Details
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Change Request
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Resolution: Persuasive
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Medium
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FHIR Core (FHIR)
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STU3
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Pharmacy
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MedicationRequest
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Jean/Dennis: 5-0-0
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Enhancement
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Non-substantive
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R5
Description
MedicationRequest.reasonCode [0..*]
Type: codeableConcept
Description: The reason or the indication for ordering or not ordering the medication
Comments statement: This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonReference
In prescription medications, a prescriber may want to include (1) diagnosis/problem, (2) intended therapeutic targets to be achieved
The cardinality *= 0.., and *description *and *comment *statement as are do not prohibit any clinical users to include both "condtion" and "target" statements in the reasonCode element
Use case examples:
(1) in prescription of antihypertensive medications, a prescriber can include in the reasonCode values of: (a) hypertension (condition), (b) achieve BP control to =< 125/80 (target value)
(2) in prescription of glycaemic control medications, a prescriber can include in the reasonCode values of: (a) Type 2 DM, (b) achieve HbA1C value =< 53mmol/mol (7%) (target 1 value), (c) BSL before meal = 6-8 mmol/L (target 2 value), (d) BSL 2 hours after meal = 6-10mmol/L (target 3 value)
If the Goal resource (that references MedicationRequest) should be used to transmit the intended therapeutic target values of prescribed medication, then documentation on MedicationRequest.reasonCode should (a) clearly constraints its use for "diagnosis/problem", (b) prohibits its use to transmit goal target information, and (c) provide directions on how to use Goal resource to transmit the intended therapeutic target values for the prescribed medication