2026 US Quality Core Implementation Guide
0.5.0 - cibuild US

2026 US Quality Core Implementation Guide, published by Office of the National Coordinator for Health Information Technology (ONC). This guide is not an authorized publication; it is the continuous build for version 0.5.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/FHIR/us-quality-core/ and changes regularly. See the Directory of published versions

## Resource Profile: US Quality Core MedicationDispense

Official URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-medicationdispense | Version: 0.5.0
Active as of 2026-05-15 | Computable Name: USQualityCoreMedicationDispense

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

Usage

To create an expression specifically requesting information that a MedicationDispense intentionally did not occur for a medical, patient or system reason, use the profile USQualityCore-medicationnotdispensed.

The following example illustrates the use of the MedicationDispense profile

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

See the patterns page for implementation and usage patterns.

### Examples

Alemtuzumab MedicationDispense Example
Alemtuzumab MedicationDispense Course Example

USCDI+ Quality Elements:

- status: (USCDI+ Quality) (USCDI) preparation​ | in-progress​ | cancelled​ | on-hold​ | completed​ | entered-in-error​ | stopped​ | unknown
- medication[x]: (USCDI+ Quality) (USCDI) What medication was supplied
- quantity: (USCDI+ Quality) (USCDI) Amount dispensed
- daysSupply: (USCDI+ Quality) Amount of medication expressed as a timing amount
- dosageInstruction: (USCDI+ Quality) (USCDI) How the medication is to be used by the patient or administered by the caregiver
- dosageInstruction.text: (USCDI+ Quality) (USCDI) Free text dosage instructions e.g. SIG
- dosageInstruction.timing: (USCDI+ Quality) (USCDI) When medication should be administered
- dosageInstruction.route: (USCDI+ Quality) How drug should enter body
- dosageInstruction.doseAndRate: (USCDI+ Quality) (USCDI) Amount of medication administered
- dosageInstruction.doseAndRate.dose[x]: (USCDI+ Quality) (USCDI) Amount of medication per dose

Usages:

- Examples for this Profile: MedicationDispense/cmd-example and MedicationDispense/example
- CapabilityStatements using this Profile: US Quality Core Client CapabilityStatement and US Quality Core Server CapabilityStatement

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

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

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense | C | 0..* | USCoreMedicationDispenseProfile(6.1.0) | Dispensing a medication to a named patient Constraints: mdd-1, us-core-20
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ C | 1..1 | code | (USCDI+ Quality) (USCDI) preparation​ | in-progress​ | cancelled​ | on-hold​ | completed​ | entered-in-error​ | stopped​ | unknown Binding: Non-Negative MedicationDispense Status (required)
medication[x] | S Σ | 1..1 |  | (USCDI+ Quality) (USCDI) What medication was supplied Binding: Medication Clinical Drug (extensible): The set of RxNorm codes to represent medications
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(US Quality Core Medication) |
subject | S Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who the dispense is for
performer | S | 0..* | BackboneElement | (USCDI) Who performed event
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
actor | S | 1..1 | Reference(US Core Practitioner Profile(7.0.0) S | US Core Patient Profile(7.0.0) | US Core Organization Profile(7.0.0) S | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0) | Device) | (USCDI) Individual who was performing
authorizingPrescription | S | 0..* | Reference(US Quality Core MedicationRequest) | (USCDI) Medication order that authorizes the dispense
type | S | 0..1 | CodeableConcept | (USCDI) Trial fill, partial fill, emergency fill, etc. Binding: V3 Value SetActPharmacySupplyType (extensible)
quantity | S | 0..1 | Quantity | (USCDI+ Quality) (USCDI) Amount dispensed Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
daysSupply |  | 0..1 | SimpleQuantity | (USCDI+ Quality) Amount of medication expressed as a timing amount
whenPrepared | Σ | 0..1 | dateTime | When product was packaged and reviewed
whenHandedOver | S C | 0..1 | dateTime | (USCDI) When product was given out or mailed
dosageInstruction | S | 0..* | Dosage | (USCDI+ Quality) (USCDI) How the medication is to be used by the patient or administered by the caregiver
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
text | S Σ | 0..1 | string | (USCDI+ Quality) (USCDI) Free text dosage instructions e.g. SIG
timing | S Σ | 0..1 | Timing | (USCDI+ Quality) (USCDI) When medication should be administered
route | Σ | 0..1 | CodeableConcept | (USCDI+ Quality) 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 | S Σ | 0..* | Element | (USCDI+ Quality) (USCDI) Amount of medication administered
dose[x] | S Σ | 0..1 |  | (USCDI+ Quality) (USCDI) Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
doseQuantity |  |  | Quantity S |
doseRange |  |  | Range |
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationDispense.status | Base | required | Non-Negative MedicationDispense Status | 📦0.5.0 | This IG
MedicationDispense.medication[x] | Base | extensible | Medication Clinical Drug | 📦20170601 | VSAC v0.18
MedicationDispense.type | Base | extensible | V3 Value SetActPharmacySupplyType | 📦2014-03-26 | FHIR Std.
MedicationDispense.quantity | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​route | Base | example | SNOMED CT Route Codes | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​doseAndRate.dose[x] | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.

#### Constraints

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

This structure is derived from USCoreMedicationDispenseProfile

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense |  | 0..* | USCoreMedicationDispenseProfile(6.1.0) | Dispensing a medication to a named patient
status |  | 1..1 | code | (USCDI+ Quality) (USCDI) preparation​ | in-progress​ | cancelled​ | on-hold​ | completed​ | entered-in-error​ | stopped​ | unknown Binding: Non-Negative MedicationDispense Status (required)
medication[x] |  | 1..1 |  | (USCDI+ Quality) (USCDI) What medication was supplied Binding: Medication Clinical Drug (extensible): The set of RxNorm codes to represent medications
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(US Quality Core Medication) |
subject |  | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who the dispense is for
authorizingPrescription |  | 0..* | Reference(US Quality Core MedicationRequest) | (USCDI) Medication order that authorizes the dispense
type |  | 0..1 | CodeableConcept | (USCDI) Trial fill, partial fill, emergency fill, etc. Binding: V3 Value SetActPharmacySupplyType (extensible)
quantity |  | 0..1 | Quantity | (USCDI+ Quality) (USCDI) Amount dispensed
daysSupply |  | 0..1 | SimpleQuantity | (USCDI+ Quality) Amount of medication expressed as a timing amount
whenPrepared |  | 0..1 | dateTime | When product was packaged and reviewed
whenHandedOver |  | 0..1 | dateTime | (USCDI) When product was given out or mailed
dosageInstruction |  | 0..* | Dosage | (USCDI+ Quality) (USCDI) How the medication is to be used by the patient or administered by the caregiver
text |  | 0..1 | string | (USCDI+ Quality) (USCDI) Free text dosage instructions e.g. SIG
timing |  | 0..1 | Timing | (USCDI+ Quality) (USCDI) When medication should be administered
route |  | 0..1 | CodeableConcept | (USCDI+ Quality) How drug should enter body
doseAndRate |  | 0..* | Element | (USCDI+ Quality) (USCDI) Amount of medication administered
dose[x] |  | 0..1 |  | (USCDI+ Quality) (USCDI) Amount of medication per dose
doseQuantity |  |  | Quantity |
doseRange |  |  | Range |
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
MedicationDispense.status | Base | required | Non-Negative MedicationDispense Status | 📦0.5.0 | This IG
MedicationDispense.medication[x] | Base | extensible | Medication Clinical Drug | 📦20170601 | VSAC v0.18
MedicationDispense.type | Base | extensible | V3 Value SetActPharmacySupplyType | 📦2014-03-26 | FHIR Std.

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense | C | 0..* | USCoreMedicationDispenseProfile(6.1.0) | Dispensing a medication to a named patient Constraints: mdd-1, us-core-20
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | External identifier
partOf |  | 0..* | Reference(Procedure) | Event that dispense is part of
status | ?!S Σ C | 1..1 | code | (USCDI+ Quality) (USCDI) preparation​ | in-progress​ | cancelled​ | on-hold​ | completed​ | entered-in-error​ | stopped​ | unknown Binding: Non-Negative MedicationDispense Status (required)
statusReason[x] |  | 0..1 |  | Why a dispense was not performed Binding: MedicationDispense Status Reason Codes (example): A code describing why a dispense was not performed.
statusReasonCodeableConcept |  |  | CodeableConcept |
statusReasonReference |  |  | Reference(DetectedIssue) |
category |  | 0..1 | CodeableConcept | Type of medication dispense Binding: MedicationDispense Category Codes (preferred): A code describing where the dispensed medication is expected to be consumed or administered.
medication[x] | S Σ | 1..1 |  | (USCDI+ Quality) (USCDI) What medication was supplied Binding: Medication Clinical Drug (extensible): The set of RxNorm codes to represent medications
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(US Quality Core Medication) |
subject | S Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI) 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 | S | 0..* | BackboneElement | (USCDI) Who performed event
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
function |  | 0..1 | CodeableConcept | Who performed the dispense and what they did Binding: MedicationDispense Performer Function Codes (example): A code describing the role an individual played in dispensing a medication.
actor | S | 1..1 | Reference(US Core Practitioner Profile(7.0.0) S | US Core Patient Profile(7.0.0) | US Core Organization Profile(7.0.0) S | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0) | Device) | (USCDI) Individual who was performing
location |  | 0..1 | Reference(Location) | Where the dispense occurred
authorizingPrescription | S | 0..* | Reference(US Quality Core MedicationRequest) | (USCDI) Medication order that authorizes the dispense
type | S | 0..1 | CodeableConcept | (USCDI) Trial fill, partial fill, emergency fill, etc. Binding: V3 Value SetActPharmacySupplyType (extensible)
quantity | S | 0..1 | Quantity | (USCDI+ Quality) (USCDI) Amount dispensed Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
daysSupply |  | 0..1 | SimpleQuantity | (USCDI+ Quality) Amount of medication expressed as a timing amount
whenPrepared | Σ | 0..1 | dateTime | When product was packaged and reviewed
whenHandedOver | S C | 0..1 | dateTime | (USCDI) When product was given out or mailed
destination |  | 0..1 | Reference(Location) | Where the medication was sent
receiver |  | 0..* | Reference(Patient | Practitioner) | Who collected the medication
note |  | 0..* | Annotation | Information about the dispense
dosageInstruction | S | 0..* | Dosage | (USCDI+ Quality) (USCDI) How the medication is to be used by the patient or administered by the caregiver
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | Σ | 0..1 | integer | The order of the dosage instructions
text | S Σ | 0..1 | string | (USCDI+ Quality) (USCDI) 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 | (USCDI+ Quality) (USCDI) When medication should be administered
asNeeded[x] | Σ | 0..1 |  | Take "as needed" (for x) Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.
asNeededBoolean |  |  | boolean |
asNeededCodeableConcept |  |  | CodeableConcept |
site | Σ | 0..1 | CodeableConcept | Body site to administer to Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.
route | Σ | 0..1 | CodeableConcept | (USCDI+ Quality) 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 | (USCDI+ Quality) (USCDI) Amount of medication administered
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
type | Σ | 0..1 | CodeableConcept | The kind of dose or rate specified Binding: DoseAndRateType (example): The kind of dose or rate specified.
dose[x] | S Σ | 0..1 |  | (USCDI+ Quality) (USCDI) Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
doseQuantity |  |  | Quantity S |
doseRange |  |  | Range |
rate[x] | Σ | 0..1 |  | Amount of medication per unit of time
rateRatio |  |  | Ratio |
rateRange |  |  | Range |
rateQuantity |  |  | Quantity(SimpleQuantity) |
maxDosePerPeriod | Σ | 0..1 | Ratio | Upper limit on medication per unit of time
maxDosePerAdministration | Σ | 0..1 | SimpleQuantity | Upper limit on medication per administration
maxDosePerLifetime | Σ | 0..1 | SimpleQuantity | Upper limit on medication per lifetime of the patient
substitution |  | 0..1 | BackboneElement | Whether a substitution was performed on the dispense
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
wasSubstituted |  | 1..1 | boolean | Whether a substitution was or was not performed on the dispense
type |  | 0..1 | CodeableConcept | Code signifying whether a different drug was dispensed from what was prescribed Binding: V3 Value SetActSubstanceAdminSubstitutionCode (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: V3 Value SetSubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
responsibleParty |  | 0..* | Reference(Practitioner | PractitionerRole) | Who is responsible for the substitution
detectedIssue |  | 0..* | Reference(DetectedIssue) | Clinical issue with action
eventHistory |  | 0..* | Reference(Provenance) | A list of relevant lifecycle events
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationDispense.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
MedicationDispense.status | Base | required | Non-Negative MedicationDispense Status | 📦0.5.0 | This IG
MedicationDispense.statusReason[x] | Base | example | Medication dispense status reason codes | 📦4.0.1 | FHIR Std.
MedicationDispense.category | Base | preferred | Medication dispense category codes | 📦4.0.1 | FHIR Std.
MedicationDispense.medication[x] | Base | extensible | Medication Clinical Drug | 📦20170601 | VSAC v0.18
MedicationDispense.performer.​function | Base | example | Medication dispense performer function codes | 📦4.0.1 | FHIR Std.
MedicationDispense.type | Base | extensible | V3 Value SetActPharmacySupplyType | 📦2014-03-26 | FHIR Std.
MedicationDispense.quantity | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​additionalInstruction | Base | example | SNOMED CT Additional Dosage Instructions | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​asNeeded[x] | Base | example | SNOMED CT Medication As Needed Reason Codes | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​site | Base | example | SNOMED CT Anatomical Structure for Administration Site Codes | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​route | Base | example | SNOMED CT Route Codes | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​method | Base | example | SNOMED CT Administration Method Codes | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​doseAndRate.type | Base | example | DoseAndRateType | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​doseAndRate.dose[x] | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.
MedicationDispense.substitution.​type | Base | example | V3 Value SetActSubstanceAdminSubstitutionCode | 📦2014-03-26 | FHIR Std.
MedicationDispense.substitution.​reason | Base | example | V3 Value SetSubstanceAdminSubstitutionReason | 📦2014-03-26 | FHIR Std.

#### Constraints

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

This structure is derived from USCoreMedicationDispenseProfile

Summary

Structures

This structure refers to these other structures:

- US Quality Core Medication (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-medication)
- US Quality Core Patient (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient)
- US Quality Core MedicationRequest (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-medicationrequest)

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense | C | 0..* | USCoreMedicationDispenseProfile(6.1.0) | Dispensing a medication to a named patient Constraints: mdd-1, us-core-20
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ C | 1..1 | code | (USCDI+ Quality) (USCDI) preparation​ | in-progress​ | cancelled​ | on-hold​ | completed​ | entered-in-error​ | stopped​ | unknown Binding: Non-Negative MedicationDispense Status (required)
medication[x] | S Σ | 1..1 |  | (USCDI+ Quality) (USCDI) What medication was supplied Binding: Medication Clinical Drug (extensible): The set of RxNorm codes to represent medications
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(US Quality Core Medication) |
subject | S Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who the dispense is for
performer | S | 0..* | BackboneElement | (USCDI) Who performed event
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
actor | S | 1..1 | Reference(US Core Practitioner Profile(7.0.0) S | US Core Patient Profile(7.0.0) | US Core Organization Profile(7.0.0) S | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0) | Device) | (USCDI) Individual who was performing
authorizingPrescription | S | 0..* | Reference(US Quality Core MedicationRequest) | (USCDI) Medication order that authorizes the dispense
type | S | 0..1 | CodeableConcept | (USCDI) Trial fill, partial fill, emergency fill, etc. Binding: V3 Value SetActPharmacySupplyType (extensible)
quantity | S | 0..1 | Quantity | (USCDI+ Quality) (USCDI) Amount dispensed Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
daysSupply |  | 0..1 | SimpleQuantity | (USCDI+ Quality) Amount of medication expressed as a timing amount
whenPrepared | Σ | 0..1 | dateTime | When product was packaged and reviewed
whenHandedOver | S C | 0..1 | dateTime | (USCDI) When product was given out or mailed
dosageInstruction | S | 0..* | Dosage | (USCDI+ Quality) (USCDI) How the medication is to be used by the patient or administered by the caregiver
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
text | S Σ | 0..1 | string | (USCDI+ Quality) (USCDI) Free text dosage instructions e.g. SIG
timing | S Σ | 0..1 | Timing | (USCDI+ Quality) (USCDI) When medication should be administered
route | Σ | 0..1 | CodeableConcept | (USCDI+ Quality) 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 | S Σ | 0..* | Element | (USCDI+ Quality) (USCDI) Amount of medication administered
dose[x] | S Σ | 0..1 |  | (USCDI+ Quality) (USCDI) Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
doseQuantity |  |  | Quantity S |
doseRange |  |  | Range |
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationDispense.status | Base | required | Non-Negative MedicationDispense Status | 📦0.5.0 | This IG
MedicationDispense.medication[x] | Base | extensible | Medication Clinical Drug | 📦20170601 | VSAC v0.18
MedicationDispense.type | Base | extensible | V3 Value SetActPharmacySupplyType | 📦2014-03-26 | FHIR Std.
MedicationDispense.quantity | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​route | Base | example | SNOMED CT Route Codes | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​doseAndRate.dose[x] | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.

#### Constraints

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

Differential View

This structure is derived from USCoreMedicationDispenseProfile

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense |  | 0..* | USCoreMedicationDispenseProfile(6.1.0) | Dispensing a medication to a named patient
status |  | 1..1 | code | (USCDI+ Quality) (USCDI) preparation​ | in-progress​ | cancelled​ | on-hold​ | completed​ | entered-in-error​ | stopped​ | unknown Binding: Non-Negative MedicationDispense Status (required)
medication[x] |  | 1..1 |  | (USCDI+ Quality) (USCDI) What medication was supplied Binding: Medication Clinical Drug (extensible): The set of RxNorm codes to represent medications
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(US Quality Core Medication) |
subject |  | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who the dispense is for
authorizingPrescription |  | 0..* | Reference(US Quality Core MedicationRequest) | (USCDI) Medication order that authorizes the dispense
type |  | 0..1 | CodeableConcept | (USCDI) Trial fill, partial fill, emergency fill, etc. Binding: V3 Value SetActPharmacySupplyType (extensible)
quantity |  | 0..1 | Quantity | (USCDI+ Quality) (USCDI) Amount dispensed
daysSupply |  | 0..1 | SimpleQuantity | (USCDI+ Quality) Amount of medication expressed as a timing amount
whenPrepared |  | 0..1 | dateTime | When product was packaged and reviewed
whenHandedOver |  | 0..1 | dateTime | (USCDI) When product was given out or mailed
dosageInstruction |  | 0..* | Dosage | (USCDI+ Quality) (USCDI) How the medication is to be used by the patient or administered by the caregiver
text |  | 0..1 | string | (USCDI+ Quality) (USCDI) Free text dosage instructions e.g. SIG
timing |  | 0..1 | Timing | (USCDI+ Quality) (USCDI) When medication should be administered
route |  | 0..1 | CodeableConcept | (USCDI+ Quality) How drug should enter body
doseAndRate |  | 0..* | Element | (USCDI+ Quality) (USCDI) Amount of medication administered
dose[x] |  | 0..1 |  | (USCDI+ Quality) (USCDI) Amount of medication per dose
doseQuantity |  |  | Quantity |
doseRange |  |  | Range |
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
MedicationDispense.status | Base | required | Non-Negative MedicationDispense Status | 📦0.5.0 | This IG
MedicationDispense.medication[x] | Base | extensible | Medication Clinical Drug | 📦20170601 | VSAC v0.18
MedicationDispense.type | Base | extensible | V3 Value SetActPharmacySupplyType | 📦2014-03-26 | FHIR Std.

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense | C | 0..* | USCoreMedicationDispenseProfile(6.1.0) | Dispensing a medication to a named patient Constraints: mdd-1, us-core-20
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | External identifier
partOf |  | 0..* | Reference(Procedure) | Event that dispense is part of
status | ?!S Σ C | 1..1 | code | (USCDI+ Quality) (USCDI) preparation​ | in-progress​ | cancelled​ | on-hold​ | completed​ | entered-in-error​ | stopped​ | unknown Binding: Non-Negative MedicationDispense Status (required)
statusReason[x] |  | 0..1 |  | Why a dispense was not performed Binding: MedicationDispense Status Reason Codes (example): A code describing why a dispense was not performed.
statusReasonCodeableConcept |  |  | CodeableConcept |
statusReasonReference |  |  | Reference(DetectedIssue) |
category |  | 0..1 | CodeableConcept | Type of medication dispense Binding: MedicationDispense Category Codes (preferred): A code describing where the dispensed medication is expected to be consumed or administered.
medication[x] | S Σ | 1..1 |  | (USCDI+ Quality) (USCDI) What medication was supplied Binding: Medication Clinical Drug (extensible): The set of RxNorm codes to represent medications
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(US Quality Core Medication) |
subject | S Σ | 1..1 | Reference(US Quality Core Patient) | (USCDI) 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 | S | 0..* | BackboneElement | (USCDI) Who performed event
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
function |  | 0..1 | CodeableConcept | Who performed the dispense and what they did Binding: MedicationDispense Performer Function Codes (example): A code describing the role an individual played in dispensing a medication.
actor | S | 1..1 | Reference(US Core Practitioner Profile(7.0.0) S | US Core Patient Profile(7.0.0) | US Core Organization Profile(7.0.0) S | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0) | Device) | (USCDI) Individual who was performing
location |  | 0..1 | Reference(Location) | Where the dispense occurred
authorizingPrescription | S | 0..* | Reference(US Quality Core MedicationRequest) | (USCDI) Medication order that authorizes the dispense
type | S | 0..1 | CodeableConcept | (USCDI) Trial fill, partial fill, emergency fill, etc. Binding: V3 Value SetActPharmacySupplyType (extensible)
quantity | S | 0..1 | Quantity | (USCDI+ Quality) (USCDI) Amount dispensed Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
daysSupply |  | 0..1 | SimpleQuantity | (USCDI+ Quality) Amount of medication expressed as a timing amount
whenPrepared | Σ | 0..1 | dateTime | When product was packaged and reviewed
whenHandedOver | S C | 0..1 | dateTime | (USCDI) When product was given out or mailed
destination |  | 0..1 | Reference(Location) | Where the medication was sent
receiver |  | 0..* | Reference(Patient | Practitioner) | Who collected the medication
note |  | 0..* | Annotation | Information about the dispense
dosageInstruction | S | 0..* | Dosage | (USCDI+ Quality) (USCDI) How the medication is to be used by the patient or administered by the caregiver
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | Σ | 0..1 | integer | The order of the dosage instructions
text | S Σ | 0..1 | string | (USCDI+ Quality) (USCDI) 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 | (USCDI+ Quality) (USCDI) When medication should be administered
asNeeded[x] | Σ | 0..1 |  | Take "as needed" (for x) Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.
asNeededBoolean |  |  | boolean |
asNeededCodeableConcept |  |  | CodeableConcept |
site | Σ | 0..1 | CodeableConcept | Body site to administer to Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.
route | Σ | 0..1 | CodeableConcept | (USCDI+ Quality) 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 | (USCDI+ Quality) (USCDI) Amount of medication administered
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
type | Σ | 0..1 | CodeableConcept | The kind of dose or rate specified Binding: DoseAndRateType (example): The kind of dose or rate specified.
dose[x] | S Σ | 0..1 |  | (USCDI+ Quality) (USCDI) Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
doseQuantity |  |  | Quantity S |
doseRange |  |  | Range |
rate[x] | Σ | 0..1 |  | Amount of medication per unit of time
rateRatio |  |  | Ratio |
rateRange |  |  | Range |
rateQuantity |  |  | Quantity(SimpleQuantity) |
maxDosePerPeriod | Σ | 0..1 | Ratio | Upper limit on medication per unit of time
maxDosePerAdministration | Σ | 0..1 | SimpleQuantity | Upper limit on medication per administration
maxDosePerLifetime | Σ | 0..1 | SimpleQuantity | Upper limit on medication per lifetime of the patient
substitution |  | 0..1 | BackboneElement | Whether a substitution was performed on the dispense
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
wasSubstituted |  | 1..1 | boolean | Whether a substitution was or was not performed on the dispense
type |  | 0..1 | CodeableConcept | Code signifying whether a different drug was dispensed from what was prescribed Binding: V3 Value SetActSubstanceAdminSubstitutionCode (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: V3 Value SetSubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
responsibleParty |  | 0..* | Reference(Practitioner | PractitionerRole) | Who is responsible for the substitution
detectedIssue |  | 0..* | Reference(DetectedIssue) | Clinical issue with action
eventHistory |  | 0..* | Reference(Provenance) | A list of relevant lifecycle events
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationDispense.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
MedicationDispense.status | Base | required | Non-Negative MedicationDispense Status | 📦0.5.0 | This IG
MedicationDispense.statusReason[x] | Base | example | Medication dispense status reason codes | 📦4.0.1 | FHIR Std.
MedicationDispense.category | Base | preferred | Medication dispense category codes | 📦4.0.1 | FHIR Std.
MedicationDispense.medication[x] | Base | extensible | Medication Clinical Drug | 📦20170601 | VSAC v0.18
MedicationDispense.performer.​function | Base | example | Medication dispense performer function codes | 📦4.0.1 | FHIR Std.
MedicationDispense.type | Base | extensible | V3 Value SetActPharmacySupplyType | 📦2014-03-26 | FHIR Std.
MedicationDispense.quantity | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​additionalInstruction | Base | example | SNOMED CT Additional Dosage Instructions | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​asNeeded[x] | Base | example | SNOMED CT Medication As Needed Reason Codes | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​site | Base | example | SNOMED CT Anatomical Structure for Administration Site Codes | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​route | Base | example | SNOMED CT Route Codes | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​method | Base | example | SNOMED CT Administration Method Codes | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​doseAndRate.type | Base | example | DoseAndRateType | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​doseAndRate.dose[x] | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.
MedicationDispense.substitution.​type | Base | example | V3 Value SetActSubstanceAdminSubstitutionCode | 📦2014-03-26 | FHIR Std.
MedicationDispense.substitution.​reason | Base | example | V3 Value SetSubstanceAdminSubstitutionReason | 📦2014-03-26 | FHIR Std.

#### Constraints

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

This structure is derived from USCoreMedicationDispenseProfile

Summary

Structures

This structure refers to these other structures:

- US Quality Core Medication (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-medication)
- US Quality Core Patient (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient)
- US Quality Core MedicationRequest (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-medicationrequest)

Other representations of profile: CSV, Excel, Schematron