QI-Core Implementation Guide
7.0.2 - STU 7

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 7.0.2 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 Declined

Official URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationdispensedeclined | Version: 7.0.2
Standards status: Trial-use | Maturity Level: 4 | Computable Name: QICoreMedicationDispenseDeclined

Negation profile of MedicationDispense for decision support/quality metrics. Indicates that a medication dispense was declined for a reason.

"Must Have", "QI Elements" and "primary code path" are defined in the QI-Core Must Support section.
Must Have:

- medication[x]: (QI) What medication was supplied
- subject: (QI) Who the dispense is for
- status: (QI) declined

QI Elements:

- extension(recorded): (QI) Extension
- authorizingPrescription: (QI) Medication order that authorizes the dispense
- dosageInstruction: (QI) How the medication is to be used by the patient or administered by the caregiver
- medication[x].extension(codeOptions): (QI) Url of a value set of candidate medications
- statusReason[x]: (QI) Why a dispense was not performed
- daysSupply: (QI) Amount of medication expressed as a timing amount
- whenPrepared: (QI) When product was packaged and reviewed
- quantity: (QI) Amount dispensed
- whenHandedOver: (QI) When product was given out or mailed
- type: (QI) Trial fill, partial fill, emergency fill, etc.

Primary code path: medication
(PCPath) This element is the primary code path for this resource CQL Retrieve
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 MedicationDispenseDeclined profile:

    define "Dementia Medication Not Dispensed":
      ["MedicationDispenseNotDone": "Dementia Medications"] MedicationDispense
        where MedicationDispense.statusReason in "Medical Reason"
          or MedicationDispense.statusReason in "Patient Refusal"

For a more complete discussion of representation of negation within QI-Core and quality improvement artifacts, see the Negation in QI-Core topic.

See the patterns page for implementation and usage patterns.

### Examples

Negation Example with valueset | Opthalmic Antihistamines not indicated; indicates that none of the drugs in the given `codeOptions` value set were dispensed.
Negation Example with code | Alcaftadine 2.5 MG/ML Opthalmic Solution not indicated; indicates that the specific drug was not dispensed.

Usages:

- Examples for this Profile: MedicationDispense/negation-example and MedicationDispense/negation-with-code-example

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

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

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense | C | 0..* | QICoreMedicationDispense | Dispensing a medication to a named patient Constraints: mdd-1, us-core-20, mdp-1
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:recorded |  | 1..1 | dateTime | (QI) Extension URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationDispense.recorded
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ C | 1..1 | code | (QI) declined Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event. Fixed Value: declined
statusReason[x] |  | 1..1 | CodeableConcept | (QI) Why a dispense was not performed Binding: QICore Negation Reason Codes (extensible): The reason the event did not occur or was not performed
medication[x] | S Σ | 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
extension: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 | S Σ | 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
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 S | US Core Patient Profile | US Core Organization Profile S | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) | 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 Bindings | Purpose
UCUMCodes | Max Binding
whenHandedOver | S C | 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 | S Σ | 0..1 | string | (QI) Free text dosage instructions e.g. SIG
timing | S Σ | 0..1 | Timing | (QI) When medication should be administered
doseAndRate | S Σ | 0..* | Element | (QI) Amount of medication administered
dose[x] | S Σ | 0..1 |  | (QI) Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
doseQuantity |  |  | Quantity S(SimpleQuantity) |
doseRange |  |  | Range |
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationDispense.status | Base | required | Medication dispense status codes | 📍4.0.1 | FHIR Std.
MedicationDispense.statusReason[x] | Base | extensible | QICore Negation Reason Codes | 📦7.0.2 | This IG
MedicationDispense.medication[x] | Base | extensible | Medication Clinical Drug | 📦20170601 | VSAC v0.18
MedicationDispense.type | Base | extensible | ActPharmacySupplyType | 📦3.0.0 | THO v6.5
MedicationDispense.quantity | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​doseAndRate.dose[x] | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | MedicationDispense | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | MedicationDispense | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | MedicationDispense | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | MedicationDispense | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | MedicationDispense | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
mdp-1 | error | MedicationDispense | 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 | `(medication is Reference).not() implies medication.extension('http://hl7.org/fhir/StructureDefinition/codeOptions').exists() xor medication.coding.exists()`
mdd-1 | error | MedicationDispense | whenHandedOver cannot be before whenPrepared | `whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared`
us-core-20 | error | MedicationDispense | whenHandedOver SHALL be present if the status is "completed" | `status='completed' implies whenHandedOver.exists()`

This structure is derived from QICoreMedicationDispense

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense |  | 0..* | QICoreMedicationDispense | Dispensing a medication to a named patient
Slices for extension |  |  |  | Content/Rules for all slices
extension:recorded |  | 1..1 | dateTime | (QI) Extension URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationDispense.recorded
status |  | 1..1 | code | (QI) declined Fixed Value: declined
statusReason[x] |  | 1..1 | CodeableConcept | (QI) Why a dispense was not performed Binding: QICore Negation Reason Codes (extensible): The reason the event did not occur or was not performed
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
MedicationDispense.statusReason[x] | Base | extensible | QICore Negation Reason Codes | 📦7.0.2 | This IG

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense | C | 0..* | QICoreMedicationDispense | Dispensing a medication to a named patient Constraints: mdd-1, us-core-20, mdp-1
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:recorded |  | 1..1 | dateTime | (QI) Extension 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 | ?!S Σ C | 1..1 | code | (QI) declined Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event. Fixed Value: declined
statusReason[x] |  | 1..1 | CodeableConcept | (QI) Why a dispense was not performed Binding: QICore Negation Reason Codes (extensible): The reason the event did not occur or was not performed
category |  | 0..1 | CodeableConcept | Type of medication dispense Binding: MedicationDispense Category Codes (preferred): A code describing where the dispensed medication is expected to be consumed or administered.
medication[x] | S Σ | 1..1 |  | (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
extension: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 | S Σ | 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 Bindings | Purpose
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 | S C | 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 | S Σ | 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 | S Σ | 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 | S Σ | 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] | S Σ | 0..1 |  | (QI) Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
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
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationDispense.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
MedicationDispense.status | Base | required | Medication dispense status codes | 📍4.0.1 | FHIR Std.
MedicationDispense.statusReason[x] | Base | extensible | QICore Negation Reason Codes | 📦7.0.2 | This IG
MedicationDispense.category | Base | preferred | Medication dispense category codes | 📦4.0.1 | FHIR Std.
MedicationDispense.medication[x] | Base | extensible | Medication Clinical Drug | 📦20170601 | VSAC v0.18
MedicationDispense.performer.​function | Base | example | Medication dispense performer function codes | 📦4.0.1 | FHIR Std.
MedicationDispense.type | Base | extensible | ActPharmacySupplyType | 📦3.0.0 | THO v6.5
MedicationDispense.quantity | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​additionalInstruction | Base | example | SNOMED CT Additional Dosage Instructions | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​asNeeded[x] | Base | example | SNOMED CT Medication As Needed Reason Codes | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​site | Base | example | SNOMED CT Anatomical Structure for Administration Site Codes | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​route | Base | example | SNOMED CT Route Codes | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​method | Base | example | SNOMED CT Administration Method Codes | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​doseAndRate.type | Base | example | DoseAndRateType | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​doseAndRate.dose[x] | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.
MedicationDispense.substitution.​type | Base | example | ActSubstanceAdminSubstitutionCode | 📦3.0.0 | THO v6.5
MedicationDispense.substitution.​reason | Base | example | SubstanceAdminSubstitutionReason | 📦3.0.0 | THO v6.5

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | MedicationDispense | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | MedicationDispense | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | MedicationDispense | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | MedicationDispense | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | MedicationDispense | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
mdp-1 | error | MedicationDispense | 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 | `(medication is Reference).not() implies medication.extension('http://hl7.org/fhir/StructureDefinition/codeOptions').exists() xor medication.coding.exists()`
mdd-1 | error | MedicationDispense | whenHandedOver cannot be before whenPrepared | `whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared`
us-core-20 | error | MedicationDispense | whenHandedOver SHALL be present if the status is "completed" | `status='completed' implies whenHandedOver.exists()`

This structure is derived from QICoreMedicationDispense

Summary

Mandatory: 2 elements
Fixed: 1 element

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationDispense.recorded

Maturity: 4

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense | C | 0..* | QICoreMedicationDispense | Dispensing a medication to a named patient Constraints: mdd-1, us-core-20, mdp-1
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:recorded |  | 1..1 | dateTime | (QI) Extension URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationDispense.recorded
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ C | 1..1 | code | (QI) declined Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event. Fixed Value: declined
statusReason[x] |  | 1..1 | CodeableConcept | (QI) Why a dispense was not performed Binding: QICore Negation Reason Codes (extensible): The reason the event did not occur or was not performed
medication[x] | S Σ | 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
extension: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 | S Σ | 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
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 S | US Core Patient Profile | US Core Organization Profile S | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) | 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 Bindings | Purpose
UCUMCodes | Max Binding
whenHandedOver | S C | 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 | S Σ | 0..1 | string | (QI) Free text dosage instructions e.g. SIG
timing | S Σ | 0..1 | Timing | (QI) When medication should be administered
doseAndRate | S Σ | 0..* | Element | (QI) Amount of medication administered
dose[x] | S Σ | 0..1 |  | (QI) Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
doseQuantity |  |  | Quantity S(SimpleQuantity) |
doseRange |  |  | Range |
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationDispense.status | Base | required | Medication dispense status codes | 📍4.0.1 | FHIR Std.
MedicationDispense.statusReason[x] | Base | extensible | QICore Negation Reason Codes | 📦7.0.2 | This IG
MedicationDispense.medication[x] | Base | extensible | Medication Clinical Drug | 📦20170601 | VSAC v0.18
MedicationDispense.type | Base | extensible | ActPharmacySupplyType | 📦3.0.0 | THO v6.5
MedicationDispense.quantity | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​doseAndRate.dose[x] | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | MedicationDispense | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | MedicationDispense | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | MedicationDispense | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | MedicationDispense | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | MedicationDispense | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
mdp-1 | error | MedicationDispense | 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 | `(medication is Reference).not() implies medication.extension('http://hl7.org/fhir/StructureDefinition/codeOptions').exists() xor medication.coding.exists()`
mdd-1 | error | MedicationDispense | whenHandedOver cannot be before whenPrepared | `whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared`
us-core-20 | error | MedicationDispense | whenHandedOver SHALL be present if the status is "completed" | `status='completed' implies whenHandedOver.exists()`

Differential View

This structure is derived from QICoreMedicationDispense

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense |  | 0..* | QICoreMedicationDispense | Dispensing a medication to a named patient
Slices for extension |  |  |  | Content/Rules for all slices
extension:recorded |  | 1..1 | dateTime | (QI) Extension URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationDispense.recorded
status |  | 1..1 | code | (QI) declined Fixed Value: declined
statusReason[x] |  | 1..1 | CodeableConcept | (QI) Why a dispense was not performed Binding: QICore Negation Reason Codes (extensible): The reason the event did not occur or was not performed
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
MedicationDispense.statusReason[x] | Base | extensible | QICore Negation Reason Codes | 📦7.0.2 | This IG

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense | C | 0..* | QICoreMedicationDispense | Dispensing a medication to a named patient Constraints: mdd-1, us-core-20, mdp-1
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:recorded |  | 1..1 | dateTime | (QI) Extension 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 | ?!S Σ C | 1..1 | code | (QI) declined Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event. Fixed Value: declined
statusReason[x] |  | 1..1 | CodeableConcept | (QI) Why a dispense was not performed Binding: QICore Negation Reason Codes (extensible): The reason the event did not occur or was not performed
category |  | 0..1 | CodeableConcept | Type of medication dispense Binding: MedicationDispense Category Codes (preferred): A code describing where the dispensed medication is expected to be consumed or administered.
medication[x] | S Σ | 1..1 |  | (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
extension: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 | S Σ | 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 Bindings | Purpose
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 | S C | 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 | S Σ | 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 | S Σ | 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 | S Σ | 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] | S Σ | 0..1 |  | (QI) Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
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
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationDispense.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
MedicationDispense.status | Base | required | Medication dispense status codes | 📍4.0.1 | FHIR Std.
MedicationDispense.statusReason[x] | Base | extensible | QICore Negation Reason Codes | 📦7.0.2 | This IG
MedicationDispense.category | Base | preferred | Medication dispense category codes | 📦4.0.1 | FHIR Std.
MedicationDispense.medication[x] | Base | extensible | Medication Clinical Drug | 📦20170601 | VSAC v0.18
MedicationDispense.performer.​function | Base | example | Medication dispense performer function codes | 📦4.0.1 | FHIR Std.
MedicationDispense.type | Base | extensible | ActPharmacySupplyType | 📦3.0.0 | THO v6.5
MedicationDispense.quantity | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​additionalInstruction | Base | example | SNOMED CT Additional Dosage Instructions | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​asNeeded[x] | Base | example | SNOMED CT Medication As Needed Reason Codes | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​site | Base | example | SNOMED CT Anatomical Structure for Administration Site Codes | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​route | Base | example | SNOMED CT Route Codes | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​method | Base | example | SNOMED CT Administration Method Codes | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​doseAndRate.type | Base | example | DoseAndRateType | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​doseAndRate.dose[x] | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.
MedicationDispense.substitution.​type | Base | example | ActSubstanceAdminSubstitutionCode | 📦3.0.0 | THO v6.5
MedicationDispense.substitution.​reason | Base | example | SubstanceAdminSubstitutionReason | 📦3.0.0 | THO v6.5

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | MedicationDispense | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | MedicationDispense | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | MedicationDispense | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | MedicationDispense | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | MedicationDispense | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
mdp-1 | error | MedicationDispense | 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 | `(medication is Reference).not() implies medication.extension('http://hl7.org/fhir/StructureDefinition/codeOptions').exists() xor medication.coding.exists()`
mdd-1 | error | MedicationDispense | whenHandedOver cannot be before whenPrepared | `whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared`
us-core-20 | error | MedicationDispense | whenHandedOver SHALL be present if the status is "completed" | `status='completed' implies whenHandedOver.exists()`

This structure is derived from QICoreMedicationDispense

Summary

Mandatory: 2 elements
Fixed: 1 element

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationDispense.recorded

Maturity: 4

Other representations of profile: CSV, Excel, Schematron