidance is to be followed to ensure appropriate level of de-identification is performed.

According to the HHS guidance, dates should not have a precision of more than the year. This means month and day cannot be included. This includes MedicationStatement.authoredOn.

In FHIR Resources, text elements and reference.display elements which provide human readable information to the providers may be generated using programs and tools from the data present within the resource. For e.g a MedicationStatement resource text element may contain information such as the MedicationStatement date, patient information. This type of information will enable identification of the individuals. In order to avoid inadvertent revealing of PII/PHI, text elements cannot be included in the De-identified FHIR resource and the submission will be rejected when text elements are present by the validation process.

Ids and References

The original MedicationStatement resource id should not be included in the De-identified MedicationStatement instance. Instead a new id should be created and provided as part of the FHIR resource. The Data Submitter should be capable of using the generated id to relink the data to the original MedicationStatement. All resource references to the MedicationStatement submitted as part of the UDS+ report should refer to newly generated id.

Resource references cannot contain text element as it may contain PHI/PII. The text element for following references are not allowed

• subject
• encounter

Date Truncation

The Data Submitter has to truncate the following dates to only have a precision of year

• effective[x]
• dateAsserted

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from MedicationStatement

Name	Flags	Card.	Type	Description & Constraints
MedicationStatement		0..*	MedicationStatement	De-Identified UDS Plus MedicationStatement
id	S	0..1	id	The de-identified MedicationStatement identifier created by the health center to send data to UDS+ Data Receiver
text		0..0
contained		0..0
status	S	1..1	code	active | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken
medication[x]	S	1..1	CodeableConcept, Reference(Medication)	What medication was taken
subject	S	1..1	Reference(De-Identified UDS Plus Patient)	Who is/was taking the medication
display		0..0
effective[x]	S	0..1	dateTime	The date/time or interval when the medication is/was/will be taken
dateAsserted	S	0..1	dateTime	When the statement was asserted?
dosage	S	0..*	Dosage	Details of how medication is/was taken or should be taken
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
MedicationStatement		0..*	MedicationStatement	De-Identified UDS Plus MedicationStatement
id	SΣ	0..1	id	The de-identified MedicationStatement identifier created by the health center to send data to UDS+ Data Receiver
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	active | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken Binding: Medication Status Codes (required): A coded concept indicating the current status of a MedicationStatement.
medication[x]	SΣ	1..1		What medication was taken Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying the substance or product being taken.
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(Medication)
subject	SΣ	1..1	Reference(De-Identified UDS Plus Patient)	Who is/was taking the medication
effective[x]	SΣ	0..1	dateTime	The date/time or interval when the medication is/was/will be taken
dateAsserted	SΣ	0..1	dateTime	When the statement was asserted?
dosage	S	0..*	Dosage	Details of how medication is/was taken or should be taken
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
MedicationStatement.status	required	Medication Status Codes
MedicationStatement.medication[x]	example	SNOMEDCTMedicationCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MedicationStatement	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MedicationStatement	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	MedicationStatement	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	MedicationStatement	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MedicationStatement	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Name	Flags	Card.	Type	Description & Constraints
MedicationStatement		0..*	MedicationStatement	De-Identified UDS Plus MedicationStatement
id	SΣ	0..1	id	The de-identified MedicationStatement identifier created by the health center to send data to UDS+ Data Receiver
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	External identifier
basedOn	Σ	0..*	Reference(MedicationRequest | CarePlan | ServiceRequest)	Fulfils plan, proposal or order
partOf	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Observation)	Part of referenced event
status	?!SΣ	1..1	code	active | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken Binding: Medication Status Codes (required): A coded concept indicating the current status of a MedicationStatement.
statusReason		0..*	CodeableConcept	Reason for current status Binding: SNOMEDCTDrugTherapyStatusCodes (example): A coded concept indicating the reason for the status of the statement.
category	Σ	0..1	CodeableConcept	Type of medication usage Binding: Medication usage category codes (preferred): A coded concept identifying where the medication included in the MedicationStatement is expected to be consumed or administered.
medication[x]	SΣ	1..1		What medication was taken Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying the substance or product being taken.
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(Medication)
subject	SΣ	1..1	Reference(De-Identified UDS Plus Patient)	Who is/was taking the medication
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
context	Σ	0..1	Reference(Encounter | EpisodeOfCare)	Encounter / Episode associated with MedicationStatement
effective[x]	SΣ	0..1	dateTime	The date/time or interval when the medication is/was/will be taken
dateAsserted	SΣ	0..1	dateTime	When the statement was asserted?
informationSource		0..1	Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | Organization)	Person or organization that provided the information about the taking of this medication
derivedFrom		0..*	Reference(Resource)	Additional supporting information
reasonCode		0..*	CodeableConcept	Reason for why the medication is being/was taken Binding: Condition/Problem/DiagnosisCodes (example): A coded concept identifying why the medication is being taken.
reasonReference		0..*	Reference(Condition | Observation | DiagnosticReport)	Condition or observation that supports why the medication is being/was taken
note		0..*	Annotation	Further information about the statement
dosage	S	0..*	Dosage	Details of how medication is/was taken or should be taken
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
MedicationStatement.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
MedicationStatement.status	required	Medication Status Codes
MedicationStatement.statusReason	example	SNOMEDCTDrugTherapyStatusCodes
MedicationStatement.category	preferred	Medication usage category codes
MedicationStatement.medication[x]	example	SNOMEDCTMedicationCodes
MedicationStatement.subject.type	extensible	ResourceType
MedicationStatement.reasonCode	example	Condition/Problem/DiagnosisCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MedicationStatement	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MedicationStatement	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	MedicationStatement	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	MedicationStatement	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MedicationStatement	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Differential View

This structure is derived from MedicationStatement

Name	Flags	Card.	Type	Description & Constraints
MedicationStatement		0..*	MedicationStatement	De-Identified UDS Plus MedicationStatement
id	S	0..1	id	The de-identified MedicationStatement identifier created by the health center to send data to UDS+ Data Receiver
text		0..0
contained		0..0
status	S	1..1	code	active | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken
medication[x]	S	1..1	CodeableConcept, Reference(Medication)	What medication was taken
subject	S	1..1	Reference(De-Identified UDS Plus Patient)	Who is/was taking the medication
display		0..0
effective[x]	S	0..1	dateTime	The date/time or interval when the medication is/was/will be taken
dateAsserted	S	0..1	dateTime	When the statement was asserted?
dosage	S	0..*	Dosage	Details of how medication is/was taken or should be taken
Documentation for this format

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
MedicationStatement		0..*	MedicationStatement	De-Identified UDS Plus MedicationStatement
id	SΣ	0..1	id	The de-identified MedicationStatement identifier created by the health center to send data to UDS+ Data Receiver
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	active | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken Binding: Medication Status Codes (required): A coded concept indicating the current status of a MedicationStatement.
medication[x]	SΣ	1..1		What medication was taken Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying the substance or product being taken.
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(Medication)
subject	SΣ	1..1	Reference(De-Identified UDS Plus Patient)	Who is/was taking the medication
effective[x]	SΣ	0..1	dateTime	The date/time or interval when the medication is/was/will be taken
dateAsserted	SΣ	0..1	dateTime	When the statement was asserted?
dosage	S	0..*	Dosage	Details of how medication is/was taken or should be taken
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
MedicationStatement.status	required	Medication Status Codes
MedicationStatement.medication[x]	example	SNOMEDCTMedicationCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MedicationStatement	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MedicationStatement	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	MedicationStatement	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	MedicationStatement	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MedicationStatement	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
MedicationStatement		0..*	MedicationStatement	De-Identified UDS Plus MedicationStatement
id	SΣ	0..1	id	The de-identified MedicationStatement identifier created by the health center to send data to UDS+ Data Receiver
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	External identifier
basedOn	Σ	0..*	Reference(MedicationRequest | CarePlan | ServiceRequest)	Fulfils plan, proposal or order
partOf	Σ	0..*	Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Observation)	Part of referenced event
status	?!SΣ	1..1	code	active | completed | entered-in-error | intended | stopped | on-hold | unknown | not-taken Binding: Medication Status Codes (required): A coded concept indicating the current status of a MedicationStatement.
statusReason		0..*	CodeableConcept	Reason for current status Binding: SNOMEDCTDrugTherapyStatusCodes (example): A coded concept indicating the reason for the status of the statement.
category	Σ	0..1	CodeableConcept	Type of medication usage Binding: Medication usage category codes (preferred): A coded concept identifying where the medication included in the MedicationStatement is expected to be consumed or administered.
medication[x]	SΣ	1..1		What medication was taken Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying the substance or product being taken.
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(Medication)
subject	SΣ	1..1	Reference(De-Identified UDS Plus Patient)	Who is/was taking the medication
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
context	Σ	0..1	Reference(Encounter | EpisodeOfCare)	Encounter / Episode associated with MedicationStatement
effective[x]	SΣ	0..1	dateTime	The date/time or interval when the medication is/was/will be taken
dateAsserted	SΣ	0..1	dateTime	When the statement was asserted?
informationSource		0..1	Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | Organization)	Person or organization that provided the information about the taking of this medication
derivedFrom		0..*	Reference(Resource)	Additional supporting information
reasonCode		0..*	CodeableConcept	Reason for why the medication is being/was taken Binding: Condition/Problem/DiagnosisCodes (example): A coded concept identifying why the medication is being taken.
reasonReference		0..*	Reference(Condition | Observation | DiagnosticReport)	Condition or observation that supports why the medication is being/was taken
note		0..*	Annotation	Further information about the statement
dosage	S	0..*	Dosage	Details of how medication is/was taken or should be taken
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
MedicationStatement.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
MedicationStatement.status	required	Medication Status Codes
MedicationStatement.statusReason	example	SNOMEDCTDrugTherapyStatusCodes
MedicationStatement.category	preferred	Medication usage category codes
MedicationStatement.medication[x]	example	SNOMEDCTMedicationCodes
MedicationStatement.subject.type	extensible	ResourceType
MedicationStatement.reasonCode	example	Condition/Problem/DiagnosisCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MedicationStatement	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MedicationStatement	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	MedicationStatement	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	MedicationStatement	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MedicationStatement	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from MedicationStatement

Summary

Mandatory: 3 elements
Must-Support: 7 elements
Prohibited: 3 elements

Structures

This structure refers to these other structures:

• De-Identified UDS Plus Patient (http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/de-identified-uds-plus-patient)

Maturity: 2