QI-Core Implementation Guide
7.0.0 - STU7 United States of America flag

QI-Core Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 7.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-qi-core/ and changes regularly. See the Directory of published versions

Resource Profile: QICore MedicationDispense

Official URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationdispense Version: 7.0.0
Active as of 2018-08-22 Computable Name: QICoreMedicationDispense

Profile of MedicationDispense for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.

Must Have:
  • status: (QI) preparation​ | in-progress​ | cancelled​ | on-hold​ | completed​ | entered-in-error​ | stopped​ | unknown
  • medication[x]: (QI) What medication was supplied
  • subject: (QI) Who the dispense is for
  • performer.actor: Individual who was performing
QI Elements:
  • recorded: (QI) Extension
  • authorizingPrescription: (QI) Medication order that authorizes the dispense
  • type: (QI) Trial fill, partial fill, emergency fill, etc.
  • quantity: (QI) Amount dispensed
  • daysSupply: (QI) Amount of medication expressed as a timing amount
  • whenPrepared: (QI) When product was packaged and reviewed
  • whenHandedOver: (QI) When product was given out or mailed
  • dosageInstruction: (QI) How the medication is to be used by the patient or administered by the caregiver
  • dosageInstruction.text: (QI) Free text dosage instructions e.g. SIG
  • dosageInstruction.timing: (QI) When medication should be administered
  • dosageInstruction.doseAndRate: (QI) Amount of medication administered
  • dosageInstruction.doseAndRate.dose[x]: (QI) Amount of medication per dose
Primary code path: medication
(PCPath) This element is the primary code path for this resource CQL Retrieve


NOTE TO BALLOT REVIEWERS:
  • US Core 7.0, and thus QI-Core 7.0, has a new approach to USCDI requirements.
    • As noted in the US Core 7.0 Must Support section, US Core 7.0 no longer highlights mandatory (cardinality 1..* or 1..1) and Must Support elements with a (USCDI) indicator as such items must be supported for interoperability.
    • Those USCDI elements that are not mandatory or Must Support now include an indicator (ADDITIONAL USCDI) in US Core. QI-Core 7.0 does not reference USCDI elements; rather, users should access US Core 7.0 to understand its implementation of USCDI version 4.
  • We invite comments about the approach and suggestions for other options that would also avoid unnecessary noise or reading load to the QI-Core profile representation.
  • Further, QI-Core 7.0 does not discuss USCDI+Quality because at the time of ballot preparation, no published version of USCDI+Quality is available. We seek reviewer advice regarding how QI-Core might address future USCDI+Quality.

Usage

The MedicationDispense profile defines the conformance expectations for a MedicationDispense event, regardless of whether it is a positive or negative statement. The MedicationDispenseDone and MedicationDispenseDeclined profiles represent the positive and negative statements for a MedicationDispense event.

To create an expression indicating existence of a MedicationDispense event, use the profile QICoreMedicationDispenseDone; to specifically request information that a MedicationDispense intentionally did not occur for a medical, patient or system reason, use the profile QICoreMedicationDispenseDeclined.

The following example illustrates the use of the MedicationDispense profile

define "Dementia Medication Dispensed":
  ["MedicationDispense": "Dementia Medications"] MedicationDispense
    where MedicationDispense.status in { 'active', 'completed', 'on-hold' }

See the patterns page for implementation and usage patterns.

Examples

Penicillin MedicationDispense Example
MedicationDispense Cumulative Duration Example

Usage:

Formal Views of Profile Content

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

This structure is derived from USCoreMedicationDispenseProfile

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense C 0..* USCoreMedicationDispenseProfile Dispensing a medication to a named patient
mdp-1: To indicate what medication, either a reference to a Medication, or at least one coding in the medication or a codeOptions extension shall be provided
... Slices for extension Content/Rules for all slices
.... recorded 0..1 dateTime (QI) When recorded
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationDispense.recorded
... status 1..1 code (QI) preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
... medication[x] 1..1 (QI) What medication was supplied
Binding: Medication Clinical Drug . (extensible): The set of RxNorm codes to represent medications

.... medication[x]All Types Content/Rules for all Types
..... Slices for extension Content/Rules for all slices
...... codeOptions 0..1 canonical(ValueSet) (QI) Url of a value set of candidate medications
URL: http://hl7.org/fhir/StructureDefinition/codeOptions
.... medicationCodeableConcept CodeableConcept
.... medicationReference Reference(QICore Medication)
... authorizingPrescription 0..* Reference(QICore MedicationRequest) (QI) Medication order that authorizes the dispense
... type 0..1 CodeableConcept (QI) Trial fill, partial fill, emergency fill, etc.
Binding: ActPharmacySupplyType (extensible)
... quantity 0..1 SimpleQuantity (QI) Amount dispensed
... daysSupply 0..1 SimpleQuantity (QI) Amount of medication expressed as a timing amount
... whenPrepared 0..1 dateTime (QI) When product was packaged and reviewed
... whenHandedOver 0..1 dateTime (QI) When product was given out or mailed
... dosageInstruction 0..* Dosage (QI) How the medication is to be used by the patient or administered by the caregiver
.... text 0..1 string (QI) Free text dosage instructions e.g. SIG
.... timing 0..1 Timing (QI) When medication should be administered
.... doseAndRate 0..* Element (QI) Amount of medication administered
..... dose[x] 0..1 (QI) Amount of medication per dose
...... doseQuantity Quantity(SimpleQuantity)
...... doseRange Range

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
MedicationDispense.medication[x]extensibleMedicationClinicalDrug .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4
MedicationDispense.typeextensibleActPharmacySupplyType
http://terminology.hl7.org/ValueSet/v3-ActPharmacySupplyType

Constraints

IdGradePath(s)DetailsRequirements
mdp-1errorMedicationDispenseTo indicate what medication, either a reference to a Medication, or at least one coding in the medication or a codeOptions extension shall be provided
: (medication is Reference).not() implies medication.extension('http://hl7.org/fhir/StructureDefinition/codeOptions').exists() xor medication.coding.exists()
NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense C 0..* USCoreMedicationDispenseProfile Dispensing a medication to a named patient
mdd-1: whenHandedOver cannot be before whenPrepared
us-core-20: whenHandedOver SHALL be present if the status is "completed"
mdp-1: To indicate what medication, either a reference to a Medication, or at least one coding in the medication or a codeOptions extension shall be provided
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension Content/Rules for all slices
.... recorded 0..1 dateTime (QI) When recorded
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationDispense.recorded
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... medication[x] SΣ 1..1 (QI) What medication was supplied
Binding: Medication Clinical Drug . (extensible): The set of RxNorm codes to represent medications

.... medication[x]All Types Content/Rules for all Types
..... Slices for extension Content/Rules for all slices
...... codeOptions 0..1 canonical(ValueSet) (QI) Url of a value set of candidate medications
URL: http://hl7.org/fhir/StructureDefinition/codeOptions
.... medicationCodeableConcept CodeableConcept
.... medicationReference Reference(QICore Medication)
... subject SΣ 1..1 Reference(QICore Patient) (QI) Who the dispense is for
... context S 0..1 Reference(US Core Encounter Profile) Encounter associated with MedicationDispense
... performer S 0..* BackboneElement Who performed event
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... actor S 1..1 Reference(US Core Practitioner Profile | US Core Organization Profile) Individual who was performing
... authorizingPrescription S 0..* Reference(QICore MedicationRequest) (QI) Medication order that authorizes the dispense
... type S 0..1 CodeableConcept (QI) Trial fill, partial fill, emergency fill, etc.
Binding: ActPharmacySupplyType (extensible)
... quantity S 0..1 SimpleQuantity (QI) Amount dispensed
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodes Max Binding
... daysSupply 0..1 SimpleQuantity (QI) Amount of medication expressed as a timing amount
... whenPrepared Σ 0..1 dateTime (QI) When product was packaged and reviewed
... whenHandedOver SC 0..1 dateTime (QI) When product was given out or mailed
... dosageInstruction S 0..* Dosage (QI) How the medication is to be used by the patient or administered by the caregiver
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... text SΣ 0..1 string (QI) Free text dosage instructions e.g. SIG
.... timing SΣ 0..1 Timing (QI) When medication should be administered
.... doseAndRate SΣ 0..* Element (QI) Amount of medication administered
..... dose[x] SΣ 0..1 (QI) Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodes Max Binding
...... doseQuantity Quantity(SimpleQuantity)

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
MedicationDispense.statusrequiredMedicationDispense Status Codes
http://hl7.org/fhir/ValueSet/medicationdispense-status|4.0.1
from the FHIR Standard
MedicationDispense.medication[x]extensibleMedicationClinicalDrug .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4
MedicationDispense.typeextensibleActPharmacySupplyType
http://terminology.hl7.org/ValueSet/v3-ActPharmacySupplyType
MedicationDispense.quantitypreferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
http://hl7.org/fhir/ValueSet/ucum-common
from the FHIR Standard
MedicationDispense.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
http://hl7.org/fhir/ValueSet/ucum-common
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorMedicationDispenseIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMedicationDispenseIf 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-4errorMedicationDispenseIf 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-5errorMedicationDispenseIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMedicationDispenseA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
mdp-1errorMedicationDispenseTo indicate what medication, either a reference to a Medication, or at least one coding in the medication or a codeOptions extension shall be provided
: (medication is Reference).not() implies medication.extension('http://hl7.org/fhir/StructureDefinition/codeOptions').exists() xor medication.coding.exists()
mdd-1errorMedicationDispensewhenHandedOver cannot be before whenPrepared
: whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared
us-core-20errorMedicationDispensewhenHandedOver SHALL be present if the status is "completed"
: status='completed' implies whenHandedOver.exists()
NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense C 0..* USCoreMedicationDispenseProfile Dispensing a medication to a named patient
mdd-1: whenHandedOver cannot be before whenPrepared
us-core-20: whenHandedOver SHALL be present if the status is "completed"
mdp-1: To indicate what medication, either a reference to a Medication, or at least one coding in the medication or a codeOptions extension shall be provided
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... recorded 0..1 dateTime (QI) When recorded
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationDispense.recorded
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier 0..* Identifier External identifier
... partOf 0..* Reference(Procedure) Event that dispense is part of
... status ?!SΣC 1..1 code (QI) preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event.

... statusReason[x] 0..1 Why a dispense was not performed
Binding: MedicationDispense Status Reason Codes (example): A code describing why a dispense was not performed.

.... statusReasonCodeableConcept CodeableConcept
.... statusReasonReference Reference(DetectedIssue)
... category 0..1 CodeableConcept Type of medication dispense
Binding: MedicationDispense Category Codes (preferred): A code describing where the dispensed medication is expected to be consumed or administered.

... medication[x] SΣ 1..1 (QI) What medication was supplied
Binding: Medication Clinical Drug . (extensible): The set of RxNorm codes to represent medications

.... medication[x]All Types Content/Rules for all Types
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... codeOptions 0..1 canonical(ValueSet) (QI) Url of a value set of candidate medications
URL: http://hl7.org/fhir/StructureDefinition/codeOptions
.... medicationCodeableConcept CodeableConcept
.... medicationReference Reference(QICore Medication)
... subject SΣ 1..1 Reference(QICore Patient) (QI) Who the dispense is for
... context S 0..1 Reference(US Core Encounter Profile S | EpisodeOfCare) Encounter associated with MedicationDispense
... supportingInformation 0..* Reference(Resource) Information that supports the dispensing of the medication
... performer S 0..* BackboneElement Who performed event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... function 0..1 CodeableConcept Who performed the dispense and what they did
Binding: MedicationDispense Performer Function Codes (example): A code describing the role an individual played in dispensing a medication.

.... actor S 1..1 Reference(US Core Practitioner Profile S | US Core Patient Profile | US Core Organization Profile S | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) Individual who was performing
... location 0..1 Reference(Location) Where the dispense occurred
... authorizingPrescription S 0..* Reference(QICore MedicationRequest) (QI) Medication order that authorizes the dispense
... type S 0..1 CodeableConcept (QI) Trial fill, partial fill, emergency fill, etc.
Binding: ActPharmacySupplyType (extensible)
... quantity S 0..1 SimpleQuantity (QI) Amount dispensed
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodes Max Binding
... daysSupply 0..1 SimpleQuantity (QI) Amount of medication expressed as a timing amount
... whenPrepared Σ 0..1 dateTime (QI) When product was packaged and reviewed
... whenHandedOver SC 0..1 dateTime (QI) When product was given out or mailed
... destination 0..1 Reference(Location) Where the medication was sent
... receiver 0..* Reference(Patient | Practitioner) Who collected the medication
... note 0..* Annotation Information about the dispense
... dosageInstruction S 0..* Dosage (QI) How the medication is to be used by the patient or administered by the caregiver
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 0..1 integer The order of the dosage instructions
.... text SΣ 0..1 string (QI) Free text dosage instructions e.g. SIG
.... additionalInstruction Σ 0..* CodeableConcept Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".


.... patientInstruction Σ 0..1 string Patient or consumer oriented instructions
.... timing SΣ 0..1 Timing (QI) When medication should be administered
.... asNeeded[x] Σ 0..1 Take "as needed" (for x)
Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.

..... asNeededBoolean boolean
..... asNeededCodeableConcept CodeableConcept
.... site Σ 0..1 CodeableConcept Body site to administer to
Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.

.... route Σ 0..1 CodeableConcept How drug should enter body
Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

.... method Σ 0..1 CodeableConcept Technique for administering medication
Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.

.... doseAndRate SΣ 0..* Element (QI) Amount of medication administered
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... type Σ 0..1 CodeableConcept The kind of dose or rate specified
Binding: DoseAndRateType (example): The kind of dose or rate specified.

..... dose[x] SΣ 0..1 (QI) Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodes Max Binding
...... doseQuantity Quantity S(SimpleQuantity)
...... doseRange Range
..... rate[x] Σ 0..1 Amount of medication per unit of time
...... rateRatio Ratio
...... rateRange Range
...... rateQuantity Quantity(SimpleQuantity)
.... maxDosePerPeriod Σ 0..1 Ratio Upper limit on medication per unit of time
.... maxDosePerAdministration Σ 0..1 SimpleQuantity Upper limit on medication per administration
.... maxDosePerLifetime Σ 0..1 SimpleQuantity Upper limit on medication per lifetime of the patient
... substitution 0..1 BackboneElement Whether a substitution was performed on the dispense
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... wasSubstituted 1..1 boolean Whether a substitution was or was not performed on the dispense
.... type 0..1 CodeableConcept Code signifying whether a different drug was dispensed from what was prescribed
Binding: ActSubstanceAdminSubstitutionCode (example): A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription.

.... reason 0..* CodeableConcept Why was substitution made
Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.


.... responsibleParty 0..* Reference(Practitioner | PractitionerRole) Who is responsible for the substitution
... detectedIssue 0..* Reference(DetectedIssue) Clinical issue with action
... eventHistory 0..* Reference(Provenance) A list of relevant lifecycle events

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
MedicationDispense.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
MedicationDispense.statusrequiredMedicationDispense Status Codes
http://hl7.org/fhir/ValueSet/medicationdispense-status|4.0.1
from the FHIR Standard
MedicationDispense.statusReason[x]exampleMedicationDispense Status Reason Codes
http://hl7.org/fhir/ValueSet/medicationdispense-status-reason
from the FHIR Standard
MedicationDispense.categorypreferredMedicationDispense Category Codes
http://hl7.org/fhir/ValueSet/medicationdispense-category
from the FHIR Standard
MedicationDispense.medication[x]extensibleMedicationClinicalDrug .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4
MedicationDispense.performer.functionexampleMedicationDispense Performer Function Codes
http://hl7.org/fhir/ValueSet/medicationdispense-performer-function
from the FHIR Standard
MedicationDispense.typeextensibleActPharmacySupplyType
http://terminology.hl7.org/ValueSet/v3-ActPharmacySupplyType
MedicationDispense.quantitypreferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
http://hl7.org/fhir/ValueSet/ucum-common
from the FHIR Standard
MedicationDispense.dosageInstruction.additionalInstructionexampleSNOMEDCTAdditionalDosageInstructions
http://hl7.org/fhir/ValueSet/additional-instruction-codes
from the FHIR Standard
MedicationDispense.dosageInstruction.asNeeded[x]exampleSNOMEDCTMedicationAsNeededReasonCodes
http://hl7.org/fhir/ValueSet/medication-as-needed-reason
from the FHIR Standard
MedicationDispense.dosageInstruction.siteexampleSNOMEDCTAnatomicalStructureForAdministrationSiteCodes
http://hl7.org/fhir/ValueSet/approach-site-codes
from the FHIR Standard
MedicationDispense.dosageInstruction.routeexampleSNOMEDCTRouteCodes
http://hl7.org/fhir/ValueSet/route-codes
from the FHIR Standard
MedicationDispense.dosageInstruction.methodexampleSNOMEDCTAdministrationMethodCodes
http://hl7.org/fhir/ValueSet/administration-method-codes
from the FHIR Standard
MedicationDispense.dosageInstruction.doseAndRate.typeexampleDoseAndRateType
http://hl7.org/fhir/ValueSet/dose-rate-type
from the FHIR Standard
MedicationDispense.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
http://hl7.org/fhir/ValueSet/ucum-common
from the FHIR Standard
MedicationDispense.substitution.typeexampleActSubstanceAdminSubstitutionCode
http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode
MedicationDispense.substitution.reasonexampleSubstanceAdminSubstitutionReason
http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorMedicationDispenseIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMedicationDispenseIf 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-4errorMedicationDispenseIf 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-5errorMedicationDispenseIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMedicationDispenseA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
mdp-1errorMedicationDispenseTo indicate what medication, either a reference to a Medication, or at least one coding in the medication or a codeOptions extension shall be provided
: (medication is Reference).not() implies medication.extension('http://hl7.org/fhir/StructureDefinition/codeOptions').exists() xor medication.coding.exists()
mdd-1errorMedicationDispensewhenHandedOver cannot be before whenPrepared
: whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared
us-core-20errorMedicationDispensewhenHandedOver SHALL be present if the status is "completed"
: status='completed' implies whenHandedOver.exists()

Differential View

This structure is derived from USCoreMedicationDispenseProfile

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense C 0..* USCoreMedicationDispenseProfile Dispensing a medication to a named patient
mdp-1: To indicate what medication, either a reference to a Medication, or at least one coding in the medication or a codeOptions extension shall be provided
... Slices for extension Content/Rules for all slices
.... recorded 0..1 dateTime (QI) When recorded
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationDispense.recorded
... status 1..1 code (QI) preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
... medication[x] 1..1 (QI) What medication was supplied
Binding: Medication Clinical Drug . (extensible): The set of RxNorm codes to represent medications

.... medication[x]All Types Content/Rules for all Types
..... Slices for extension Content/Rules for all slices
...... codeOptions 0..1 canonical(ValueSet) (QI) Url of a value set of candidate medications
URL: http://hl7.org/fhir/StructureDefinition/codeOptions
.... medicationCodeableConcept CodeableConcept
.... medicationReference Reference(QICore Medication)
... authorizingPrescription 0..* Reference(QICore MedicationRequest) (QI) Medication order that authorizes the dispense
... type 0..1 CodeableConcept (QI) Trial fill, partial fill, emergency fill, etc.
Binding: ActPharmacySupplyType (extensible)
... quantity 0..1 SimpleQuantity (QI) Amount dispensed
... daysSupply 0..1 SimpleQuantity (QI) Amount of medication expressed as a timing amount
... whenPrepared 0..1 dateTime (QI) When product was packaged and reviewed
... whenHandedOver 0..1 dateTime (QI) When product was given out or mailed
... dosageInstruction 0..* Dosage (QI) How the medication is to be used by the patient or administered by the caregiver
.... text 0..1 string (QI) Free text dosage instructions e.g. SIG
.... timing 0..1 Timing (QI) When medication should be administered
.... doseAndRate 0..* Element (QI) Amount of medication administered
..... dose[x] 0..1 (QI) Amount of medication per dose
...... doseQuantity Quantity(SimpleQuantity)
...... doseRange Range

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
MedicationDispense.medication[x]extensibleMedicationClinicalDrug .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4
MedicationDispense.typeextensibleActPharmacySupplyType
http://terminology.hl7.org/ValueSet/v3-ActPharmacySupplyType

Constraints

IdGradePath(s)DetailsRequirements
mdp-1errorMedicationDispenseTo indicate what medication, either a reference to a Medication, or at least one coding in the medication or a codeOptions extension shall be provided
: (medication is Reference).not() implies medication.extension('http://hl7.org/fhir/StructureDefinition/codeOptions').exists() xor medication.coding.exists()

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense C 0..* USCoreMedicationDispenseProfile Dispensing a medication to a named patient
mdd-1: whenHandedOver cannot be before whenPrepared
us-core-20: whenHandedOver SHALL be present if the status is "completed"
mdp-1: To indicate what medication, either a reference to a Medication, or at least one coding in the medication or a codeOptions extension shall be provided
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension Content/Rules for all slices
.... recorded 0..1 dateTime (QI) When recorded
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationDispense.recorded
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... medication[x] SΣ 1..1 (QI) What medication was supplied
Binding: Medication Clinical Drug . (extensible): The set of RxNorm codes to represent medications

.... medication[x]All Types Content/Rules for all Types
..... Slices for extension Content/Rules for all slices
...... codeOptions 0..1 canonical(ValueSet) (QI) Url of a value set of candidate medications
URL: http://hl7.org/fhir/StructureDefinition/codeOptions
.... medicationCodeableConcept CodeableConcept
.... medicationReference Reference(QICore Medication)
... subject SΣ 1..1 Reference(QICore Patient) (QI) Who the dispense is for
... context S 0..1 Reference(US Core Encounter Profile) Encounter associated with MedicationDispense
... performer S 0..* BackboneElement Who performed event
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... actor S 1..1 Reference(US Core Practitioner Profile | US Core Organization Profile) Individual who was performing
... authorizingPrescription S 0..* Reference(QICore MedicationRequest) (QI) Medication order that authorizes the dispense
... type S 0..1 CodeableConcept (QI) Trial fill, partial fill, emergency fill, etc.
Binding: ActPharmacySupplyType (extensible)
... quantity S 0..1 SimpleQuantity (QI) Amount dispensed
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodes Max Binding
... daysSupply 0..1 SimpleQuantity (QI) Amount of medication expressed as a timing amount
... whenPrepared Σ 0..1 dateTime (QI) When product was packaged and reviewed
... whenHandedOver SC 0..1 dateTime (QI) When product was given out or mailed
... dosageInstruction S 0..* Dosage (QI) How the medication is to be used by the patient or administered by the caregiver
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... text SΣ 0..1 string (QI) Free text dosage instructions e.g. SIG
.... timing SΣ 0..1 Timing (QI) When medication should be administered
.... doseAndRate SΣ 0..* Element (QI) Amount of medication administered
..... dose[x] SΣ 0..1 (QI) Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodes Max Binding
...... doseQuantity Quantity(SimpleQuantity)

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
MedicationDispense.statusrequiredMedicationDispense Status Codes
http://hl7.org/fhir/ValueSet/medicationdispense-status|4.0.1
from the FHIR Standard
MedicationDispense.medication[x]extensibleMedicationClinicalDrug .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4
MedicationDispense.typeextensibleActPharmacySupplyType
http://terminology.hl7.org/ValueSet/v3-ActPharmacySupplyType
MedicationDispense.quantitypreferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
http://hl7.org/fhir/ValueSet/ucum-common
from the FHIR Standard
MedicationDispense.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
http://hl7.org/fhir/ValueSet/ucum-common
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorMedicationDispenseIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMedicationDispenseIf 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-4errorMedicationDispenseIf 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-5errorMedicationDispenseIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMedicationDispenseA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
mdp-1errorMedicationDispenseTo indicate what medication, either a reference to a Medication, or at least one coding in the medication or a codeOptions extension shall be provided
: (medication is Reference).not() implies medication.extension('http://hl7.org/fhir/StructureDefinition/codeOptions').exists() xor medication.coding.exists()
mdd-1errorMedicationDispensewhenHandedOver cannot be before whenPrepared
: whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared
us-core-20errorMedicationDispensewhenHandedOver SHALL be present if the status is "completed"
: status='completed' implies whenHandedOver.exists()

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense C 0..* USCoreMedicationDispenseProfile Dispensing a medication to a named patient
mdd-1: whenHandedOver cannot be before whenPrepared
us-core-20: whenHandedOver SHALL be present if the status is "completed"
mdp-1: To indicate what medication, either a reference to a Medication, or at least one coding in the medication or a codeOptions extension shall be provided
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... recorded 0..1 dateTime (QI) When recorded
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationDispense.recorded
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier 0..* Identifier External identifier
... partOf 0..* Reference(Procedure) Event that dispense is part of
... status ?!SΣC 1..1 code (QI) preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event.

... statusReason[x] 0..1 Why a dispense was not performed
Binding: MedicationDispense Status Reason Codes (example): A code describing why a dispense was not performed.

.... statusReasonCodeableConcept CodeableConcept
.... statusReasonReference Reference(DetectedIssue)
... category 0..1 CodeableConcept Type of medication dispense
Binding: MedicationDispense Category Codes (preferred): A code describing where the dispensed medication is expected to be consumed or administered.

... medication[x] SΣ 1..1 (QI) What medication was supplied
Binding: Medication Clinical Drug . (extensible): The set of RxNorm codes to represent medications

.... medication[x]All Types Content/Rules for all Types
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... codeOptions 0..1 canonical(ValueSet) (QI) Url of a value set of candidate medications
URL: http://hl7.org/fhir/StructureDefinition/codeOptions
.... medicationCodeableConcept CodeableConcept
.... medicationReference Reference(QICore Medication)
... subject SΣ 1..1 Reference(QICore Patient) (QI) Who the dispense is for
... context S 0..1 Reference(US Core Encounter Profile S | EpisodeOfCare) Encounter associated with MedicationDispense
... supportingInformation 0..* Reference(Resource) Information that supports the dispensing of the medication
... performer S 0..* BackboneElement Who performed event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... function 0..1 CodeableConcept Who performed the dispense and what they did
Binding: MedicationDispense Performer Function Codes (example): A code describing the role an individual played in dispensing a medication.

.... actor S 1..1 Reference(US Core Practitioner Profile S | US Core Patient Profile | US Core Organization Profile S | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) Individual who was performing
... location 0..1 Reference(Location) Where the dispense occurred
... authorizingPrescription S 0..* Reference(QICore MedicationRequest) (QI) Medication order that authorizes the dispense
... type S 0..1 CodeableConcept (QI) Trial fill, partial fill, emergency fill, etc.
Binding: ActPharmacySupplyType (extensible)
... quantity S 0..1 SimpleQuantity (QI) Amount dispensed
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodes Max Binding
... daysSupply 0..1 SimpleQuantity (QI) Amount of medication expressed as a timing amount
... whenPrepared Σ 0..1 dateTime (QI) When product was packaged and reviewed
... whenHandedOver SC 0..1 dateTime (QI) When product was given out or mailed
... destination 0..1 Reference(Location) Where the medication was sent
... receiver 0..* Reference(Patient | Practitioner) Who collected the medication
... note 0..* Annotation Information about the dispense
... dosageInstruction S 0..* Dosage (QI) How the medication is to be used by the patient or administered by the caregiver
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 0..1 integer The order of the dosage instructions
.... text SΣ 0..1 string (QI) Free text dosage instructions e.g. SIG
.... additionalInstruction Σ 0..* CodeableConcept Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".


.... patientInstruction Σ 0..1 string Patient or consumer oriented instructions
.... timing SΣ 0..1 Timing (QI) When medication should be administered
.... asNeeded[x] Σ 0..1 Take "as needed" (for x)
Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.

..... asNeededBoolean boolean
..... asNeededCodeableConcept CodeableConcept
.... site Σ 0..1 CodeableConcept Body site to administer to
Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.

.... route Σ 0..1 CodeableConcept How drug should enter body
Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

.... method Σ 0..1 CodeableConcept Technique for administering medication
Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.

.... doseAndRate SΣ 0..* Element (QI) Amount of medication administered
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... type Σ 0..1 CodeableConcept The kind of dose or rate specified
Binding: DoseAndRateType (example): The kind of dose or rate specified.

..... dose[x] SΣ 0..1 (QI) Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodes Max Binding
...... doseQuantity Quantity S(SimpleQuantity)
...... doseRange Range
..... rate[x] Σ 0..1 Amount of medication per unit of time
...... rateRatio Ratio
...... rateRange Range
...... rateQuantity Quantity(SimpleQuantity)
.... maxDosePerPeriod Σ 0..1 Ratio Upper limit on medication per unit of time
.... maxDosePerAdministration Σ 0..1 SimpleQuantity Upper limit on medication per administration
.... maxDosePerLifetime Σ 0..1 SimpleQuantity Upper limit on medication per lifetime of the patient
... substitution 0..1 BackboneElement Whether a substitution was performed on the dispense
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... wasSubstituted 1..1 boolean Whether a substitution was or was not performed on the dispense
.... type 0..1 CodeableConcept Code signifying whether a different drug was dispensed from what was prescribed
Binding: ActSubstanceAdminSubstitutionCode (example): A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription.

.... reason 0..* CodeableConcept Why was substitution made
Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.


.... responsibleParty 0..* Reference(Practitioner | PractitionerRole) Who is responsible for the substitution
... detectedIssue 0..* Reference(DetectedIssue) Clinical issue with action
... eventHistory 0..* Reference(Provenance) A list of relevant lifecycle events

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
MedicationDispense.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
MedicationDispense.statusrequiredMedicationDispense Status Codes
http://hl7.org/fhir/ValueSet/medicationdispense-status|4.0.1
from the FHIR Standard
MedicationDispense.statusReason[x]exampleMedicationDispense Status Reason Codes
http://hl7.org/fhir/ValueSet/medicationdispense-status-reason
from the FHIR Standard
MedicationDispense.categorypreferredMedicationDispense Category Codes
http://hl7.org/fhir/ValueSet/medicationdispense-category
from the FHIR Standard
MedicationDispense.medication[x]extensibleMedicationClinicalDrug .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4
MedicationDispense.performer.functionexampleMedicationDispense Performer Function Codes
http://hl7.org/fhir/ValueSet/medicationdispense-performer-function
from the FHIR Standard
MedicationDispense.typeextensibleActPharmacySupplyType
http://terminology.hl7.org/ValueSet/v3-ActPharmacySupplyType
MedicationDispense.quantitypreferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
http://hl7.org/fhir/ValueSet/ucum-common
from the FHIR Standard
MedicationDispense.dosageInstruction.additionalInstructionexampleSNOMEDCTAdditionalDosageInstructions
http://hl7.org/fhir/ValueSet/additional-instruction-codes
from the FHIR Standard
MedicationDispense.dosageInstruction.asNeeded[x]exampleSNOMEDCTMedicationAsNeededReasonCodes
http://hl7.org/fhir/ValueSet/medication-as-needed-reason
from the FHIR Standard
MedicationDispense.dosageInstruction.siteexampleSNOMEDCTAnatomicalStructureForAdministrationSiteCodes
http://hl7.org/fhir/ValueSet/approach-site-codes
from the FHIR Standard
MedicationDispense.dosageInstruction.routeexampleSNOMEDCTRouteCodes
http://hl7.org/fhir/ValueSet/route-codes
from the FHIR Standard
MedicationDispense.dosageInstruction.methodexampleSNOMEDCTAdministrationMethodCodes
http://hl7.org/fhir/ValueSet/administration-method-codes
from the FHIR Standard
MedicationDispense.dosageInstruction.doseAndRate.typeexampleDoseAndRateType
http://hl7.org/fhir/ValueSet/dose-rate-type
from the FHIR Standard
MedicationDispense.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
http://hl7.org/fhir/ValueSet/ucum-common
from the FHIR Standard
MedicationDispense.substitution.typeexampleActSubstanceAdminSubstitutionCode
http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode
MedicationDispense.substitution.reasonexampleSubstanceAdminSubstitutionReason
http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorMedicationDispenseIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMedicationDispenseIf 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-4errorMedicationDispenseIf 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-5errorMedicationDispenseIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMedicationDispenseA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
mdp-1errorMedicationDispenseTo indicate what medication, either a reference to a Medication, or at least one coding in the medication or a codeOptions extension shall be provided
: (medication is Reference).not() implies medication.extension('http://hl7.org/fhir/StructureDefinition/codeOptions').exists() xor medication.coding.exists()
mdd-1errorMedicationDispensewhenHandedOver cannot be before whenPrepared
: whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared
us-core-20errorMedicationDispensewhenHandedOver SHALL be present if the status is "completed"
: status='completed' implies whenHandedOver.exists()

 

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