Canadian Baseline
1.1.0 - CI Build Canada flag

Canadian Baseline, published by HL7 Canada - FHIR Implementation Work Group. This guide is not an authorized publication; it is the continuous build for version 1.1.0 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: MedicationDispenseProfile - Detailed Descriptions

Draft as of 2020-03-05

Definitions for the profile-medicationdispense resource profile.

Guidance on how to interpret the contents of this table can be found here

0. MedicationDispense
Definition

The Canadian Baseline MedicationDispense Profile is based upon the core FHIR MedicationDispense Resource

ShortMedicationDispense Profile
2. MedicationDispense.extension
SlicingThis element introduces a set of slices on MedicationDispense.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 4. MedicationDispense.extension:renderedDosageInstruction
    Slice NamerenderedDosageInstruction
    Definition

    Provides a complete text rendering of dosageInstruction lines for an order or dispense (separate from the rendering of the overall resource instance)

    ShortSocialized Optional Extension: PrescribeIT renderedDosageInstruction
    Control0..1
    TypeExtension(http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage)
    6. MedicationDispense.extension:quantityRemaining
    Slice NamequantityRemaining
    Definition

    The total authorized quantity outstanding after the fill issued as part of this dispense record

    ShortSocialized Optional Extension: PrescribeIT quantityRemaining
    Comments

    In R5, an equivalent extension is put forth in the base FHIR specification - R5 implementors are encouraged to review: http://hl7.org/fhir/StructureDefinition/medicationdispense-quantityRemaining

    Control0..1
    TypeExtension(http://prescribeit.ca/fhir/StructureDefinition/ext-dispense-quantity-remaining)
    8. MedicationDispense.partOf
    TypeReference(Procedure Profile)
    10. MedicationDispense.status
    Must Supporttrue
    12. MedicationDispense.medication[x]
    BindingThe codes SHOULD be taken from https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct
    (preferred to https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct)

    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.

    TypeChoice of: CodeableConcept, Reference(Medication Profile)
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Must Supporttrue
    Must Support TypesNo must-support rules about the choice of types/profiles
    Example<br/><b>DIN</b>:{ "coding" : [{ "system" : "https://fhir.infoway-inforoute.ca/ValueSet/CA-HC-DIN" }] } <br/><b>NPN</b>:{ "coding" : [{ "system" : "https://fhir.infoway-inforoute.ca/ValueSet/CA-HC-NPN" }] } <br/><b>CCDD</b>:{ "coding" : [{ "system" : "https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct" }] } <br/><b>SNOMED CT (Medications) - IPS</b>:{ "coding" : [{ "system" : "http://hl7.org/fhir/uv/ips/ValueSet/medication-snomed-uv-ips" }] } <br/><b>WHO ATC IPS</b>:{ "coding" : [{ "system" : "http://hl7.org/fhir/uv/ips/ValueSet/whoatc-uv-ips" }] }
    14. MedicationDispense.subject
    Control1..?
    TypeReference(Patient Profile)
    Must Supporttrue
    16. MedicationDispense.context
    TypeReference(Encounter Profile, EpisodeOfCare)
    18. MedicationDispense.performer
    20. MedicationDispense.performer.actor
    TypeReference(Practitioner Profile (General), PractitionerRole Profile (General), Organization Profile, Patient Profile, Device Profile (Implantable), RelatedPerson)
    Must Supporttrue
    Must Support TypesNo must-support rules about the choice of types/profiles
    22. MedicationDispense.location
    TypeReference(Location Profile)
    24. MedicationDispense.authorizingPrescription
    TypeReference(MedicationRequest Profile)
    26. MedicationDispense.quantity
    Must Supporttrue
    28. MedicationDispense.whenPrepared
    Must Supporttrue
    30. MedicationDispense.destination
    TypeReference(Location Profile)
    32. MedicationDispense.receiver
    TypeReference(Patient Profile, Practitioner Profile (General))
    34. MedicationDispense.dosageInstruction
    Must Supporttrue
    36. MedicationDispense.dosageInstruction.extension
    SlicingThis element introduces a set of slices on MedicationDispense.dosageInstruction.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 38. MedicationDispense.dosageInstruction.extension:instructionRelationship
      Slice NameinstructionRelationship
      Definition

      Indicates how the timing of this dosage instruction relates to the preceding dosage instruction. Specifically, is it concurrent (AND) or sequential (THEN).

      ShortSocialized Optional Extension: PrescribeIT dosageInstruction Relationship
      Control0..1
      TypeExtension(http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship)
      40. MedicationDispense.dosageInstruction.text
      Must Supporttrue
      42. MedicationDispense.substitution
      44. MedicationDispense.substitution.responsibleParty
      TypeReference(Practitioner Profile (General), PractitionerRole Profile (General))

      Guidance on how to interpret the contents of this table can be found here

      0. MedicationDispense
      Definition

      The Canadian Baseline MedicationDispense Profile is based upon the core FHIR MedicationDispense Resource


      Indicates that a medication product is to be or has been dispensed for a named person/patient. This includes a description of the medication product (supply) provided and the instructions for administering the medication. The medication dispense is the result of a pharmacy system responding to a medication order.

      ShortMedicationDispense ProfileDispensing a medication to a named patient
      Control0..*
      Is Modifierfalse
      Summaryfalse
      Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
      dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
      dom-6: A resource should have narrative for robust management (text.`div`.exists())
      mdd-1: whenHandedOver cannot be before whenPrepared (whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared)
      mdd-1: whenHandedOver cannot be before whenPrepared (whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared)
      2. MedicationDispense.implicitRules
      Definition

      A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

      ShortA set of rules under which this content was created
      Comments

      Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

      Control0..1
      Typeuri
      Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      4. MedicationDispense.extension
      Definition

      An Extension


      May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

      ShortExtensionAdditional content defined by implementations
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      SlicingThis element introduces a set of slices on MedicationDispense.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 6. MedicationDispense.extension:renderedDosageInstruction
        Slice NamerenderedDosageInstruction
        Definition

        Provides a complete text rendering of dosageInstruction lines for an order or dispense (separate from the rendering of the overall resource instance)

        ShortSocialized Optional Extension: PrescribeIT renderedDosageInstruction
        Control0..1
        TypeExtension(http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        8. MedicationDispense.extension:quantityRemaining
        Slice NamequantityRemaining
        Definition

        The total authorized quantity outstanding after the fill issued as part of this dispense record

        ShortSocialized Optional Extension: PrescribeIT quantityRemaining
        Comments

        In R5, an equivalent extension is put forth in the base FHIR specification - R5 implementors are encouraged to review: http://hl7.org/fhir/StructureDefinition/medicationdispense-quantityRemaining

        Control0..1
        TypeExtension(http://prescribeit.ca/fhir/StructureDefinition/ext-dispense-quantity-remaining)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        10. MedicationDispense.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
        Summaryfalse
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        12. MedicationDispense.partOf
        Definition

        The procedure that trigger the dispense.

        ShortEvent that dispense is part of
        Control0..*
        TypeReference(Procedure Profile, Procedure)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        14. MedicationDispense.status
        Definition

        A code specifying the state of the set of dispense events.

        Shortpreparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
        Comments

        This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

        Control1..1
        BindingThe codes SHALL be taken from MedicationDispense Status Codeshttp://hl7.org/fhir/ValueSet/medicationdispense-status|4.0.1
        (required to http://hl7.org/fhir/ValueSet/medicationdispense-status|4.0.1)

        A coded concept specifying the state of the dispense event.

        Typecode
        Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        16. MedicationDispense.medication[x]
        Definition

        Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.

        ShortWhat medication was supplied
        Comments

        If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended. For example, if you require form or lot number, then you must reference the Medication resource.

        Control1..1
        BindingThe codes SHOULD be taken from For example codes, see https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproducthttp://hl7.org/fhir/ValueSet/medication-codes
        (preferred to https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct)

        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.


        A coded concept identifying which substance or product can be dispensed.

        TypeChoice of: CodeableConcept, Reference(Medication Profile, Medication)
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Must Supporttrue
        Must Support TypesNo must-support rules about the choice of types/profiles
        Summarytrue
        Example<br/><b>DIN</b>:{ "coding" : [{ "system" : "https://fhir.infoway-inforoute.ca/ValueSet/CA-HC-DIN" }] } <br/><b>NPN</b>:{ "coding" : [{ "system" : "https://fhir.infoway-inforoute.ca/ValueSet/CA-HC-NPN" }] } <br/><b>CCDD</b>:{ "coding" : [{ "system" : "https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct" }] } <br/><b>SNOMED CT (Medications) - IPS</b>:{ "coding" : [{ "system" : "http://hl7.org/fhir/uv/ips/ValueSet/medication-snomed-uv-ips" }] } <br/><b>WHO ATC IPS</b>:{ "coding" : [{ "system" : "http://hl7.org/fhir/uv/ips/ValueSet/whoatc-uv-ips" }] }
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        18. MedicationDispense.subject
        Definition

        A link to a resource representing the person or the group to whom the medication will be given.

        ShortWho the dispense is for
        Comments

        SubstanceAdministration->subject->Patient.

        Control10..1
        TypeReference(Patient Profile, Patient, Group)
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        20. MedicationDispense.context
        Definition

        The encounter or episode of care that establishes the context for this event.

        ShortEncounter / Episode associated with event
        Control0..1
        TypeReference(Encounter Profile, EpisodeOfCare, Encounter)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        22. MedicationDispense.performer
        Definition

        Indicates who or what performed the event.

        ShortWho performed event
        Control0..*
        TypeBackboneElement
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        24. MedicationDispense.performer.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        26. MedicationDispense.performer.actor
        Definition

        The device, practitioner, etc. who performed the action. It should be assumed that the actor is the dispenser of the medication.

        ShortIndividual who was performing
        Control1..1
        TypeReference(Practitioner Profile (General), PractitionerRole Profile (General), Organization Profile, Patient Profile, Device Profile (Implantable), RelatedPerson, Practitioner, PractitionerRole, Organization, Patient, Device)
        Is Modifierfalse
        Must Supporttrue
        Must Support TypesNo must-support rules about the choice of types/profiles
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        28. MedicationDispense.location
        Definition

        The principal physical location where the dispense was performed.

        ShortWhere the dispense occurred
        Control0..1
        TypeReference(Location Profile, Location)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        30. MedicationDispense.authorizingPrescription
        Definition

        Indicates the medication order that is being dispensed against.

        ShortMedication order that authorizes the dispense
        Comments

        Maps to basedOn in Event logical model.

        Control0..*
        TypeReference(MedicationRequest Profile, MedicationRequest)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        32. MedicationDispense.quantity
        Definition

        The amount of medication that has been dispensed. Includes unit of measure.

        ShortAmount dispensed
        Control0..1
        TypeQuantity(SimpleQuantity)
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        34. MedicationDispense.whenPrepared
        Definition

        The time when the dispensed product was packaged and reviewed.

        ShortWhen product was packaged and reviewed
        Control0..1
        TypedateTime
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        36. MedicationDispense.destination
        Definition

        Identification of the facility/location where the medication was shipped to, as part of the dispense event.

        ShortWhere the medication was sent
        Control0..1
        TypeReference(Location Profile, Location)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        38. MedicationDispense.receiver
        Definition

        Identifies the person who picked up the medication. This will usually be a patient or their caregiver, but some cases exist where it can be a healthcare professional.

        ShortWho collected the medication
        Control0..*
        TypeReference(Patient Profile, Practitioner Profile (General), Patient, Practitioner)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        40. MedicationDispense.dosageInstruction
        Definition

        Indicates how the medication is to be used by the patient.

        ShortHow the medication is to be used by the patient or administered by the caregiver
        Comments

        When the dose or rate is intended to change over the entire administration period (e.g. Tapering dose prescriptions), multiple instances of dosage instructions will need to be supplied to convey the different doses/rates. The pharmacist reviews the medication order prior to dispense and updates the dosageInstruction based on the actual product being dispensed.

        Control0..*
        TypeDosage
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        42. MedicationDispense.dosageInstruction.extension
        Definition

        An Extension


        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

        ShortExtensionAdditional content defined by implementations
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        SlicingThis element introduces a set of slices on MedicationDispense.dosageInstruction.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 44. MedicationDispense.dosageInstruction.extension:instructionRelationship
          Slice NameinstructionRelationship
          Definition

          Indicates how the timing of this dosage instruction relates to the preceding dosage instruction. Specifically, is it concurrent (AND) or sequential (THEN).

          ShortSocialized Optional Extension: PrescribeIT dosageInstruction Relationship
          Control0..1
          TypeExtension(http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship)
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          46. MedicationDispense.dosageInstruction.modifierExtension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
          Summarytrue
          Requirements

          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

          Alternate Namesextensions, user content, modifiers
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          48. MedicationDispense.dosageInstruction.text
          Definition

          Free text dosage instructions e.g. SIG.

          ShortFree text dosage instructions e.g. SIG
          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Requirements

          Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing. Additional information about administration or preparation of the medication should be included as text.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

          Guidance on how to interpret the contents of this table can be found here

          0. MedicationDispense
          Definition

          The Canadian Baseline MedicationDispense Profile is based upon the core FHIR MedicationDispense Resource

          ShortMedicationDispense Profile
          Control0..*
          Is Modifierfalse
          Summaryfalse
          Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
          dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
          dom-6: A resource should have narrative for robust management (text.`div`.exists())
          mdd-1: whenHandedOver cannot be before whenPrepared (whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared)
          2. MedicationDispense.id
          Definition

          The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

          ShortLogical id of this artifact
          Comments

          The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

          Control0..1
          Typeid
          Is Modifierfalse
          Summarytrue
          4. MedicationDispense.meta
          Definition

          The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

          ShortMetadata about the resource
          Control0..1
          TypeMeta
          Is Modifierfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          6. MedicationDispense.implicitRules
          Definition

          A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

          ShortA set of rules under which this content was created
          Comments

          Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

          Control0..1
          Typeuri
          Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          8. MedicationDispense.language
          Definition

          The base language in which the resource is written.

          ShortLanguage of the resource content
          Comments

          Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

          Control0..1
          BindingThe codes SHOULD be taken from CommonLanguages
          (preferred to http://hl7.org/fhir/ValueSet/languages)

          A human language.

          Additional BindingsPurpose
          AllLanguagesMax Binding
          Typecode
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          10. MedicationDispense.text
          Definition

          A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

          ShortText summary of the resource, for human interpretation
          Comments

          Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

          Control0..1
          TypeNarrative
          Is Modifierfalse
          Summaryfalse
          Alternate Namesnarrative, html, xhtml, display
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          12. MedicationDispense.contained
          Definition

          These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

          ShortContained, inline Resources
          Comments

          This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

          Control0..*
          TypeResource
          Is Modifierfalse
          Summaryfalse
          Alternate Namesinline resources, anonymous resources, contained resources
          14. MedicationDispense.extension
          Definition

          An Extension

          ShortExtension
          Control0..*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          SlicingThis element introduces a set of slices on MedicationDispense.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 16. MedicationDispense.extension:renderedDosageInstruction
            Slice NamerenderedDosageInstruction
            Definition

            Provides a complete text rendering of dosageInstruction lines for an order or dispense (separate from the rendering of the overall resource instance)

            ShortSocialized Optional Extension: PrescribeIT renderedDosageInstruction
            Control0..1
            TypeExtension(http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage)
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            18. MedicationDispense.extension:quantityRemaining
            Slice NamequantityRemaining
            Definition

            The total authorized quantity outstanding after the fill issued as part of this dispense record

            ShortSocialized Optional Extension: PrescribeIT quantityRemaining
            Comments

            In R5, an equivalent extension is put forth in the base FHIR specification - R5 implementors are encouraged to review: http://hl7.org/fhir/StructureDefinition/medicationdispense-quantityRemaining

            Control0..1
            TypeExtension(http://prescribeit.ca/fhir/StructureDefinition/ext-dispense-quantity-remaining)
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            20. MedicationDispense.modifierExtension
            Definition

            May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

            ShortExtensions that cannot be ignored
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control0..*
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
            Summaryfalse
            Requirements

            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

            Alternate Namesextensions, user content
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            22. MedicationDispense.identifier
            Definition

            Identifiers associated with this Medication Dispense that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server.

            ShortExternal identifier
            Comments

            This is a business identifier, not a resource identifier.

            NoteThis is a business identifier, not a resource identifier (see discussion)
            Control0..*
            TypeIdentifier
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            24. MedicationDispense.partOf
            Definition

            The procedure that trigger the dispense.

            ShortEvent that dispense is part of
            Control0..*
            TypeReference(Procedure Profile)
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            26. MedicationDispense.status
            Definition

            A code specifying the state of the set of dispense events.

            Shortpreparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
            Comments

            This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

            Control1..1
            BindingThe codes SHALL be taken from MedicationDispense Status Codes
            (required to http://hl7.org/fhir/ValueSet/medicationdispense-status|4.0.1)

            A coded concept specifying the state of the dispense event.

            Typecode
            Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            28. MedicationDispense.statusReason[x]
            Definition

            Indicates the reason why a dispense was not performed.

            ShortWhy a dispense was not performed
            Control0..1
            BindingFor example codes, see MedicationDispense Status Reason Codes
            (example to http://hl7.org/fhir/ValueSet/medicationdispense-status-reason)

            A code describing why a dispense was not performed.

            TypeChoice of: CodeableConcept, Reference(DetectedIssue)
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            30. MedicationDispense.category
            Definition

            Indicates the type of medication dispense (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)).

            ShortType of medication dispense
            Comments

            The category can be used to include where the medication is expected to be consumed or other types of dispenses. Invariants can be used to bind to different value sets when profiling to bind.

            Control0..1
            BindingThe codes SHOULD be taken from MedicationDispense Category Codes
            (preferred to http://hl7.org/fhir/ValueSet/medicationdispense-category)

            A code describing where the dispensed medication is expected to be consumed or administered.

            TypeCodeableConcept
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            32. MedicationDispense.medication[x]
            Definition

            Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.

            ShortWhat medication was supplied
            Comments

            If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended. For example, if you require form or lot number, then you must reference the Medication resource.

            Control1..1
            BindingThe codes SHOULD be taken from https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct
            (preferred to https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct)

            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.

            TypeChoice of: CodeableConcept, Reference(Medication Profile)
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Must Supporttrue
            Must Support TypesNo must-support rules about the choice of types/profiles
            Summarytrue
            Example<br/><b>DIN</b>:{ "coding" : [{ "system" : "https://fhir.infoway-inforoute.ca/ValueSet/CA-HC-DIN" }] } <br/><b>NPN</b>:{ "coding" : [{ "system" : "https://fhir.infoway-inforoute.ca/ValueSet/CA-HC-NPN" }] } <br/><b>CCDD</b>:{ "coding" : [{ "system" : "https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct" }] } <br/><b>SNOMED CT (Medications) - IPS</b>:{ "coding" : [{ "system" : "http://hl7.org/fhir/uv/ips/ValueSet/medication-snomed-uv-ips" }] } <br/><b>WHO ATC IPS</b>:{ "coding" : [{ "system" : "http://hl7.org/fhir/uv/ips/ValueSet/whoatc-uv-ips" }] }
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            34. MedicationDispense.subject
            Definition

            A link to a resource representing the person or the group to whom the medication will be given.

            ShortWho the dispense is for
            Comments

            SubstanceAdministration->subject->Patient.

            Control1..1
            TypeReference(Patient Profile)
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            36. MedicationDispense.context
            Definition

            The encounter or episode of care that establishes the context for this event.

            ShortEncounter / Episode associated with event
            Control0..1
            TypeReference(Encounter Profile, EpisodeOfCare)
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            38. MedicationDispense.supportingInformation
            Definition

            Additional information that supports the medication being dispensed.

            ShortInformation that supports the dispensing of the medication
            Control0..*
            TypeReference(Resource)
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            40. MedicationDispense.performer
            Definition

            Indicates who or what performed the event.

            ShortWho performed event
            Control0..*
            TypeBackboneElement
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            42. MedicationDispense.performer.id
            Definition

            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

            ShortUnique id for inter-element referencing
            Control0..1
            Typestring
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            44. MedicationDispense.performer.extension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

            ShortAdditional content defined by implementations
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control0..*
            TypeExtension
            Is Modifierfalse
            Summaryfalse
            Alternate Namesextensions, user content
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            46. MedicationDispense.performer.modifierExtension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

            ShortExtensions that cannot be ignored even if unrecognized
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control0..*
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summarytrue
            Requirements

            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

            Alternate Namesextensions, user content, modifiers
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            48. MedicationDispense.performer.function
            Definition

            Distinguishes the type of performer in the dispense. For example, date enterer, packager, final checker.

            ShortWho performed the dispense and what they did
            Control0..1
            BindingFor example codes, see MedicationDispense Performer Function Codes
            (example to http://hl7.org/fhir/ValueSet/medicationdispense-performer-function)

            A code describing the role an individual played in dispensing a medication.

            TypeCodeableConcept
            Is Modifierfalse
            Summaryfalse
            Requirements

            Allows disambiguation of the types of involvement of different performers.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            50. MedicationDispense.performer.actor
            Definition

            The device, practitioner, etc. who performed the action. It should be assumed that the actor is the dispenser of the medication.

            ShortIndividual who was performing
            Control1..1
            TypeReference(Practitioner Profile (General), PractitionerRole Profile (General), Organization Profile, Patient Profile, Device Profile (Implantable), RelatedPerson)
            Is Modifierfalse
            Must Supporttrue
            Must Support TypesNo must-support rules about the choice of types/profiles
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            52. MedicationDispense.location
            Definition

            The principal physical location where the dispense was performed.

            ShortWhere the dispense occurred
            Control0..1
            TypeReference(Location Profile)
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            54. MedicationDispense.authorizingPrescription
            Definition

            Indicates the medication order that is being dispensed against.

            ShortMedication order that authorizes the dispense
            Comments

            Maps to basedOn in Event logical model.

            Control0..*
            TypeReference(MedicationRequest Profile)
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            56. MedicationDispense.type
            Definition

            Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc.

            ShortTrial fill, partial fill, emergency fill, etc.
            Control0..1
            BindingFor example codes, see ActPharmacySupplyType
            (example to http://terminology.hl7.org/ValueSet/v3-ActPharmacySupplyType)

            Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc.

            TypeCodeableConcept
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            58. MedicationDispense.quantity
            Definition

            The amount of medication that has been dispensed. Includes unit of measure.

            ShortAmount dispensed
            Control0..1
            TypeQuantity(SimpleQuantity)
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            60. MedicationDispense.daysSupply
            Definition

            The amount of medication expressed as a timing amount.

            ShortAmount of medication expressed as a timing amount
            Control0..1
            TypeQuantity(SimpleQuantity)
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            62. MedicationDispense.whenPrepared
            Definition

            The time when the dispensed product was packaged and reviewed.

            ShortWhen product was packaged and reviewed
            Control0..1
            TypedateTime
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            64. MedicationDispense.whenHandedOver
            Definition

            The time the dispensed product was provided to the patient or their representative.

            ShortWhen product was given out
            Control0..1
            TypedateTime
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            66. MedicationDispense.destination
            Definition

            Identification of the facility/location where the medication was shipped to, as part of the dispense event.

            ShortWhere the medication was sent
            Control0..1
            TypeReference(Location Profile)
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            68. MedicationDispense.receiver
            Definition

            Identifies the person who picked up the medication. This will usually be a patient or their caregiver, but some cases exist where it can be a healthcare professional.

            ShortWho collected the medication
            Control0..*
            TypeReference(Patient Profile, Practitioner Profile (General))
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            70. MedicationDispense.note
            Definition

            Extra information about the dispense that could not be conveyed in the other attributes.

            ShortInformation about the dispense
            Control0..*
            TypeAnnotation
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            72. MedicationDispense.dosageInstruction
            Definition

            Indicates how the medication is to be used by the patient.

            ShortHow the medication is to be used by the patient or administered by the caregiver
            Comments

            When the dose or rate is intended to change over the entire administration period (e.g. Tapering dose prescriptions), multiple instances of dosage instructions will need to be supplied to convey the different doses/rates. The pharmacist reviews the medication order prior to dispense and updates the dosageInstruction based on the actual product being dispensed.

            Control0..*
            TypeDosage
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            74. MedicationDispense.dosageInstruction.id
            Definition

            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

            ShortUnique id for inter-element referencing
            Control0..1
            Typestring
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            76. MedicationDispense.dosageInstruction.extension
            Definition

            An Extension

            ShortExtension
            Control0..*
            TypeExtension
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            SlicingThis element introduces a set of slices on MedicationDispense.dosageInstruction.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 78. MedicationDispense.dosageInstruction.extension:instructionRelationship
              Slice NameinstructionRelationship
              Definition

              Indicates how the timing of this dosage instruction relates to the preceding dosage instruction. Specifically, is it concurrent (AND) or sequential (THEN).

              ShortSocialized Optional Extension: PrescribeIT dosageInstruction Relationship
              Control0..1
              TypeExtension(http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship)
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              80. MedicationDispense.dosageInstruction.modifierExtension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summarytrue
              Requirements

              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

              Alternate Namesextensions, user content, modifiers
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              82. MedicationDispense.dosageInstruction.sequence
              Definition

              Indicates the order in which the dosage instructions should be applied or interpreted.

              ShortThe order of the dosage instructions
              Control0..1
              Typeinteger
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. If the sequence number is different, then the Dosages are intended to be sequential.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              84. MedicationDispense.dosageInstruction.text
              Definition

              Free text dosage instructions e.g. SIG.

              ShortFree text dosage instructions e.g. SIG
              Control0..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Requirements

              Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing. Additional information about administration or preparation of the medication should be included as text.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              86. MedicationDispense.dosageInstruction.additionalInstruction
              Definition

              Supplemental instructions to the patient on how to take the medication (e.g. "with meals" or"take half to one hour before food") or warnings for the patient about the medication (e.g. "may cause drowsiness" or "avoid exposure of skin to direct sunlight or sunlamps").

              ShortSupplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
              Comments

              Information about administration or preparation of the medication (e.g. "infuse as rapidly as possibly via intraperitoneal port" or "immediately following drug x") should be populated in dosage.text.

              Control0..*
              BindingFor example codes, see SNOMEDCTAdditionalDosageInstructions
              (example to http://hl7.org/fhir/ValueSet/additional-instruction-codes)

              A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".

              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Requirements

              Additional instruction is intended to be coded, but where no code exists, the element could include text. For example, "Swallow with plenty of water" which might or might not be coded.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              88. MedicationDispense.dosageInstruction.patientInstruction
              Definition

              Instructions in terms that are understood by the patient or consumer.

              ShortPatient or consumer oriented instructions
              Control0..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              90. MedicationDispense.dosageInstruction.timing
              Definition

              When medication should be administered.

              ShortWhen medication should be administered
              Comments

              This attribute might not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.

              Control0..1
              TypeTiming
              Is Modifierfalse
              Summarytrue
              Requirements

              The timing schedule for giving the medication to the patient. This data type allows many different expressions. For example: "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              92. MedicationDispense.dosageInstruction.asNeeded[x]
              Definition

              Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept).

              ShortTake "as needed" (for x)
              Comments

              Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not "prn" or "as needed".

              Control0..1
              BindingFor example codes, see SNOMEDCTMedicationAsNeededReasonCodes
              (example to http://hl7.org/fhir/ValueSet/medication-as-needed-reason)

              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.

              TypeChoice of: boolean, CodeableConcept
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              94. MedicationDispense.dosageInstruction.site
              Definition

              Body site to administer to.

              ShortBody site to administer to
              Comments

              If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.

              Control0..1
              BindingFor example codes, see SNOMEDCTAnatomicalStructureForAdministrationSiteCodes
              (example to http://hl7.org/fhir/ValueSet/approach-site-codes)

              A coded concept describing the site location the medicine enters into or onto the body.

              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Requirements

              A coded specification of the anatomic site where the medication first enters the body.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              96. MedicationDispense.dosageInstruction.route
              Definition

              How drug should enter body.

              ShortHow drug should enter body
              Control0..1
              BindingFor example codes, see SNOMEDCTRouteCodes
              (example to http://hl7.org/fhir/ValueSet/route-codes)

              A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Requirements

              A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              98. MedicationDispense.dosageInstruction.method
              Definition

              Technique for administering medication.

              ShortTechnique for administering medication
              Comments

              Terminologies used often pre-coordinate this term with the route and or form of administration.

              Control0..1
              BindingFor example codes, see SNOMEDCTAdministrationMethodCodes
              (example to http://hl7.org/fhir/ValueSet/administration-method-codes)

              A coded concept describing the technique by which the medicine is administered.

              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Requirements

              A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              100. MedicationDispense.dosageInstruction.doseAndRate
              Definition

              The amount of medication administered.

              ShortAmount of medication administered
              Control0..*
              TypeElement
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              102. MedicationDispense.dosageInstruction.doseAndRate.id
              Definition

              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

              ShortUnique id for inter-element referencing
              Control0..1
              Typestring
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              104. MedicationDispense.dosageInstruction.doseAndRate.extension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

              ShortAdditional content defined by implementations
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Alternate Namesextensions, user content
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              SlicingThis element introduces a set of slices on MedicationDispense.dosageInstruction.doseAndRate.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 106. MedicationDispense.dosageInstruction.doseAndRate.type
                Definition

                The kind of dose or rate specified, for example, ordered or calculated.

                ShortThe kind of dose or rate specified
                Control0..1
                BindingFor example codes, see DoseAndRateType
                (example to http://hl7.org/fhir/ValueSet/dose-rate-type)

                The kind of dose or rate specified.

                TypeCodeableConcept
                Is Modifierfalse
                Summarytrue
                Requirements

                If the type is not populated, assume to be "ordered".

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                108. MedicationDispense.dosageInstruction.doseAndRate.dose[x]
                Definition

                Amount of medication per dose.

                ShortAmount of medication per dose
                Comments

                Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.

                Control0..1
                TypeChoice of: Range, Quantity(SimpleQuantity)
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Is Modifierfalse
                Summarytrue
                Requirements

                The amount of therapeutic or other substance given at one administration event.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                110. MedicationDispense.dosageInstruction.doseAndRate.rate[x]
                Definition

                Amount of medication per unit of time.

                ShortAmount of medication per unit of time
                Comments

                It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate.

                It is possible to specify a rate over time (for example, 100 ml/hour) using either the rateRatio and rateQuantity. The rateQuantity approach requires systems to have the capability to parse UCUM grammer where ml/hour is included rather than a specific ratio where the time is specified as the denominator. Where a rate such as 500ml over 2 hours is specified, the use of rateRatio may be more semantically correct than specifying using a rateQuantity of 250 mg/hour.

                Control0..1
                TypeChoice of: Ratio, Range, Quantity(SimpleQuantity)
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Is Modifierfalse
                Summarytrue
                Requirements

                Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                112. MedicationDispense.dosageInstruction.maxDosePerPeriod
                Definition

                Upper limit on medication per unit of time.

                ShortUpper limit on medication per unit of time
                Comments

                This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".

                Control0..1
                TypeRatio
                Is Modifierfalse
                Summarytrue
                Requirements

                The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                114. MedicationDispense.dosageInstruction.maxDosePerAdministration
                Definition

                Upper limit on medication per administration.

                ShortUpper limit on medication per administration
                Comments

                This is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg.

                Control0..1
                TypeQuantity(SimpleQuantity)
                Is Modifierfalse
                Summarytrue
                Requirements

                The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                116. MedicationDispense.dosageInstruction.maxDosePerLifetime
                Definition

                Upper limit on medication per lifetime of the patient.

                ShortUpper limit on medication per lifetime of the patient
                Control0..1
                TypeQuantity(SimpleQuantity)
                Is Modifierfalse
                Summarytrue
                Requirements

                The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                118. MedicationDispense.substitution
                Definition

                Indicates whether or not substitution was made as part of the dispense. In some cases, substitution will be expected but does not happen, in other cases substitution is not expected but does happen. This block explains what substitution did or did not happen and why. If nothing is specified, substitution was not done.

                ShortWhether a substitution was performed on the dispense
                Control0..1
                TypeBackboneElement
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                120. MedicationDispense.substitution.id
                Definition

                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                ShortUnique id for inter-element referencing
                Control0..1
                Typestring
                Is Modifierfalse
                XML FormatIn the XML format, this property is represented as an attribute.
                Summaryfalse
                122. MedicationDispense.substitution.extension
                Definition

                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                ShortAdditional content defined by implementations
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Is Modifierfalse
                Summaryfalse
                Alternate Namesextensions, user content
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                124. MedicationDispense.substitution.modifierExtension
                Definition

                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                ShortExtensions that cannot be ignored even if unrecognized
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                Summarytrue
                Requirements

                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                Alternate Namesextensions, user content, modifiers
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                126. MedicationDispense.substitution.wasSubstituted
                Definition

                True if the dispenser dispensed a different drug or product from what was prescribed.

                ShortWhether a substitution was or was not performed on the dispense
                Control1..1
                Typeboolean
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                128. MedicationDispense.substitution.type
                Definition

                A code signifying whether a different drug was dispensed from what was prescribed.

                ShortCode signifying whether a different drug was dispensed from what was prescribed
                Control0..1
                BindingFor example codes, see ActSubstanceAdminSubstitutionCode
                (example to http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode)

                A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription.

                TypeCodeableConcept
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                130. MedicationDispense.substitution.reason
                Definition

                Indicates the reason for the substitution (or lack of substitution) from what was prescribed.

                ShortWhy was substitution made
                Control0..*
                BindingFor example codes, see SubstanceAdminSubstitutionReason
                (example to http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason)

                A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.

                TypeCodeableConcept
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                132. MedicationDispense.substitution.responsibleParty
                Definition

                The person or organization that has primary responsibility for the substitution.

                ShortWho is responsible for the substitution
                Control0..*
                TypeReference(Practitioner Profile (General), PractitionerRole Profile (General))
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                134. MedicationDispense.detectedIssue
                Definition

                Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. drug-drug interaction, duplicate therapy, dosage alert etc.

                ShortClinical issue with action
                Comments

                This element can include a detected issue that has been identified either by a decision support system or by a clinician and may include information on the steps that were taken to address the issue.

                Control0..*
                TypeReference(DetectedIssue)
                Is Modifierfalse
                Summaryfalse
                Alternate NamesContraindication, Drug Utilization Review (DUR), Alert
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                136. MedicationDispense.eventHistory
                Definition

                A summary of the events of interest that have occurred, such as when the dispense was verified.

                ShortA list of relevant lifecycle events
                Comments

                This might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.).

                Control0..*
                TypeReference(Provenance)
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))