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QDM defines Medication as clinical drugs or chemical substances intended for use in the medical diagnosis, cure, treatment, or prevention of disease. Medications are defined as direct referenced values or value sets containing values derived from code systems such as RxNorm. QDM defines five contexts for Medication: Medication, Active; Medication, Administered; Medication, Discharge; Medication, Dispensed; Medication, Order.
Medication, Active
| QDM Attribute
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QI Core Metadata Element
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Comment
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| Medication, Active
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MedicationStatement (the .status metadata allows conformance to the specific QDM datatype context)
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The Medication, Active datatype requires use of the "active" status code from the FHIR value set
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| Dosage
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MedicationStatement.dosage.dose
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QDM matched to QI Core / FHIR
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| Supply
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Not addressed in QI Core. The CQI Workgroup discussion on 13 April considered whether a supply attribute is required. The use case discussed includes a "single" dose of medication provided as an intravenous infusion. In the use case, due to the nature of the medication requiring a large amount of volume for dilution, the pharmacy provides two one-liter intravenous infusion "bags", one to follow the other to complete the ordered dose. In this use case, should the two infusion "bags" be considered a supply of 2? The CQI Workgroup considered the issue and determined it is an implementation concern. Some guidance in QDM documentation may be helpful, but the Workgroup consensus was to consider removing supply as a requirement for Medication, Active - for discussion in the QDM User Group on April 18, 2018.
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| Frequency
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MedicationStatement.dosage.timing
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QDM matched to QI Core / FHIR
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| Route
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MedicationStatement.dosage.route
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QDM matched to QI Core / FHIR
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| Relevant Period
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MedicationStatement.effective
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QDM matched to QI Core / FHIR
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| Code
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MedicationStatement.medication[x]
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QDM matched to QI Core / FHIR
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| id
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IMedicationStatement.id
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QDM matched to QI Core / FHIR
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| Source
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MedicationStatement.informationSource
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Source addressed by primarySource or reportOrigin
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Medication, Administered
| QDM Attribute
|
QI Core Metadata Element
|
Comment
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| Medication, Administered
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MedicationAdministration (the .status metadata allows conformance to the specific QDM datatype context)
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QDM matched to QI Core / FHIR
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| Dosage
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MedicationAdministration.dosage.dose
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QDM matched to QI Core / FHIR
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| Supply
|
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Not addressed in QI Core. The CQI Workgroup discussion on 13 April considered whether a supply attribute is required. The use case discussed includes a "single" dose of medication provided as an intravenous infusion. In the use case, due to the nature of the medication requiring a large amount of volume for dilution, the pharmacy provides two one-liter intravenous infusion "bags", one to follow the other to complete the ordered dose. In this use case, should the two infusion "bags" be considered a supply of 2? The CQI Workgroup considered the issue and determined it is an implementation concern. Some guidance in QDM documentation may be helpful, but the Workgroup consensus was to consider removing supply as a requirement for Medication, Active - for discussion in the QDM User Group on April 18, 2018.
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| Frequency
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MedicationStatement.dosage.timing
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Medication Administration documents a single administration, thus frequency is not a concept in the Medication Administered resource.
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| Negation Rationale
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MedicationAdministration.reasonNotGiven
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QDM matched to QI Core / FHIR
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| Reason
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MedicationAdministration.reasonCode
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QDM matched to QI Core / FHIR
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| Route
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MedicationAdministration.dosage.route
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QDM matched to QI Core / FHIR
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| Relevant Period
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MedicationAdministration.effective[x]
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QDM matched to QI Core / FHIR
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| Author dateTime
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FHIRprovenance.recorded
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FHIR references authorDatetime as part of the provenance resource for all resources. Is authorDatetime still appropriate for this datatype?
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| Code
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MedicationAdministration.medication[x]
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QDM matched to QI Core / FHIR
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| id
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MedicationAdministration.id
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QDM matched to QI Core / FHIR
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Medication, Dispensed
| QDM Attribute
|
QI Core Metadata Element
|
Comment
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| Medication, Dispensed
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MedicationDispense (the .status metadata allows conformance to the specific QDM datatype context)
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QDM matched to QI Core / FHIR
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| Dosage
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MedicationDispense.quantity
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QDM matched to QI Core / FHIR
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| Supply
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MedicationDispense.daysSupply
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QDM matched to QI Core / FHIR
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| Frequency
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MedicationDispense.dosageInstruction.timing
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QDM matched to QI Core / FHIR
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| Negation Rationale
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MedicationDispense.notDoneReason[x]
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QDM matched to QI Core / FHIR
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| Refills
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MedicationDispense.extension (http://hl7.org/fhir/StructureDefinition/pharmacy-core-refillsRemaining)
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QDM matched to QI Core / FHIR
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| Route
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MedicationDispense.dosageInstruction.route
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QDM matched to QI Core / FHIR
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| Relevant Period
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MedicationDispense.extension (http://hl7.org/fhir/StructureDefinition/medicationdispense-validityPeriod)
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QDM matched to QI Core / FHIR
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| Author dateTime
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part of FHIR Provenance Resource
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FHIR references authorDatetime as part of the provenance resource for all resources.
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| Code
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MedicationDispense.medication[x]
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QDM matched to QI Core / FHIR
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| id
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MedicationDispense.id
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QDM matched to QI Core / FHIR
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| Source
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MedicationDispense.performer
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QDM matched to QI Core / FHIR
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Medication, Discharge
| QDM Attribute
|
QI Core Metadata Element
|
Comment
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| Medication, Discharge
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MedicationRequest.intent
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New profile created to address Medication-request-category = dischargeMedication (LOINC code 8654-6 Hospital Discharge medications) bound to RxNorm.
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| Dosage
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MedicationRequest.dosageInstruction.dose[x]
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Note - modeled using MedicationRequest - could also be modeled as MedicationStatement with a status of "intended". May be modeled better as a component of a discharge instruction set but I can't find that in QI Core or FHIR
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| Supply
|
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Supply shouldn't be required for Medication, Discharge since it is a set of medication instructions for a patient after departing from the hospital. Consider removing this attribute from this QDM datatype. Also- not present in MedicationStatement in QI Core.
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| Frequency
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MedicationRequest.dosageInstruction.timing
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Note - MedicationRequest.dosageInstruction.timing includes both the frequency instruction (e.g., every 8 hours) and the start and stop dates for the amount included.
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| Negation Rationale
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MedicationStatement.reasonNotTaken
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Medication Request in QI Core does not reference negation rationale
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| Refills
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MedicationStatement.reasonNotTaken
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Not present in QI Core - refills shouldn't be an attribute for a list of medications intended at discharge - consider retiring this attribute for Medication, Discharge in QDM
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| Route
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MedicationRequest.dosageInstruction.route
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QDM matched to QI Core / FHIR
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| Author dateTime
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MedicationRequest.authoredOn
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Start of relevant period - no specific author time in QI Core
Note MedicationRequest.dispenseRequest.validityPeriod (Consider prescription validity as a QDM attribute)
MedicationRequest.dosageInstruction.timing (Note - MedicationRequest.dosageInstruction.timing includes both the frequency instruction (e.g., every 8 hours) and the start and stop dates for the amount included.)
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| Code
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MedicationRequest.reasonCode
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QDM matched to QI Core / FHIR
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| id
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MedicationRequest.id
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QDM matched to QI Core / FHIR
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Medication, Order
| QDM Attribute
|
QI Core Metadata Element
|
Comment
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| Medication, Order
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MedicationRequest.intent
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Medication Request intent uses the concepts proposal, plan, order, original-order, reflex-order, filler-order, instance-order, option. Constrain to "order" from the intent value set for QDM datatypes with the order context.
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| Dosage
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MedicationRequest.dosageInstruction.dose[x]
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QDM matched to QI Core / FHIR
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| Supply
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MedicationRequest.dispenseRequest.quantity
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QDM matched to QI Core / FHIR
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| Frequency
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MedicationRequest.dosageInstruction.timing
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QDM matched to QI Core / FHIR
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| Code
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MedicationRequest.medication
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QDM matched to QI Core / FHIR
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| Method
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MedicationRequest.dosageInstruction.method
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QDM matched to QI Core / FHIR
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| Negation Rationale
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MedicationStatement.reasonNotTaken
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Medication Request in QI Core does not reference negation rationale
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| Reason
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MedicationRequest.reasonCode
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QDM matched to QI Core / FHIR
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| Refills
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MedicationRequest.dispenseRequest.numberOfRepeatsAllowed
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QDM matched to QI Core / FHIR
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| Relevant Period
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MedicationRequest.dispenseRequest.expectedSupplyDuration
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QDM matched to QI Core / FHIR
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| Route
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MedicationRequest.dosageInstruction.route
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QDM matched to QI Core / FHIR
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| Author dateTime
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MedicationRequest.authoredOn
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QDM matched to QI Core / FHIR
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| id
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MedicationRequest.id
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QDM matched to QI Core / FHIR
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| Source
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MedicationRequest.requester
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QDM matched to QI Core / FHIR
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