Canadian Baseline
1.2.0 - CI Build

Canadian Baseline, published by HL7 Canada - FHIR Implementation Work Group. This guide is not an authorized publication; it is the continuous build for version 1.2.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7-Canada/ca-baseline/ and changes regularly. See the Directory of published versions

## Resource Profile: MedicationDispense Profile

Official URL: http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-medicationdispense | Version: 1.2.0
Draft as of 2024-08-09 | Computable Name: MedicationDispenseProfile

Proposed constraints and extensions on the MedicationDispense resource. Generated as a first step toward creating a set of Canadian Baseline FHIR profiles.

# CA Baseline MedicationDispense Profile

This profile sets minimum expectations for the MedicationDispense resource. This profile defines localization concepts for use in the Canadian context.

## Mandatory Data Elements

All elements or attributes within the FHIR specification have cardinality as part of their definition - a minimum number of required appearances and a maximum number of allowable appearances.

Most elements in the FHIR specification have a minimum cardinality of 0, so most elements are not required and subsequently they may be missing from a resource when it is exchanged between systems.

Required elements in the Observation (General Use) profile:

- status (required in the base specification)
- medication (required in the base specification)
- subject

## Must Support Data Elements

The following elements are marked as Must Support in this profile:

Must Support elements:

- status
- medication
- subject
- quantity
- whenPrepared
- dosageInstruction

## CA Core Considerations

The whenHandedOver element was initially profiled as must support and was later relaxed through the Due Diligence Review Process with the goal of not constraining for certain use cases over others. Given the criticality to many clinical/pharmaceutical use cases, it has been identified as an element to consider for additional constraints in the CA Core Profiles which are to be developed in the future under the guidance of a larger collaborative of pan-Canadian governing bodies.

Usages:

- Refer to this Profile: MedicationStatement Profile

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense | C | 0..* | MedicationDispense | MedicationDispense Profile Constraints: mdd-1
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:renderedDosageInstruction |  | 0..1 | ?gen-e1? [CanonicalType[http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage]] | Socialized Optional Extension: PrescribeIT renderedDosageInstruction URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage
extension:quantityRemaining |  | 0..1 | ?gen-e1? [CanonicalType[http://prescribeit.ca/fhir/StructureDefinition/ext-dispense-quantity-remaining]] | Socialized Optional Extension: PrescribeIT quantityRemaining URL: http://prescribeit.ca/fhir/StructureDefinition/ext-dispense-quantity-remaining
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
partOf |  | 0..* | Reference(Procedure Profile) | Event that dispense is part of
status | ?!S Σ | 1..1 | code | preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event.
medication[x] | S Σ | 1..1 |  | What medication was supplied Binding: https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct (preferred): TBD. This is a placeholder for a comprehensive valueset, consisting of all Manufactured Product (MP), Non-proprietary Therapeutic Product (NTP) and Therapeutic Moiety (TM) codes, which would be created and maintained by Canada Health Infoway. Medicinal products for prescribing and dispensing in Canada. The content of this subset only contains commonly used medicinal products that are available for prescribing and dispensing in Canada. This content will expand to include all human medicinal products over time. Example DIN: {"coding":[{"system":"https://fhir.infoway-inforoute.ca/ValueSet/CA-HC-DIN"}]} Example NPN: {"coding":[{"system":"https://fhir.infoway-inforoute.ca/ValueSet/CA-HC-NPN"}]} Example CCDD: {"coding":[{"system":"https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct"}]} Example SNOMED CT (Medications) - IPS: {"coding":[{"system":"http://hl7.org/fhir/uv/ips/ValueSet/medication-snomed-uv-ips"}]} Example WHO ATC IPS: {"coding":[{"system":"http://hl7.org/fhir/uv/ips/ValueSet/whoatc-uv-ips"}]}
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(Medication Profile) |
subject | S Σ | 1..1 | Reference(Patient Profile) | Who the dispense is for
context |  | 0..1 | Reference(Encounter Profile | EpisodeOfCare) | Encounter / Episode associated with event
performer |  | 0..* | BackboneElement | Who performed event
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
actor | S | 1..1 | Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile | Patient Profile | Device Profile (Implantable) | RelatedPerson) | Individual who was performing
location |  | 0..1 | Reference(Location Profile) | Where the dispense occurred
authorizingPrescription |  | 0..* | Reference(MedicationRequest Profile) | Medication order that authorizes the dispense
quantity | S | 0..1 | SimpleQuantity(4.0.1) | Amount dispensed
whenPrepared | S Σ | 0..1 | dateTime | When product was packaged and reviewed
destination |  | 0..1 | Reference(Location Profile) | Where the medication was sent
receiver |  | 0..* | Reference(Patient Profile | Practitioner Profile (General)) | Who collected the medication
dosageInstruction | S | 0..* | Dosage | How the medication is to be used by the patient or administered by the caregiver
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:instructionRelationship |  | 0..1 | ?gen-e1? [CanonicalType[http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship]] | Socialized Optional Extension: PrescribeIT dosageInstruction Relationship URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
text | S Σ | 0..1 | string | Free text dosage instructions e.g. SIG
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationDispense.status | Base | required | Medication dispense status codes | 📍4.0.1 | FHIR Std.
MedicationDispense.medication[x] | Base | preferred | https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct | Not Stated | Unknown

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | MedicationDispense | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | MedicationDispense | 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 | MedicationDispense | 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 | MedicationDispense | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | MedicationDispense | 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()`
mdd-1 | error | MedicationDispense | whenHandedOver cannot be before whenPrepared | `whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared`

This structure is derived from MedicationDispense

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense |  | 0..* | MedicationDispense | MedicationDispense Profile
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:renderedDosageInstruction |  | 0..1 | ?gen-e1? [CanonicalType[http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage]] | Socialized Optional Extension: PrescribeIT renderedDosageInstruction URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage
extension:quantityRemaining |  | 0..1 | ?gen-e1? [CanonicalType[http://prescribeit.ca/fhir/StructureDefinition/ext-dispense-quantity-remaining]] | Socialized Optional Extension: PrescribeIT quantityRemaining URL: http://prescribeit.ca/fhir/StructureDefinition/ext-dispense-quantity-remaining
partOf |  | 0..* | Reference(Procedure Profile) | Event that dispense is part of
status | S | 1..1 | code | preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
medication[x] | S | 1..1 |  | What medication was supplied Binding: https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct (preferred): TBD. This is a placeholder for a comprehensive valueset, consisting of all Manufactured Product (MP), Non-proprietary Therapeutic Product (NTP) and Therapeutic Moiety (TM) codes, which would be created and maintained by Canada Health Infoway. Medicinal products for prescribing and dispensing in Canada. The content of this subset only contains commonly used medicinal products that are available for prescribing and dispensing in Canada. This content will expand to include all human medicinal products over time. Example DIN: {"coding":[{"system":"https://fhir.infoway-inforoute.ca/ValueSet/CA-HC-DIN"}]} Example NPN: {"coding":[{"system":"https://fhir.infoway-inforoute.ca/ValueSet/CA-HC-NPN"}]} Example CCDD: {"coding":[{"system":"https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct"}]} Example SNOMED CT (Medications) - IPS: {"coding":[{"system":"http://hl7.org/fhir/uv/ips/ValueSet/medication-snomed-uv-ips"}]} Example WHO ATC IPS: {"coding":[{"system":"http://hl7.org/fhir/uv/ips/ValueSet/whoatc-uv-ips"}]}
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(Medication Profile) |
subject | S | 1..1 | Reference(Patient Profile) | Who the dispense is for
context |  | 0..1 | Reference(Encounter Profile | EpisodeOfCare) | Encounter / Episode associated with event
performer |  |  |  |
actor | S | 1..1 | Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile | Patient Profile | Device Profile (Implantable) | RelatedPerson) | Individual who was performing
location |  | 0..1 | Reference(Location Profile) | Where the dispense occurred
authorizingPrescription |  | 0..* | Reference(MedicationRequest Profile) | Medication order that authorizes the dispense
quantity | S | 0..1 | SimpleQuantity(4.0.1) | Amount dispensed
whenPrepared | S | 0..1 | dateTime | When product was packaged and reviewed
destination |  | 0..1 | Reference(Location Profile) | Where the medication was sent
receiver |  | 0..* | Reference(Patient Profile | Practitioner Profile (General)) | Who collected the medication
dosageInstruction | S | 0..* | Dosage | How the medication is to be used by the patient or administered by the caregiver
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:instructionRelationship |  | 0..1 | ?gen-e1? [CanonicalType[http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship]] | Socialized Optional Extension: PrescribeIT dosageInstruction Relationship URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship
text | S | 0..1 | string | Free text dosage instructions e.g. SIG
substitution |  |  |  |
responsibleParty |  | 0..* | Reference(Practitioner Profile (General) | PractitionerRole Profile (General)) | Who is responsible for the substitution
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
MedicationDispense.medication[x] | Base | preferred | https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct | Not Stated | Unknown

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense | C | 0..* | MedicationDispense | MedicationDispense Profile Constraints: mdd-1
id | Σ | 0..1 | id | Logical id of this artifact
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
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:renderedDosageInstruction |  | 0..1 | ?gen-e1? [CanonicalType[http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage]] | Socialized Optional Extension: PrescribeIT renderedDosageInstruction URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage
extension:quantityRemaining |  | 0..1 | ?gen-e1? [CanonicalType[http://prescribeit.ca/fhir/StructureDefinition/ext-dispense-quantity-remaining]] | Socialized Optional Extension: PrescribeIT quantityRemaining URL: http://prescribeit.ca/fhir/StructureDefinition/ext-dispense-quantity-remaining
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | External identifier
partOf |  | 0..* | Reference(Procedure Profile) | Event that dispense is part of
status | ?!S Σ | 1..1 | code | preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event.
statusReason[x] |  | 0..1 |  | Why a dispense was not performed Binding: MedicationDispense Status Reason Codes (example): A code describing why a dispense was not performed.
statusReasonCodeableConcept |  |  | CodeableConcept |
statusReasonReference |  |  | Reference(DetectedIssue) |
category |  | 0..1 | CodeableConcept | Type of medication dispense Binding: MedicationDispense Category Codes (preferred): A code describing where the dispensed medication is expected to be consumed or administered.
medication[x] | S Σ | 1..1 |  | What medication was supplied Binding: https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct (preferred): TBD. This is a placeholder for a comprehensive valueset, consisting of all Manufactured Product (MP), Non-proprietary Therapeutic Product (NTP) and Therapeutic Moiety (TM) codes, which would be created and maintained by Canada Health Infoway. Medicinal products for prescribing and dispensing in Canada. The content of this subset only contains commonly used medicinal products that are available for prescribing and dispensing in Canada. This content will expand to include all human medicinal products over time. Example DIN: {"coding":[{"system":"https://fhir.infoway-inforoute.ca/ValueSet/CA-HC-DIN"}]} Example NPN: {"coding":[{"system":"https://fhir.infoway-inforoute.ca/ValueSet/CA-HC-NPN"}]} Example CCDD: {"coding":[{"system":"https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct"}]} Example SNOMED CT (Medications) - IPS: {"coding":[{"system":"http://hl7.org/fhir/uv/ips/ValueSet/medication-snomed-uv-ips"}]} Example WHO ATC IPS: {"coding":[{"system":"http://hl7.org/fhir/uv/ips/ValueSet/whoatc-uv-ips"}]}
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(Medication Profile) |
subject | S Σ | 1..1 | Reference(Patient Profile) | Who the dispense is for
context |  | 0..1 | Reference(Encounter Profile | EpisodeOfCare) | Encounter / Episode associated with event
supportingInformation |  | 0..* | Reference(Resource) | Information that supports the dispensing of the medication
performer |  | 0..* | BackboneElement | Who performed event
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
function |  | 0..1 | CodeableConcept | Who performed the dispense and what they did Binding: MedicationDispense Performer Function Codes (example): A code describing the role an individual played in dispensing a medication.
actor | S | 1..1 | Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile | Patient Profile | Device Profile (Implantable) | RelatedPerson) | Individual who was performing
location |  | 0..1 | Reference(Location Profile) | Where the dispense occurred
authorizingPrescription |  | 0..* | Reference(MedicationRequest Profile) | Medication order that authorizes the dispense
type |  | 0..1 | CodeableConcept | Trial fill, partial fill, emergency fill, etc. Binding: ActPharmacySupplyType (example): Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc.
quantity | S | 0..1 | SimpleQuantity(4.0.1) | Amount dispensed
daysSupply |  | 0..1 | SimpleQuantity(4.0.1) | Amount of medication expressed as a timing amount
whenPrepared | S Σ | 0..1 | dateTime | When product was packaged and reviewed
whenHandedOver |  | 0..1 | dateTime | When product was given out
destination |  | 0..1 | Reference(Location Profile) | Where the medication was sent
receiver |  | 0..* | Reference(Patient Profile | Practitioner Profile (General)) | Who collected the medication
note |  | 0..* | Annotation | Information about the dispense
dosageInstruction | S | 0..* | Dosage | How the medication is to be used by the patient or administered by the caregiver
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:instructionRelationship |  | 0..1 | ?gen-e1? [CanonicalType[http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship]] | Socialized Optional Extension: PrescribeIT dosageInstruction Relationship URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | Σ | 0..1 | integer | The order of the dosage instructions
text | S Σ | 0..1 | string | Free text dosage instructions e.g. SIG
additionalInstruction | Σ | 0..* | CodeableConcept | Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness" Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
patientInstruction | Σ | 0..1 | string | Patient or consumer oriented instructions
timing | Σ | 0..1 | Timing | When medication should be administered
asNeeded[x] | Σ | 0..1 |  | Take "as needed" (for x) Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.
asNeededBoolean |  |  | boolean |
asNeededCodeableConcept |  |  | CodeableConcept |
site | Σ | 0..1 | CodeableConcept | Body site to administer to Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.
route | Σ | 0..1 | CodeableConcept | How drug should enter body Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
method | Σ | 0..1 | CodeableConcept | Technique for administering medication Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.
doseAndRate | Σ | 0..* | Element | Amount of medication administered
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
type | Σ | 0..1 | CodeableConcept | The kind of dose or rate specified Binding: DoseAndRateType (example): The kind of dose or rate specified.
dose[x] | Σ | 0..1 |  | Amount of medication per dose
doseRange |  |  | Range |
doseQuantity |  |  | Quantity(SimpleQuantity) |
rate[x] | Σ | 0..1 |  | Amount of medication per unit of time
rateRatio |  |  | Ratio |
rateRange |  |  | Range |
rateQuantity |  |  | Quantity(SimpleQuantity) |
maxDosePerPeriod | Σ | 0..1 | Ratio | Upper limit on medication per unit of time
maxDosePerAdministration | Σ | 0..1 | SimpleQuantity(4.0.1) | Upper limit on medication per administration
maxDosePerLifetime | Σ | 0..1 | SimpleQuantity(4.0.1) | Upper limit on medication per lifetime of the patient
substitution |  | 0..1 | BackboneElement | Whether a substitution was performed on the dispense
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
wasSubstituted |  | 1..1 | boolean | Whether a substitution was or was not performed on the dispense
type |  | 0..1 | CodeableConcept | Code signifying whether a different drug was dispensed from what was prescribed Binding: ActSubstanceAdminSubstitutionCode (example): A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription.
reason |  | 0..* | CodeableConcept | Why was substitution made Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
responsibleParty |  | 0..* | Reference(Practitioner Profile (General) | PractitionerRole Profile (General)) | Who is responsible for the substitution
detectedIssue |  | 0..* | Reference(DetectedIssue) | Clinical issue with action
eventHistory |  | 0..* | Reference(Provenance) | A list of relevant lifecycle events
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationDispense.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
MedicationDispense.status | Base | required | Medication dispense status codes | 📍4.0.1 | FHIR Std.
MedicationDispense.statusReason[x] | Base | example | Medication dispense status reason codes | 📍4.0.1 | FHIR Std.
MedicationDispense.category | Base | preferred | Medication dispense category codes | 📍4.0.1 | FHIR Std.
MedicationDispense.medication[x] | Base | preferred | https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct | Not Stated | Unknown
MedicationDispense.performer.​function | Base | example | Medication dispense performer function codes | 📍4.0.1 | FHIR Std.
MedicationDispense.type | Base | example | ActPharmacySupplyType | 📦3.0.0 | THO v6.5
MedicationDispense.dosageInstruction.​additionalInstruction | Base | example | SNOMED CT Additional Dosage Instructions | 📍4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​asNeeded[x] | Base | example | SNOMED CT Medication As Needed Reason Codes | 📍4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​site | Base | example | SNOMED CT Anatomical Structure for Administration Site Codes | 📍4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​route | Base | example | SNOMED CT Route Codes | 📍4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​method | Base | example | SNOMED CT Administration Method Codes | 📍4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​doseAndRate.type | Base | example | DoseAndRateType | 📍4.0.1 | FHIR Std.
MedicationDispense.substitution.​type | Base | example | ActSubstanceAdminSubstitutionCode | 📦3.0.0 | THO v6.5
MedicationDispense.substitution.​reason | Base | example | SubstanceAdminSubstitutionReason | 📦3.0.0 | THO v6.5

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | MedicationDispense | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | MedicationDispense | 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 | MedicationDispense | 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 | MedicationDispense | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | MedicationDispense | 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()`
mdd-1 | error | MedicationDispense | whenHandedOver cannot be before whenPrepared | `whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared`

This structure is derived from MedicationDispense

Summary

Mandatory: 1 element
Must-Support: 8 elements

Structures

This structure refers to these other structures:

- Procedure Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-procedure)
- Medication Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-medication)
- Patient Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-patient)
- Encounter Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-encounter)
- Practitioner Profile (General) (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitioner)
- PractitionerRole Profile (General) (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitionerrole)
- Organization Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-organization)
- Device Profile (Implantable) (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-device)
- Location Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-location)
- MedicationRequest Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-medicationrequest)

Extensions

This structure refers to these extensions:

- Unable to summarise extension http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage (no extension found)
- Unable to summarise extension http://prescribeit.ca/fhir/StructureDefinition/ext-dispense-quantity-remaining (no extension found)
- Unable to summarise extension http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship (no extension found)

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense | C | 0..* | MedicationDispense | MedicationDispense Profile Constraints: mdd-1
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:renderedDosageInstruction |  | 0..1 | ?gen-e1? [CanonicalType[http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage]] | Socialized Optional Extension: PrescribeIT renderedDosageInstruction URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage
extension:quantityRemaining |  | 0..1 | ?gen-e1? [CanonicalType[http://prescribeit.ca/fhir/StructureDefinition/ext-dispense-quantity-remaining]] | Socialized Optional Extension: PrescribeIT quantityRemaining URL: http://prescribeit.ca/fhir/StructureDefinition/ext-dispense-quantity-remaining
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
partOf |  | 0..* | Reference(Procedure Profile) | Event that dispense is part of
status | ?!S Σ | 1..1 | code | preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event.
medication[x] | S Σ | 1..1 |  | What medication was supplied Binding: https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct (preferred): TBD. This is a placeholder for a comprehensive valueset, consisting of all Manufactured Product (MP), Non-proprietary Therapeutic Product (NTP) and Therapeutic Moiety (TM) codes, which would be created and maintained by Canada Health Infoway. Medicinal products for prescribing and dispensing in Canada. The content of this subset only contains commonly used medicinal products that are available for prescribing and dispensing in Canada. This content will expand to include all human medicinal products over time. Example DIN: {"coding":[{"system":"https://fhir.infoway-inforoute.ca/ValueSet/CA-HC-DIN"}]} Example NPN: {"coding":[{"system":"https://fhir.infoway-inforoute.ca/ValueSet/CA-HC-NPN"}]} Example CCDD: {"coding":[{"system":"https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct"}]} Example SNOMED CT (Medications) - IPS: {"coding":[{"system":"http://hl7.org/fhir/uv/ips/ValueSet/medication-snomed-uv-ips"}]} Example WHO ATC IPS: {"coding":[{"system":"http://hl7.org/fhir/uv/ips/ValueSet/whoatc-uv-ips"}]}
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(Medication Profile) |
subject | S Σ | 1..1 | Reference(Patient Profile) | Who the dispense is for
context |  | 0..1 | Reference(Encounter Profile | EpisodeOfCare) | Encounter / Episode associated with event
performer |  | 0..* | BackboneElement | Who performed event
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
actor | S | 1..1 | Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile | Patient Profile | Device Profile (Implantable) | RelatedPerson) | Individual who was performing
location |  | 0..1 | Reference(Location Profile) | Where the dispense occurred
authorizingPrescription |  | 0..* | Reference(MedicationRequest Profile) | Medication order that authorizes the dispense
quantity | S | 0..1 | SimpleQuantity(4.0.1) | Amount dispensed
whenPrepared | S Σ | 0..1 | dateTime | When product was packaged and reviewed
destination |  | 0..1 | Reference(Location Profile) | Where the medication was sent
receiver |  | 0..* | Reference(Patient Profile | Practitioner Profile (General)) | Who collected the medication
dosageInstruction | S | 0..* | Dosage | How the medication is to be used by the patient or administered by the caregiver
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:instructionRelationship |  | 0..1 | ?gen-e1? [CanonicalType[http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship]] | Socialized Optional Extension: PrescribeIT dosageInstruction Relationship URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
text | S Σ | 0..1 | string | Free text dosage instructions e.g. SIG
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationDispense.status | Base | required | Medication dispense status codes | 📍4.0.1 | FHIR Std.
MedicationDispense.medication[x] | Base | preferred | https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct | Not Stated | Unknown

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | MedicationDispense | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | MedicationDispense | 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 | MedicationDispense | 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 | MedicationDispense | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | MedicationDispense | 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()`
mdd-1 | error | MedicationDispense | whenHandedOver cannot be before whenPrepared | `whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared`

Differential View

This structure is derived from MedicationDispense

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense |  | 0..* | MedicationDispense | MedicationDispense Profile
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:renderedDosageInstruction |  | 0..1 | ?gen-e1? [CanonicalType[http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage]] | Socialized Optional Extension: PrescribeIT renderedDosageInstruction URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage
extension:quantityRemaining |  | 0..1 | ?gen-e1? [CanonicalType[http://prescribeit.ca/fhir/StructureDefinition/ext-dispense-quantity-remaining]] | Socialized Optional Extension: PrescribeIT quantityRemaining URL: http://prescribeit.ca/fhir/StructureDefinition/ext-dispense-quantity-remaining
partOf |  | 0..* | Reference(Procedure Profile) | Event that dispense is part of
status | S | 1..1 | code | preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
medication[x] | S | 1..1 |  | What medication was supplied Binding: https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct (preferred): TBD. This is a placeholder for a comprehensive valueset, consisting of all Manufactured Product (MP), Non-proprietary Therapeutic Product (NTP) and Therapeutic Moiety (TM) codes, which would be created and maintained by Canada Health Infoway. Medicinal products for prescribing and dispensing in Canada. The content of this subset only contains commonly used medicinal products that are available for prescribing and dispensing in Canada. This content will expand to include all human medicinal products over time. Example DIN: {"coding":[{"system":"https://fhir.infoway-inforoute.ca/ValueSet/CA-HC-DIN"}]} Example NPN: {"coding":[{"system":"https://fhir.infoway-inforoute.ca/ValueSet/CA-HC-NPN"}]} Example CCDD: {"coding":[{"system":"https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct"}]} Example SNOMED CT (Medications) - IPS: {"coding":[{"system":"http://hl7.org/fhir/uv/ips/ValueSet/medication-snomed-uv-ips"}]} Example WHO ATC IPS: {"coding":[{"system":"http://hl7.org/fhir/uv/ips/ValueSet/whoatc-uv-ips"}]}
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(Medication Profile) |
subject | S | 1..1 | Reference(Patient Profile) | Who the dispense is for
context |  | 0..1 | Reference(Encounter Profile | EpisodeOfCare) | Encounter / Episode associated with event
performer |  |  |  |
actor | S | 1..1 | Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile | Patient Profile | Device Profile (Implantable) | RelatedPerson) | Individual who was performing
location |  | 0..1 | Reference(Location Profile) | Where the dispense occurred
authorizingPrescription |  | 0..* | Reference(MedicationRequest Profile) | Medication order that authorizes the dispense
quantity | S | 0..1 | SimpleQuantity(4.0.1) | Amount dispensed
whenPrepared | S | 0..1 | dateTime | When product was packaged and reviewed
destination |  | 0..1 | Reference(Location Profile) | Where the medication was sent
receiver |  | 0..* | Reference(Patient Profile | Practitioner Profile (General)) | Who collected the medication
dosageInstruction | S | 0..* | Dosage | How the medication is to be used by the patient or administered by the caregiver
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:instructionRelationship |  | 0..1 | ?gen-e1? [CanonicalType[http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship]] | Socialized Optional Extension: PrescribeIT dosageInstruction Relationship URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship
text | S | 0..1 | string | Free text dosage instructions e.g. SIG
substitution |  |  |  |
responsibleParty |  | 0..* | Reference(Practitioner Profile (General) | PractitionerRole Profile (General)) | Who is responsible for the substitution
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
MedicationDispense.medication[x] | Base | preferred | https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct | Not Stated | Unknown

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense | C | 0..* | MedicationDispense | MedicationDispense Profile Constraints: mdd-1
id | Σ | 0..1 | id | Logical id of this artifact
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
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:renderedDosageInstruction |  | 0..1 | ?gen-e1? [CanonicalType[http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage]] | Socialized Optional Extension: PrescribeIT renderedDosageInstruction URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage
extension:quantityRemaining |  | 0..1 | ?gen-e1? [CanonicalType[http://prescribeit.ca/fhir/StructureDefinition/ext-dispense-quantity-remaining]] | Socialized Optional Extension: PrescribeIT quantityRemaining URL: http://prescribeit.ca/fhir/StructureDefinition/ext-dispense-quantity-remaining
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | External identifier
partOf |  | 0..* | Reference(Procedure Profile) | Event that dispense is part of
status | ?!S Σ | 1..1 | code | preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event.
statusReason[x] |  | 0..1 |  | Why a dispense was not performed Binding: MedicationDispense Status Reason Codes (example): A code describing why a dispense was not performed.
statusReasonCodeableConcept |  |  | CodeableConcept |
statusReasonReference |  |  | Reference(DetectedIssue) |
category |  | 0..1 | CodeableConcept | Type of medication dispense Binding: MedicationDispense Category Codes (preferred): A code describing where the dispensed medication is expected to be consumed or administered.
medication[x] | S Σ | 1..1 |  | What medication was supplied Binding: https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct (preferred): TBD. This is a placeholder for a comprehensive valueset, consisting of all Manufactured Product (MP), Non-proprietary Therapeutic Product (NTP) and Therapeutic Moiety (TM) codes, which would be created and maintained by Canada Health Infoway. Medicinal products for prescribing and dispensing in Canada. The content of this subset only contains commonly used medicinal products that are available for prescribing and dispensing in Canada. This content will expand to include all human medicinal products over time. Example DIN: {"coding":[{"system":"https://fhir.infoway-inforoute.ca/ValueSet/CA-HC-DIN"}]} Example NPN: {"coding":[{"system":"https://fhir.infoway-inforoute.ca/ValueSet/CA-HC-NPN"}]} Example CCDD: {"coding":[{"system":"https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct"}]} Example SNOMED CT (Medications) - IPS: {"coding":[{"system":"http://hl7.org/fhir/uv/ips/ValueSet/medication-snomed-uv-ips"}]} Example WHO ATC IPS: {"coding":[{"system":"http://hl7.org/fhir/uv/ips/ValueSet/whoatc-uv-ips"}]}
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(Medication Profile) |
subject | S Σ | 1..1 | Reference(Patient Profile) | Who the dispense is for
context |  | 0..1 | Reference(Encounter Profile | EpisodeOfCare) | Encounter / Episode associated with event
supportingInformation |  | 0..* | Reference(Resource) | Information that supports the dispensing of the medication
performer |  | 0..* | BackboneElement | Who performed event
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
function |  | 0..1 | CodeableConcept | Who performed the dispense and what they did Binding: MedicationDispense Performer Function Codes (example): A code describing the role an individual played in dispensing a medication.
actor | S | 1..1 | Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Organization Profile | Patient Profile | Device Profile (Implantable) | RelatedPerson) | Individual who was performing
location |  | 0..1 | Reference(Location Profile) | Where the dispense occurred
authorizingPrescription |  | 0..* | Reference(MedicationRequest Profile) | Medication order that authorizes the dispense
type |  | 0..1 | CodeableConcept | Trial fill, partial fill, emergency fill, etc. Binding: ActPharmacySupplyType (example): Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc.
quantity | S | 0..1 | SimpleQuantity(4.0.1) | Amount dispensed
daysSupply |  | 0..1 | SimpleQuantity(4.0.1) | Amount of medication expressed as a timing amount
whenPrepared | S Σ | 0..1 | dateTime | When product was packaged and reviewed
whenHandedOver |  | 0..1 | dateTime | When product was given out
destination |  | 0..1 | Reference(Location Profile) | Where the medication was sent
receiver |  | 0..* | Reference(Patient Profile | Practitioner Profile (General)) | Who collected the medication
note |  | 0..* | Annotation | Information about the dispense
dosageInstruction | S | 0..* | Dosage | How the medication is to be used by the patient or administered by the caregiver
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:instructionRelationship |  | 0..1 | ?gen-e1? [CanonicalType[http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship]] | Socialized Optional Extension: PrescribeIT dosageInstruction Relationship URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | Σ | 0..1 | integer | The order of the dosage instructions
text | S Σ | 0..1 | string | Free text dosage instructions e.g. SIG
additionalInstruction | Σ | 0..* | CodeableConcept | Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness" Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
patientInstruction | Σ | 0..1 | string | Patient or consumer oriented instructions
timing | Σ | 0..1 | Timing | When medication should be administered
asNeeded[x] | Σ | 0..1 |  | Take "as needed" (for x) Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.
asNeededBoolean |  |  | boolean |
asNeededCodeableConcept |  |  | CodeableConcept |
site | Σ | 0..1 | CodeableConcept | Body site to administer to Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.
route | Σ | 0..1 | CodeableConcept | How drug should enter body Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
method | Σ | 0..1 | CodeableConcept | Technique for administering medication Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.
doseAndRate | Σ | 0..* | Element | Amount of medication administered
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
type | Σ | 0..1 | CodeableConcept | The kind of dose or rate specified Binding: DoseAndRateType (example): The kind of dose or rate specified.
dose[x] | Σ | 0..1 |  | Amount of medication per dose
doseRange |  |  | Range |
doseQuantity |  |  | Quantity(SimpleQuantity) |
rate[x] | Σ | 0..1 |  | Amount of medication per unit of time
rateRatio |  |  | Ratio |
rateRange |  |  | Range |
rateQuantity |  |  | Quantity(SimpleQuantity) |
maxDosePerPeriod | Σ | 0..1 | Ratio | Upper limit on medication per unit of time
maxDosePerAdministration | Σ | 0..1 | SimpleQuantity(4.0.1) | Upper limit on medication per administration
maxDosePerLifetime | Σ | 0..1 | SimpleQuantity(4.0.1) | Upper limit on medication per lifetime of the patient
substitution |  | 0..1 | BackboneElement | Whether a substitution was performed on the dispense
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
wasSubstituted |  | 1..1 | boolean | Whether a substitution was or was not performed on the dispense
type |  | 0..1 | CodeableConcept | Code signifying whether a different drug was dispensed from what was prescribed Binding: ActSubstanceAdminSubstitutionCode (example): A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription.
reason |  | 0..* | CodeableConcept | Why was substitution made Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
responsibleParty |  | 0..* | Reference(Practitioner Profile (General) | PractitionerRole Profile (General)) | Who is responsible for the substitution
detectedIssue |  | 0..* | Reference(DetectedIssue) | Clinical issue with action
eventHistory |  | 0..* | Reference(Provenance) | A list of relevant lifecycle events
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationDispense.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
MedicationDispense.status | Base | required | Medication dispense status codes | 📍4.0.1 | FHIR Std.
MedicationDispense.statusReason[x] | Base | example | Medication dispense status reason codes | 📍4.0.1 | FHIR Std.
MedicationDispense.category | Base | preferred | Medication dispense category codes | 📍4.0.1 | FHIR Std.
MedicationDispense.medication[x] | Base | preferred | https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct | Not Stated | Unknown
MedicationDispense.performer.​function | Base | example | Medication dispense performer function codes | 📍4.0.1 | FHIR Std.
MedicationDispense.type | Base | example | ActPharmacySupplyType | 📦3.0.0 | THO v6.5
MedicationDispense.dosageInstruction.​additionalInstruction | Base | example | SNOMED CT Additional Dosage Instructions | 📍4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​asNeeded[x] | Base | example | SNOMED CT Medication As Needed Reason Codes | 📍4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​site | Base | example | SNOMED CT Anatomical Structure for Administration Site Codes | 📍4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​route | Base | example | SNOMED CT Route Codes | 📍4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​method | Base | example | SNOMED CT Administration Method Codes | 📍4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​doseAndRate.type | Base | example | DoseAndRateType | 📍4.0.1 | FHIR Std.
MedicationDispense.substitution.​type | Base | example | ActSubstanceAdminSubstitutionCode | 📦3.0.0 | THO v6.5
MedicationDispense.substitution.​reason | Base | example | SubstanceAdminSubstitutionReason | 📦3.0.0 | THO v6.5

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | MedicationDispense | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | MedicationDispense | 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 | MedicationDispense | 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 | MedicationDispense | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | MedicationDispense | 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()`
mdd-1 | error | MedicationDispense | whenHandedOver cannot be before whenPrepared | `whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared`

This structure is derived from MedicationDispense

Summary

Mandatory: 1 element
Must-Support: 8 elements

Structures

This structure refers to these other structures:

- Procedure Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-procedure)
- Medication Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-medication)
- Patient Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-patient)
- Encounter Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-encounter)
- Practitioner Profile (General) (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitioner)
- PractitionerRole Profile (General) (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitionerrole)
- Organization Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-organization)
- Device Profile (Implantable) (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-device)
- Location Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-location)
- MedicationRequest Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-medicationrequest)

Extensions

This structure refers to these extensions:

- Unable to summarise extension http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage (no extension found)
- Unable to summarise extension http://prescribeit.ca/fhir/StructureDefinition/ext-dispense-quantity-remaining (no extension found)
- Unable to summarise extension http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship (no extension found)

Other representations of profile: CSV, Excel, Schematron