QI-Core Implementation Guide
4.1.0 - release

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## Resource Profile: QICoreMedicationDispenseNotDone

Defining URL: | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-mednotdispensed
Version: | 4.1.0
Name: | QICoreMedicationDispenseNotDone
Status: | Draft as of 8/22/18
Definition: | Negation profile of MedicationDispense for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.
Publisher: | http://www.hl7.org/Special/committees/cqi/index.cfm
Source Resource: | XML / JSON / Turtle

The official URL for this profile is:

    http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-mednotdispensed

Usage

See the patterns page for implementation and usage patterns.

The MedicationDispense and MedicationDispenseNotDone profiles represent the positive and negative statements for a medication dispensing event. To ensure instances retrieved meet negative intent, applications should check the status element as illustrated in this example:

    define MedicationDispenseNotDone:
      [MedicationDispense] D
        where D.status in { 'cancelled', 'declined' }

The following example illustrates the use of the MedicationNotDispensed profile:

    define "Dementia Medications Not Dispensed":
      ["MedicationDispense": "Dementia Medications"] MedicationDispense
        where MedicationDispense.status = 'declined'

### Examples

Negation Example with valueset
Negation Example with code

### Formal Views of Profile Content

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

- Text Summary
- Differential Table
- Snapshot Table
- Snapshot Table (Must Support)
- All

This structure is derived from MedicationDispense

Summary

Mandatory: 3 elements (1 nested mandatory element)
Must-Support: 11 elements
Fixed Value: 1 element

Structures

This structure refers to these other structures:

- QICorePatient (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient)
- QICoreMedicationRequest (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest)

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-recorded
- http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet

This structure is derived from MedicationDispense

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
MedicationDispense | I | 0..* | MedicationDispense | Dispensing a medication to a named patient mnd-1: To indicate what medication was not dispensed, either at least one coding in the medication or a notDoneValueSet extension shall be provided
qicore-recorded | S | 1..1 | dateTime | Extension URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-recorded
status | S | 1..1 | code | preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown Fixed Value: declined
statusReason[x] | S | 1..1 | CodeableConcept | Why a dispense was not performed Binding: Negation Reason Codes (extensible): The reason the event did not occur or was not performed
medication[x] | S | 1..1 | CodeableConcept | What medication was supplied
qicore-notDoneValueSet | S | 0..1 | canonical(ValueSet) | Url of a value set of activities not requested or performed URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
subject | S | 0..1 | Reference(QICorePatient) | Who the dispense is for
authorizingPrescription |  | 0..* | Reference(QICoreMedicationRequest) | Medication order that authorizes the dispense
dosageInstruction |  | 0..* | Dosage | How the medication is to be used by the patient or administered by the caregiver
timing | S | 0..1 | Timing | When medication should be administered
site |  | 0..1 | CodeableConcept | Body site to administer to
route | S | 0..1 | CodeableConcept | How drug should enter body
doseAndRate | S | 0..* | Element | Amount of medication administered
type | S | 1..1 | CodeableConcept | The kind of dose or rate specified Binding: SNOMED CT Dosages Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)
dose[x] | S | 0..1 | Range, SimpleQuantity | Amount of medication per dose
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
MedicationDispense | I | 0..* | MedicationDispense | Dispensing a medication to a named patient mnd-1: To indicate what medication was not dispensed, either at least one coding in the medication or a notDoneValueSet extension shall be provided
id | Σ | 0..1 | string | 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) Max Binding: AllLanguages: A human language.
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
qicore-recorded | S | 1..1 | dateTime | Extension URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-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 | 1..1 | code | preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event. Fixed Value: declined
statusReason[x] | S | 1..1 | CodeableConcept | Why a dispense was not performed Binding: 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 | CodeableConcept | What medication was supplied Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying which substance or product can be dispensed.
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
qicore-notDoneValueSet | S | 0..1 | canonical(ValueSet) | Url of a value set of activities not requested or performed URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
coding | Σ | 0..* | Coding | Code defined by a terminology system
text | Σ | 0..1 | string | Plain text representation of the concept
subject | S Σ | 0..1 | Reference(QICorePatient) | Who the dispense is for
context |  | 0..1 | Reference(Encounter | EpisodeOfCare) | Encounter / Episode associated with event
supportingInformation |  | 0..* | Reference(Resource) | Information that supports the dispensing of the medication
performer |  | 0..* | BackboneElement | Who performed event
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
function |  | 0..1 | CodeableConcept | Who performed the dispense and what they did Binding: MedicationDispense Performer Function Codes (example): A code describing the role an individual played in dispensing a medication.
actor |  | 1..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson) | Individual who was performing
location |  | 0..1 | Reference(Location) | Where the dispense occurred
authorizingPrescription |  | 0..* | Reference(QICoreMedicationRequest) | Medication order that authorizes the dispense
type |  | 0..1 | CodeableConcept | Trial fill, partial fill, emergency fill, etc. Binding: ActPharmacySupplyType (example): Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc.
quantity |  | 0..1 | SimpleQuantity | Amount dispensed
daysSupply |  | 0..1 | SimpleQuantity | Amount of medication expressed as a timing amount
whenPrepared | Σ | 0..1 | dateTime | When product was packaged and reviewed
whenHandedOver |  | 0..1 | dateTime | When product was given out
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 |  | 0..* | Dosage | How the medication is to be used by the patient or administered by the caregiver
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | 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 | Σ | 0..1 | string | Free text dosage instructions e.g. SIG
additionalInstruction | Σ | 0..* | CodeableConcept | Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness" Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
patientInstruction | Σ | 0..1 | string | Patient or consumer oriented instructions
timing | S Σ | 0..1 | Timing | When medication should be administered
asNeeded[x] | Σ | 0..1 |  | Take "as needed" (for x) Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.
asNeededBoolean |  |  | boolean |
asNeededCodeableConcept |  |  | CodeableConcept |
site | Σ | 0..1 | CodeableConcept | Body site to administer to Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.
route | S 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 | Amount of medication administered
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
type | S Σ | 1..1 | CodeableConcept | The kind of dose or rate specified Binding: SNOMED CT Dosages Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)
dose[x] | S Σ | 0..1 |  | Amount of medication per dose
doseRange |  |  | Range |
doseQuantity |  |  | Quantity(SimpleQuantity) |
rate[x] | Σ | 0..1 |  | Amount of medication per unit of time
rateRatio |  |  | Ratio |
rateRange |  |  | Range |
rateQuantity |  |  | Quantity(SimpleQuantity) |
maxDosePerPeriod | Σ | 0..1 | Ratio | Upper limit on medication per unit of time
maxDosePerAdministration | Σ | 0..1 | SimpleQuantity | 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

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
MedicationDispense | I | 0..* | MedicationDispense | Dispensing a medication to a named patient mnd-1: To indicate what medication was not dispensed, either at least one coding in the medication or a notDoneValueSet extension shall be provided
qicore-recorded |  | 1..1 | dateTime | Extension URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-recorded
status | ?!Σ | 1..1 | code | preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event. Fixed Value: declined
statusReason[x] |  | 1..1 | CodeableConcept | Why a dispense was not performed Binding: Negation Reason Codes (extensible): The reason the event did not occur or was not performed
medication[x] | Σ | 1..1 | CodeableConcept | What medication was supplied Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying which substance or product can be dispensed.
qicore-notDoneValueSet |  | 0..1 | canonical(ValueSet) | Url of a value set of activities not requested or performed URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
subject | Σ | 0..1 | Reference(QICorePatient) | Who the dispense is for
dosageInstruction |  | 0..* | Dosage | How the medication is to be used by the patient or administered by the caregiver
timing | Σ | 0..1 | Timing | When medication should be administered
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.
doseAndRate | Σ | 0..* | Element | Amount of medication administered
type | Σ | 1..1 | CodeableConcept | The kind of dose or rate specified Binding: SNOMED CT Dosages Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)
dose[x] | Σ | 0..1 |  | Amount of medication per dose
doseRange |  |  | Range |
doseQuantity |  |  | Quantity(SimpleQuantity) |
Documentation for this format

This structure is derived from MedicationDispense

Summary

Mandatory: 3 elements (1 nested mandatory element)
Must-Support: 11 elements
Fixed Value: 1 element

Structures

This structure refers to these other structures:

- QICorePatient (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient)
- QICoreMedicationRequest (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest)

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-recorded
- http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet

Differential View

This structure is derived from MedicationDispense

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
MedicationDispense | I | 0..* | MedicationDispense | Dispensing a medication to a named patient mnd-1: To indicate what medication was not dispensed, either at least one coding in the medication or a notDoneValueSet extension shall be provided
qicore-recorded | S | 1..1 | dateTime | Extension URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-recorded
status | S | 1..1 | code | preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown Fixed Value: declined
statusReason[x] | S | 1..1 | CodeableConcept | Why a dispense was not performed Binding: Negation Reason Codes (extensible): The reason the event did not occur or was not performed
medication[x] | S | 1..1 | CodeableConcept | What medication was supplied
qicore-notDoneValueSet | S | 0..1 | canonical(ValueSet) | Url of a value set of activities not requested or performed URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
subject | S | 0..1 | Reference(QICorePatient) | Who the dispense is for
authorizingPrescription |  | 0..* | Reference(QICoreMedicationRequest) | Medication order that authorizes the dispense
dosageInstruction |  | 0..* | Dosage | How the medication is to be used by the patient or administered by the caregiver
timing | S | 0..1 | Timing | When medication should be administered
site |  | 0..1 | CodeableConcept | Body site to administer to
route | S | 0..1 | CodeableConcept | How drug should enter body
doseAndRate | S | 0..* | Element | Amount of medication administered
type | S | 1..1 | CodeableConcept | The kind of dose or rate specified Binding: SNOMED CT Dosages Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)
dose[x] | S | 0..1 | Range, SimpleQuantity | Amount of medication per dose
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
MedicationDispense | I | 0..* | MedicationDispense | Dispensing a medication to a named patient mnd-1: To indicate what medication was not dispensed, either at least one coding in the medication or a notDoneValueSet extension shall be provided
id | Σ | 0..1 | string | 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) Max Binding: AllLanguages: A human language.
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
qicore-recorded | S | 1..1 | dateTime | Extension URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-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 | 1..1 | code | preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event. Fixed Value: declined
statusReason[x] | S | 1..1 | CodeableConcept | Why a dispense was not performed Binding: 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 | CodeableConcept | What medication was supplied Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying which substance or product can be dispensed.
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
qicore-notDoneValueSet | S | 0..1 | canonical(ValueSet) | Url of a value set of activities not requested or performed URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
coding | Σ | 0..* | Coding | Code defined by a terminology system
text | Σ | 0..1 | string | Plain text representation of the concept
subject | S Σ | 0..1 | Reference(QICorePatient) | Who the dispense is for
context |  | 0..1 | Reference(Encounter | EpisodeOfCare) | Encounter / Episode associated with event
supportingInformation |  | 0..* | Reference(Resource) | Information that supports the dispensing of the medication
performer |  | 0..* | BackboneElement | Who performed event
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
function |  | 0..1 | CodeableConcept | Who performed the dispense and what they did Binding: MedicationDispense Performer Function Codes (example): A code describing the role an individual played in dispensing a medication.
actor |  | 1..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson) | Individual who was performing
location |  | 0..1 | Reference(Location) | Where the dispense occurred
authorizingPrescription |  | 0..* | Reference(QICoreMedicationRequest) | Medication order that authorizes the dispense
type |  | 0..1 | CodeableConcept | Trial fill, partial fill, emergency fill, etc. Binding: ActPharmacySupplyType (example): Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc.
quantity |  | 0..1 | SimpleQuantity | Amount dispensed
daysSupply |  | 0..1 | SimpleQuantity | Amount of medication expressed as a timing amount
whenPrepared | Σ | 0..1 | dateTime | When product was packaged and reviewed
whenHandedOver |  | 0..1 | dateTime | When product was given out
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 |  | 0..* | Dosage | How the medication is to be used by the patient or administered by the caregiver
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | 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 | Σ | 0..1 | string | Free text dosage instructions e.g. SIG
additionalInstruction | Σ | 0..* | CodeableConcept | Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness" Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
patientInstruction | Σ | 0..1 | string | Patient or consumer oriented instructions
timing | S Σ | 0..1 | Timing | When medication should be administered
asNeeded[x] | Σ | 0..1 |  | Take "as needed" (for x) Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.
asNeededBoolean |  |  | boolean |
asNeededCodeableConcept |  |  | CodeableConcept |
site | Σ | 0..1 | CodeableConcept | Body site to administer to Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.
route | S 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 | Amount of medication administered
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
type | S Σ | 1..1 | CodeableConcept | The kind of dose or rate specified Binding: SNOMED CT Dosages Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)
dose[x] | S Σ | 0..1 |  | Amount of medication per dose
doseRange |  |  | Range |
doseQuantity |  |  | Quantity(SimpleQuantity) |
rate[x] | Σ | 0..1 |  | Amount of medication per unit of time
rateRatio |  |  | Ratio |
rateRange |  |  | Range |
rateQuantity |  |  | Quantity(SimpleQuantity) |
maxDosePerPeriod | Σ | 0..1 | Ratio | Upper limit on medication per unit of time
maxDosePerAdministration | Σ | 0..1 | SimpleQuantity | 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

Other representations of profile: CSV, Excel, Schematron

#### Terminology Bindings

Path | Conformance | ValueSet / Code
MedicationDispense.language | preferred | CommonLanguages Max Binding: AllLanguages
MedicationDispense.status | required | Fixed Value: declined
MedicationDispense.statusReason[x] | extensible | NegationReasonCodes
MedicationDispense.category | preferred | MedicationDispense Category Codes
MedicationDispense.medication[x] | example | SNOMEDCTMedicationCodes
MedicationDispense.performer.function | example | MedicationDispense Performer Function Codes
MedicationDispense.type | example | ActPharmacySupplyType
MedicationDispense.dosageInstruction.additionalInstruction | example | SNOMEDCTAdditionalDosageInstructions
MedicationDispense.dosageInstruction.asNeeded[x] | example | SNOMEDCTMedicationAsNeededReasonCodes
MedicationDispense.dosageInstruction.site | example | SNOMEDCTAnatomicalStructureForAdministrationSiteCodes
MedicationDispense.dosageInstruction.route | example | SNOMEDCTRouteCodes
MedicationDispense.dosageInstruction.method | example | SNOMEDCTAdministrationMethodCodes
MedicationDispense.dosageInstruction.doseAndRate.type | preferred | QICoreMedicationDoseType
MedicationDispense.substitution.type | example | ActSubstanceAdminSubstitutionCode
MedicationDispense.substitution.reason | example | SubstanceAdminSubstitutionReason

#### Constraints

Id | Grade | Path | Details | Requirements
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() |
mdd-1 | error | MedicationDispense | whenHandedOver cannot be before whenPrepared : whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared |
mnd-1 | error | MedicationDispense | To indicate what medication was not dispensed, either at least one coding in the medication or a notDoneValueSet extension shall be provided : medication.extension('http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet').exists() xor medication.coding.exists() |
ele-1 | error | MedicationDispense.meta | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.implicitRules | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.language | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.text | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | MedicationDispense.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | MedicationDispense.extension:recorded | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | MedicationDispense.extension:recorded | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | MedicationDispense.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | MedicationDispense.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | MedicationDispense.identifier | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.partOf | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.status | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.statusReason[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.category | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.medication[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.medication[x].extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | MedicationDispense.medication[x].extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | MedicationDispense.medication[x].extension:notDoneValueSet | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | MedicationDispense.medication[x].extension:notDoneValueSet | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | MedicationDispense.medication[x].coding | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.medication[x].text | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.subject | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.context | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.supportingInformation | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.performer | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.performer.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | MedicationDispense.performer.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | MedicationDispense.performer.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | MedicationDispense.performer.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | MedicationDispense.performer.function | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.performer.actor | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.location | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.authorizingPrescription | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.quantity | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.daysSupply | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.whenPrepared | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.whenHandedOver | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.destination | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.receiver | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.note | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.dosageInstruction | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.dosageInstruction.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | MedicationDispense.dosageInstruction.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | MedicationDispense.dosageInstruction.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | MedicationDispense.dosageInstruction.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | MedicationDispense.dosageInstruction.sequence | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.dosageInstruction.text | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.dosageInstruction.additionalInstruction | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.dosageInstruction.patientInstruction | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.dosageInstruction.timing | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.dosageInstruction.asNeeded[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.dosageInstruction.site | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.dosageInstruction.route | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.dosageInstruction.method | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.dosageInstruction.doseAndRate | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.dosageInstruction.doseAndRate.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | MedicationDispense.dosageInstruction.doseAndRate.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | MedicationDispense.dosageInstruction.doseAndRate.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.dosageInstruction.doseAndRate.dose[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.dosageInstruction.doseAndRate.rate[x] | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.dosageInstruction.maxDosePerPeriod | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.dosageInstruction.maxDosePerAdministration | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.dosageInstruction.maxDosePerLifetime | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.substitution | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.substitution.extension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | MedicationDispense.substitution.extension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | MedicationDispense.substitution.modifierExtension | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | MedicationDispense.substitution.modifierExtension | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
ele-1 | error | MedicationDispense.substitution.wasSubstituted | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.substitution.type | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.substitution.reason | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.substitution.responsibleParty | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.detectedIssue | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ele-1 | error | MedicationDispense.eventHistory | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |