The status of the MedicationRequest reflects the status of the ‘authorization’. As such, once it is signed, it reflects an ‘active’ order (even if the effective date doesn’t start for two weeks). It might still be dispensed tomorrow and there might be other preparatory steps (training, etc.) that could occur. 'On hold" means that the authorization is temporarily suspended. I guess you could put the authorization “on hold” and then activate it again immediately prior to the effective date, but that would be unusual behavior. For most systems, on-hold is only used when something occurs to disrupt the original plan.