alvinhenrick/medications

Medication Realism

Generate medication data across the full FHIR R4B medication family. Each resource has a distinct role — pick the right one for the clinical scenario.

Resource selection guide

| Resource | When to use | |---|---| | MedicationRequest | Prescription / order. The default for outpatient and discharge meds. US Core profiled. | | Medication | The drug itself as a referenced resource (when the same drug is referenced by multiple Requests/Dispenses, or when it carries batch/lot/expiration info). For simple cases, use inline medicationCodeableConcept on the Request and skip this resource. | | MedicationDispense | Pharmacy fill event — what was actually dispensed (drug, quantity, days supply, dispenser). One Request can have many Dispenses (refills). | | MedicationAdministration | A single given dose — inpatient nurse documents administration, IV infusion, immunization-adjacent. Use for inpatient/ED scenarios. | | MedicationStatement | Patient-reported / reconciled history ("patient says they take metformin daily"). Use for medication-reconciliation, intake forms, home meds. | | MedicationKnowledge | Drug reference data (rarely needed for synthetic patient data — only for formulary/catalog scenarios). |

Cross-resource relationships

MedicationRequest  ──authorizingPrescription──▶  MedicationDispense
        │                                                │
        └──── medication[x] ───▶ Medication ◀────────────┘
                                       │
MedicationAdministration ──request──▶ MedicationRequest
MedicationStatement ──basedOn──▶ MedicationRequest (optional)

• medicationCodeableConcept (inline RxNorm) vs medicationReference (link to Medication resource) — both are valid on Request/Dispense/Administration/Statement. Prefer inline for simplicity unless you need the shared Medication resource for batch/lot or multiple referencers.

Code systems

• RxNorm (http://www.nlm.nih.gov/research/umls/rxnorm) — primary US ingredient/strength code system. Always include for clinical drugs.
• NDC (http://hl7.org/fhir/sid/ndc) — package-level code (used on MedicationDispense.medicationCodeableConcept to reflect what was actually pulled from the shelf).
• SNOMED CT for route codes (e.g. 26643006=Oral, 78421000=Intramuscular, 47625008=Intravenous).

Realism rules

• POLYPHARMACY: Geriatric patients commonly take 5–15 medications. Common combinations:
  • Antihypertensives: Lisinopril (RxNorm 29046), Amlodipine (17767), Metoprolol (6918)
  • Diabetes: Metformin (6809), Glipizide (4815), Insulin glargine (261551)
  • Statins: Atorvastatin (83367), Rosuvastatin (301542)
  • Anticoagulants: Warfarin (11289), Apixaban (1364430), Rivaroxaban (1114195)
  • Pain: Acetaminophen (161), Ibuprofen (5640), Tramadol (10689)
  • Psych: Sertraline (36437), Escitalopram (321988), Quetiapine (51272)
  • GI: Omeprazole (7646), Pantoprazole (40790)
• DOSAGE FORMS: Tablets, capsules, injections, inhalers, patches, liquids, eye drops.
• FREQUENCY: Include dosageInstruction.timing.repeat with frequency, period, periodUnit, when (AC, PC, HS, etc.).
• MedicationRequest.status: active, on-hold, cancelled, completed, entered-in-error, stopped, draft.
• MedicationRequest.intent: proposal, plan, order, original-order, reflex-order, filler-order, instance-order, option.
• MedicationDispense.status: preparation, in-progress, cancelled, on-hold, completed, entered-in-error, stopped, declined, unknown.
• MedicationDispense.daysSupply: Realistic — 30/90 days for chronic outpatient; smaller for controlled substances or trials.
• MedicationDispense.quantity: Numeric value + RxNorm/UCUM unit. Match the days supply × frequency.
• MedicationDispense.authorizingPrescription: Reference back to the originating MedicationRequest. Multiple dispenses (refills) share one Request.
• MedicationAdministration.effectiveDateTime: When the dose was given. For infusions, use effectivePeriod with start/end.
• MedicationAdministration.performer.actor: Reference the administering Practitioner (nurse, RN).
• MedicationStatement.status: active, completed, entered-in-error, intended, stopped, on-hold, unknown, not-taken.
• MedicationStatement.dateAsserted: When the statement was recorded (often the visit date).
• PRN medications: Set dosageInstruction.asNeededBoolean=True or asNeededCodeableConcept with an indication.
• REQUESTER (US Core must-support on MedicationRequest): Always include requester, referencing the prescribing Practitioner resource. Create a Practitioner if one does not already exist in the bundle.
• DRUG ALLERGIES in AllergyIntolerance: Include medication allergies (Penicillin, Sulfa, NSAIDs) with reaction severity (mild, moderate, severe) and manifestation codes.