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

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

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

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

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

An Extension

Optional Extension Element - found in all resources.

An Extension

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

An Extension

An Extension

All modifiers SHALL be documented in the profile, in order to be usable.

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

This is a business identifier, not a resource identifier.

The purpose of this identifier.

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Identifies the purpose for this identifier, if known .

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Identifier.system is always case sensitive.

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

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

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

A coded concept specifying the state of the dispense event.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

A code describing why a dispense was not performed.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

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

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

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

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

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

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

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

SubstanceAdministration->subject->Patient.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Indicates who or what performed the event.

An Extension

All modifiers SHALL be documented in the profile, in order to be usable.

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

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Maps to basedOn in Event logical model.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

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

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

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

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

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Indicates how the medication is/was taken or should be taken by the patient.

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

Indicates how the medication is/was taken or should be taken by the patient.

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

Indicates how the medication is/was taken or should be taken by the patient.

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

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

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

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

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

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

...All modifiers SHALL be documented in the profile, in order to be usable.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

...All modifiers SHALL be documented in the profile, in order to be usable.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

...All modifiers SHALL be documented in the profile, in order to be usable.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

...All modifiers SHALL be documented in the profile, in order to be usable.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

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

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

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

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

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

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.

This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

Security Labels from the Healthcare Privacy and Security Classification System.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

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

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

The base language in which the resource is written.

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

A human language.

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

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

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

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

An Extension

Optional Extension Element - found in all resources.

An Extension

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

An Extension

An Extension

All modifiers SHALL be documented in the profile, in order to be usable.

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

This is a business identifier, not a resource identifier.

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

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

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

The purpose of this identifier.

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Identifies the purpose for this identifier, if known .

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Allows users to make use of identifiers when the identifier system is not known.

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Identifier.system is always case sensitive.

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

Time period during which identifier is/was valid for use.

Organization that issued/manages the identifier.

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

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

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

A coded concept specifying the state of the dispense event.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

A code describing why a dispense was not performed.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

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

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

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

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

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

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

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

SubstanceAdministration->subject->Patient.

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

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

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

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Aa resource (or, for logical models, the URI of the logical model).

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Indicates who or what performed the event.

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

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

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

An Extension

All modifiers SHALL be documented in the profile, in order to be usable.

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

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

Allows disambiguation of the types of involvement of different performers.

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

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

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

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

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Aa resource (or, for logical models, the URI of the logical model).

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Maps to basedOn in Event logical model.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

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

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

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

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

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

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

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Organization is used when there's no need for specific attribution as to who made the comment.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

The text of the annotation in markdown format.

Indicates how the medication is/was taken or should be taken by the patient.

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

Indicates how the medication is/was taken or should be taken by the patient.

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

Indicates how the medication is/was taken or should be taken by the patient.

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

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

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

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

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

An Extension

All modifiers SHALL be documented in the profile, in order to be usable.

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

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

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

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

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

A reference to a code defined by a terminology system.

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

Allows for alternative encodings within a code system, and translations to other code systems.

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

Very often the text is the same as a displayName of one of the codings.

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

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

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

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

Implementers should not set or read this element. This element is only kept as optional to allow submission of documents that would contain a value, since those documents are still readable by others. The meaning of this element is undefined in this profile.

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