US Core Implementation Guide
8.0.1 - STU 8 US

US Core Implementation Guide, published by HL7 International / Cross-Group Projects. This guide is not an authorized publication; it is the continuous build for version 8.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/US-Core/ and changes regularly. See the Directory of published versions

## Resource Profile: US Core MedicationDispense Profile

Official URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationdispense | Version: 8.0.1
Standards status: Trial-use | Maturity Level: 3 | Computable Name: USCoreMedicationDispenseProfile
Other Identifiers: OID:2.16.840.1.113883.4.642.40.2.42.38
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

The US Core MedicationDispense Profile inherits from the FHIR MedicationDispense resource; refer to it for scope and usage definitions. This profile sets minimum expectations for the MedicationDispense resource to record, search, and fetch the state of a patients medication with regards to dispensing or other activity. (e.g., dispensed, partially dispensed, not dispensed) It specifies which core elements, extensions, vocabularies, and value sets SHALL be present and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption.

Example Usage Scenarios:

The following are example usage scenarios for the US Core-MedicationDispense profile:

- Fetching dispense statuses for medications that have been prescribed to a particular patient
- Record or update dispense statuses for medications that have been prescribed for a particular patient

### Mandatory and Must Support Data Elements

The following data elements must always be present (Mandatory definition) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements.

Each MedicationDispense Must Have:

1. a status (e.g., dispensed, not dispensed)
2. a medication*
3. a patient

* see guidance below

Each MedicationDispense Must Support:

1. the encounter associated with the dispense
2. who dispensed the medication*
3. the authorizing prescription
4. type of dispense (e.g., partially dispensed)
5. the quantity dispensed
6. a date for when medication was dispensed to the patient
7. free text dosage instructions (the SIG)
8. when medication should be administered
9. the route of administration
10. the dose and rate

*see guidance below

Profile Specific Implementation Guidance:

- The MedicationDispense resource is used to represent the USCDI medication fill status.
- *This Profile can represent a medication using a code or reference a Medication resource.
  - The Server systems are not required to support both a code and a reference, but SHALL support at least one of these methods.
  - The Client application SHALL support all methods.
  - When using a code, RXNorm concepts are used. They are defined as an extensible binding to `.medicationCodeableConcept`. USCDI recommends the National Drug Codes (NDC) as an optional terminology. They can be supplied as an additional coding element.
    - Systems that primarily rely on NDC codes instead of RxNorm to represent medications can use the National Library of Medicine's (NLM) NDC to RxNorm mappings to aid in additional codings.
  - When referencing a Medication resource in `.medicationReference`, the resource may be contained or an external resource. If an external reference to a Medication resource is used, the Server SHALL support the `_include` parameter for searching this element.

- *The profile element `MedicationDispense.performer.actor` communicates the individual level provenance author data corresponding to the U.S. Core Data for Interoperability (USCDI) Provenance Author Data Elements.

Usages:

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

You can also check for usages in the FHIR IG Statistics

Changes since version 7.0.0:

- The data elements list has changed

### 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..* | MedicationDispense | 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 | preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event.
medication[x] | S Σ | 1..1 |  | What medication was supplied Binding: Medication Clinical Drug (extensible)
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(US Core Medication Profile) |
subject | S Σ | 1..1 | Reference(US Core Patient Profile S | Group) | Who the dispense is for
context | S | 0..1 | Reference(US Core Encounter Profile S | EpisodeOfCare) | Encounter associated with MedicationDispense
performer | S | 0..* | BackboneElement | Who performed event
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
actor | S | 1..1 | Reference(US Core Organization Profile S | US Core Practitioner Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) | Individual who was performing
authorizingPrescription | S | 0..* | Reference(US Core MedicationRequest Profile) | Medication order that authorizes the dispense
type | S | 0..1 | CodeableConcept | Trial fill, partial fill, emergency fill, etc. Binding: ActPharmacySupplyType (extensible)
quantity | S | 0..1 | SimpleQuantity(4.0.1) | Amount dispensed Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
whenHandedOver | S C | 0..1 | dateTime | When product was given out or mailed
dosageInstruction | S | 0..* | Dosage | 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 | Free text dosage instructions e.g. SIG
timing | S Σ | 0..1 | Timing | When medication should be administered
route | S Σ | 0..1 | CodeableConcept | How drug should enter body Binding: Route of Administration of Therapeutic Agents (extensible): SNOMED CT and NCI Thesaurus SPL route of administration codes
doseAndRate | S Σ | 0..* | Element | Amount of medication administered
dose[x] | S Σ | 0..1 |  | Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
doseQuantity |  |  | Quantity S(SimpleQuantity) |
doseRange |  |  | Range |
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationDispense.status | Base | required | Medication dispense status codes | 📍4.0.1 | FHIR Std.
MedicationDispense.medication[x] | Base | extensible | Medication Clinical Drug | 📦20240606 | VSAC v0.24
MedicationDispense.type | Base | extensible | ActPharmacySupplyType | 📦3.0.0 | THO v7.1
MedicationDispense.quantity | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​route | Base | extensible | Route of Administration of Therapeutic Agents | 📦20241015 | VSAC v0.24
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 MedicationDispense

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense | C | 0..* | MedicationDispense | Dispensing a medication to a named patient Constraints: us-core-20
status | S C | 1..1 | code | preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
medication[x] | S | 1..1 |  | What medication was supplied Binding: Medication Clinical Drug (extensible)
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(US Core Medication Profile) |
subject | S | 1..1 | Reference(US Core Patient Profile S | Group) | Who the dispense is for
context | S | 0..1 | Reference(US Core Encounter Profile S | EpisodeOfCare) | Encounter associated with MedicationDispense
performer | S | 0..* | BackboneElement | Who performed event
actor | S | 1..1 | Reference(US Core Organization Profile S | US Core Practitioner Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) | Individual who was performing
authorizingPrescription | S | 0..* | Reference(US Core MedicationRequest Profile) | Medication order that authorizes the dispense
type | S | 0..1 | CodeableConcept | Trial fill, partial fill, emergency fill, etc. Binding: ActPharmacySupplyType (extensible)
quantity | S | 0..1 | SimpleQuantity(4.0.1) | Amount dispensed Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
whenHandedOver | S C | 0..1 | dateTime | When product was given out or mailed
dosageInstruction | S | 0..* | Dosage | How the medication is to be used by the patient or administered by the caregiver
text | S | 0..1 | string | Free text dosage instructions e.g. SIG
timing | S | 0..1 | Timing | When medication should be administered
route | S | 0..1 | CodeableConcept | How drug should enter body Binding: Route of Administration of Therapeutic Agents (extensible): SNOMED CT and NCI Thesaurus SPL route of administration codes
doseAndRate | S | 0..* | Element | Amount of medication administered
dose[x] | S | 0..1 |  | Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
doseQuantity |  |  | Quantity S(SimpleQuantity) |
doseRange |  |  | Range |
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
MedicationDispense.medication[x] | Base | extensible | Medication Clinical Drug | 📦20240606 | VSAC v0.24
MedicationDispense.type | Base | extensible | ActPharmacySupplyType | 📦3.0.0 | THO v7.1
MedicationDispense.quantity | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​route | Base | extensible | Route of Administration of Therapeutic Agents | 📦20241015 | VSAC v0.24
MedicationDispense.dosageInstruction.​doseAndRate.dose[x] | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
us-core-20 | error | MedicationDispense | whenHandedOver SHALL be present if the status is "completed" | `status='completed' implies whenHandedOver.exists()`

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense | C | 0..* | MedicationDispense | 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 | preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event.
statusReason[x] |  | 0..1 |  | Why a dispense was not performed Binding: MedicationDispense Status Reason Codes (example): A code describing why a dispense was not performed.
statusReasonCodeableConcept |  |  | CodeableConcept |
statusReasonReference |  |  | Reference(DetectedIssue) |
category |  | 0..1 | CodeableConcept | Type of medication dispense Binding: MedicationDispense Category Codes (preferred): A code describing where the dispensed medication is expected to be consumed or administered.
medication[x] | S Σ | 1..1 |  | What medication was supplied Binding: Medication Clinical Drug (extensible)
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(US Core Medication Profile) |
subject | S Σ | 1..1 | Reference(US Core Patient Profile S | Group) | Who the dispense is for
context | S | 0..1 | Reference(US Core Encounter Profile S | EpisodeOfCare) | Encounter associated with MedicationDispense
supportingInformation |  | 0..* | Reference(Resource) | Information that supports the dispensing of the medication
performer | S | 0..* | BackboneElement | Who performed event
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
function |  | 0..1 | CodeableConcept | Who performed the dispense and what they did Binding: MedicationDispense Performer Function Codes (example): A code describing the role an individual played in dispensing a medication.
actor | S | 1..1 | Reference(US Core Organization Profile S | US Core Practitioner Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) | Individual who was performing
location |  | 0..1 | Reference(Location) | Where the dispense occurred
authorizingPrescription | S | 0..* | Reference(US Core MedicationRequest Profile) | Medication order that authorizes the dispense
type | S | 0..1 | CodeableConcept | Trial fill, partial fill, emergency fill, etc. Binding: ActPharmacySupplyType (extensible)
quantity | S | 0..1 | SimpleQuantity(4.0.1) | Amount dispensed Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
daysSupply |  | 0..1 | SimpleQuantity(4.0.1) | 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 | 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 | 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 | Free text dosage instructions e.g. SIG
additionalInstruction | Σ | 0..* | CodeableConcept | Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness" Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
patientInstruction | Σ | 0..1 | string | Patient or consumer oriented instructions
timing | S Σ | 0..1 | Timing | When medication should be administered
asNeeded[x] | Σ | 0..1 |  | Take "as needed" (for x) Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.
asNeededBoolean |  |  | boolean |
asNeededCodeableConcept |  |  | CodeableConcept |
site | Σ | 0..1 | CodeableConcept | Body site to administer to Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.
route | S Σ | 0..1 | CodeableConcept | How drug should enter body Binding: Route of Administration of Therapeutic Agents (extensible): SNOMED CT and NCI Thesaurus SPL route of administration codes
method | Σ | 0..1 | CodeableConcept | Technique for administering medication Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.
doseAndRate | S Σ | 0..* | Element | Amount of medication administered
id |  | 0..1 | string | Unique id for inter-element referencing
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 |  | Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
doseQuantity |  |  | Quantity S(SimpleQuantity) |
doseRange |  |  | Range |
rate[x] | Σ | 0..1 |  | Amount of medication per unit of time
rateRatio |  |  | Ratio |
rateRange |  |  | Range |
rateQuantity |  |  | Quantity(SimpleQuantity) |
maxDosePerPeriod | Σ | 0..1 | Ratio | Upper limit on medication per unit of time
maxDosePerAdministration | Σ | 0..1 | SimpleQuantity(4.0.1) | Upper limit on medication per administration
maxDosePerLifetime | Σ | 0..1 | SimpleQuantity(4.0.1) | Upper limit on medication per lifetime of the patient
substitution |  | 0..1 | BackboneElement | Whether a substitution was performed on the dispense
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
wasSubstituted |  | 1..1 | boolean | Whether a substitution was or was not performed on the dispense
type |  | 0..1 | CodeableConcept | Code signifying whether a different drug was dispensed from what was prescribed Binding: ActSubstanceAdminSubstitutionCode (example): A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription.
reason |  | 0..* | CodeableConcept | Why was substitution made Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
responsibleParty |  | 0..* | Reference(Practitioner | PractitionerRole) | Who is responsible for the substitution
detectedIssue |  | 0..* | Reference(DetectedIssue) | Clinical issue with action
eventHistory |  | 0..* | Reference(Provenance) | A list of relevant lifecycle events
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationDispense.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
MedicationDispense.status | Base | required | Medication dispense status codes | 📍4.0.1 | FHIR Std.
MedicationDispense.statusReason[x] | Base | 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 | 📦20240606 | VSAC v0.24
MedicationDispense.performer.​function | Base | example | Medication dispense performer function codes | 📍4.0.1 | FHIR Std.
MedicationDispense.type | Base | extensible | ActPharmacySupplyType | 📦3.0.0 | THO v7.1
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 | extensible | Route of Administration of Therapeutic Agents | 📦20241015 | VSAC v0.24
MedicationDispense.dosageInstruction.​method | Base | example | SNOMED CT Administration Method Codes | 📍4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​doseAndRate.type | Base | example | DoseAndRateType | 📍4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​doseAndRate.dose[x] | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.
MedicationDispense.substitution.​type | Base | example | ActSubstanceAdminSubstitutionCode | 📦3.0.0 | THO v7.1
MedicationDispense.substitution.​reason | Base | example | SubstanceAdminSubstitutionReason | 📦3.0.0 | THO v7.1

#### 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 MedicationDispense

Summary

Mandatory: 1 element
Must-Support: 16 elements

Structures

This structure refers to these other structures:

- US Core Medication Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication)
- US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)
- US Core Encounter Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter)
- US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)
- US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner)
- US Core PractitionerRole Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole)
- US Core RelatedPerson Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson)
- US Core MedicationRequest Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest)
- SimpleQuantity (http://hl7.org/fhir/StructureDefinition/SimpleQuantity)

Maturity: 3

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense | C | 0..* | MedicationDispense | 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 | preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event.
medication[x] | S Σ | 1..1 |  | What medication was supplied Binding: Medication Clinical Drug (extensible)
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(US Core Medication Profile) |
subject | S Σ | 1..1 | Reference(US Core Patient Profile S | Group) | Who the dispense is for
context | S | 0..1 | Reference(US Core Encounter Profile S | EpisodeOfCare) | Encounter associated with MedicationDispense
performer | S | 0..* | BackboneElement | Who performed event
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
actor | S | 1..1 | Reference(US Core Organization Profile S | US Core Practitioner Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) | Individual who was performing
authorizingPrescription | S | 0..* | Reference(US Core MedicationRequest Profile) | Medication order that authorizes the dispense
type | S | 0..1 | CodeableConcept | Trial fill, partial fill, emergency fill, etc. Binding: ActPharmacySupplyType (extensible)
quantity | S | 0..1 | SimpleQuantity(4.0.1) | Amount dispensed Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
whenHandedOver | S C | 0..1 | dateTime | When product was given out or mailed
dosageInstruction | S | 0..* | Dosage | 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 | Free text dosage instructions e.g. SIG
timing | S Σ | 0..1 | Timing | When medication should be administered
route | S Σ | 0..1 | CodeableConcept | How drug should enter body Binding: Route of Administration of Therapeutic Agents (extensible): SNOMED CT and NCI Thesaurus SPL route of administration codes
doseAndRate | S Σ | 0..* | Element | Amount of medication administered
dose[x] | S Σ | 0..1 |  | Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
doseQuantity |  |  | Quantity S(SimpleQuantity) |
doseRange |  |  | Range |
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationDispense.status | Base | required | Medication dispense status codes | 📍4.0.1 | FHIR Std.
MedicationDispense.medication[x] | Base | extensible | Medication Clinical Drug | 📦20240606 | VSAC v0.24
MedicationDispense.type | Base | extensible | ActPharmacySupplyType | 📦3.0.0 | THO v7.1
MedicationDispense.quantity | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​route | Base | extensible | Route of Administration of Therapeutic Agents | 📦20241015 | VSAC v0.24
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 MedicationDispense

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense | C | 0..* | MedicationDispense | Dispensing a medication to a named patient Constraints: us-core-20
status | S C | 1..1 | code | preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
medication[x] | S | 1..1 |  | What medication was supplied Binding: Medication Clinical Drug (extensible)
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(US Core Medication Profile) |
subject | S | 1..1 | Reference(US Core Patient Profile S | Group) | Who the dispense is for
context | S | 0..1 | Reference(US Core Encounter Profile S | EpisodeOfCare) | Encounter associated with MedicationDispense
performer | S | 0..* | BackboneElement | Who performed event
actor | S | 1..1 | Reference(US Core Organization Profile S | US Core Practitioner Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) | Individual who was performing
authorizingPrescription | S | 0..* | Reference(US Core MedicationRequest Profile) | Medication order that authorizes the dispense
type | S | 0..1 | CodeableConcept | Trial fill, partial fill, emergency fill, etc. Binding: ActPharmacySupplyType (extensible)
quantity | S | 0..1 | SimpleQuantity(4.0.1) | Amount dispensed Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
whenHandedOver | S C | 0..1 | dateTime | When product was given out or mailed
dosageInstruction | S | 0..* | Dosage | How the medication is to be used by the patient or administered by the caregiver
text | S | 0..1 | string | Free text dosage instructions e.g. SIG
timing | S | 0..1 | Timing | When medication should be administered
route | S | 0..1 | CodeableConcept | How drug should enter body Binding: Route of Administration of Therapeutic Agents (extensible): SNOMED CT and NCI Thesaurus SPL route of administration codes
doseAndRate | S | 0..* | Element | Amount of medication administered
dose[x] | S | 0..1 |  | Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
doseQuantity |  |  | Quantity S(SimpleQuantity) |
doseRange |  |  | Range |
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
MedicationDispense.medication[x] | Base | extensible | Medication Clinical Drug | 📦20240606 | VSAC v0.24
MedicationDispense.type | Base | extensible | ActPharmacySupplyType | 📦3.0.0 | THO v7.1
MedicationDispense.quantity | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​route | Base | extensible | Route of Administration of Therapeutic Agents | 📦20241015 | VSAC v0.24
MedicationDispense.dosageInstruction.​doseAndRate.dose[x] | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
us-core-20 | error | MedicationDispense | whenHandedOver SHALL be present if the status is "completed" | `status='completed' implies whenHandedOver.exists()`

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense | C | 0..* | MedicationDispense | 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 | preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event.
statusReason[x] |  | 0..1 |  | Why a dispense was not performed Binding: MedicationDispense Status Reason Codes (example): A code describing why a dispense was not performed.
statusReasonCodeableConcept |  |  | CodeableConcept |
statusReasonReference |  |  | Reference(DetectedIssue) |
category |  | 0..1 | CodeableConcept | Type of medication dispense Binding: MedicationDispense Category Codes (preferred): A code describing where the dispensed medication is expected to be consumed or administered.
medication[x] | S Σ | 1..1 |  | What medication was supplied Binding: Medication Clinical Drug (extensible)
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(US Core Medication Profile) |
subject | S Σ | 1..1 | Reference(US Core Patient Profile S | Group) | Who the dispense is for
context | S | 0..1 | Reference(US Core Encounter Profile S | EpisodeOfCare) | Encounter associated with MedicationDispense
supportingInformation |  | 0..* | Reference(Resource) | Information that supports the dispensing of the medication
performer | S | 0..* | BackboneElement | Who performed event
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
function |  | 0..1 | CodeableConcept | Who performed the dispense and what they did Binding: MedicationDispense Performer Function Codes (example): A code describing the role an individual played in dispensing a medication.
actor | S | 1..1 | Reference(US Core Organization Profile S | US Core Practitioner Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) | Individual who was performing
location |  | 0..1 | Reference(Location) | Where the dispense occurred
authorizingPrescription | S | 0..* | Reference(US Core MedicationRequest Profile) | Medication order that authorizes the dispense
type | S | 0..1 | CodeableConcept | Trial fill, partial fill, emergency fill, etc. Binding: ActPharmacySupplyType (extensible)
quantity | S | 0..1 | SimpleQuantity(4.0.1) | Amount dispensed Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
daysSupply |  | 0..1 | SimpleQuantity(4.0.1) | 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 | 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 | 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 | Free text dosage instructions e.g. SIG
additionalInstruction | Σ | 0..* | CodeableConcept | Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness" Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
patientInstruction | Σ | 0..1 | string | Patient or consumer oriented instructions
timing | S Σ | 0..1 | Timing | When medication should be administered
asNeeded[x] | Σ | 0..1 |  | Take "as needed" (for x) Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.
asNeededBoolean |  |  | boolean |
asNeededCodeableConcept |  |  | CodeableConcept |
site | Σ | 0..1 | CodeableConcept | Body site to administer to Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.
route | S Σ | 0..1 | CodeableConcept | How drug should enter body Binding: Route of Administration of Therapeutic Agents (extensible): SNOMED CT and NCI Thesaurus SPL route of administration codes
method | Σ | 0..1 | CodeableConcept | Technique for administering medication Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.
doseAndRate | S Σ | 0..* | Element | Amount of medication administered
id |  | 0..1 | string | Unique id for inter-element referencing
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 |  | Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
doseQuantity |  |  | Quantity S(SimpleQuantity) |
doseRange |  |  | Range |
rate[x] | Σ | 0..1 |  | Amount of medication per unit of time
rateRatio |  |  | Ratio |
rateRange |  |  | Range |
rateQuantity |  |  | Quantity(SimpleQuantity) |
maxDosePerPeriod | Σ | 0..1 | Ratio | Upper limit on medication per unit of time
maxDosePerAdministration | Σ | 0..1 | SimpleQuantity(4.0.1) | Upper limit on medication per administration
maxDosePerLifetime | Σ | 0..1 | SimpleQuantity(4.0.1) | Upper limit on medication per lifetime of the patient
substitution |  | 0..1 | BackboneElement | Whether a substitution was performed on the dispense
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
wasSubstituted |  | 1..1 | boolean | Whether a substitution was or was not performed on the dispense
type |  | 0..1 | CodeableConcept | Code signifying whether a different drug was dispensed from what was prescribed Binding: ActSubstanceAdminSubstitutionCode (example): A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription.
reason |  | 0..* | CodeableConcept | Why was substitution made Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
responsibleParty |  | 0..* | Reference(Practitioner | PractitionerRole) | Who is responsible for the substitution
detectedIssue |  | 0..* | Reference(DetectedIssue) | Clinical issue with action
eventHistory |  | 0..* | Reference(Provenance) | A list of relevant lifecycle events
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationDispense.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
MedicationDispense.status | Base | required | Medication dispense status codes | 📍4.0.1 | FHIR Std.
MedicationDispense.statusReason[x] | Base | 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 | 📦20240606 | VSAC v0.24
MedicationDispense.performer.​function | Base | example | Medication dispense performer function codes | 📍4.0.1 | FHIR Std.
MedicationDispense.type | Base | extensible | ActPharmacySupplyType | 📦3.0.0 | THO v7.1
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 | extensible | Route of Administration of Therapeutic Agents | 📦20241015 | VSAC v0.24
MedicationDispense.dosageInstruction.​method | Base | example | SNOMED CT Administration Method Codes | 📍4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​doseAndRate.type | Base | example | DoseAndRateType | 📍4.0.1 | FHIR Std.
MedicationDispense.dosageInstruction.​doseAndRate.dose[x] | Base | preferred | Common UCUM units | 📦4.0.1 | FHIR Std.
MedicationDispense.substitution.​type | Base | example | ActSubstanceAdminSubstitutionCode | 📦3.0.0 | THO v7.1
MedicationDispense.substitution.​reason | Base | example | SubstanceAdminSubstitutionReason | 📦3.0.0 | THO v7.1

#### 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 MedicationDispense

Summary

Mandatory: 1 element
Must-Support: 16 elements

Structures

This structure refers to these other structures:

- US Core Medication Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication)
- US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)
- US Core Encounter Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter)
- US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)
- US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner)
- US Core PractitionerRole Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole)
- US Core RelatedPerson Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson)
- US Core MedicationRequest Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest)
- SimpleQuantity (http://hl7.org/fhir/StructureDefinition/SimpleQuantity)

Maturity: 3

Other representations of profile: CSV, Excel, Schematron

### Notes:

Quick Start

Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile's information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

- See the Scopes Format section for a description of the SMART scopes syntax.
- See the Search Syntax section for a description of the US Core search syntax.
- See the General Requirements section for additional rules and expectations when a Server requires status parameters.
- See the General Guidance section for additional guidance on searching for multiple patients.

#### US Core Scopes

Servers providing access to dispensed medication data SHALL support these US Core SMART Scopes:

- resource level scopes: `<patient|user|system>/MedicationDispense.rs`

#### Mandatory Search Parameters:

1. SHALL support searching using the `patient` search parameter:

   - including optional support for these `_include` parameters: `MedicationDispense:medication`

   `GET [base]/MedicationDispense?patient={Type/}[id]`

   Example:

   1. GET [base]/MedicationDispense?patient=14676
   2. GET [base]/MedicationStatement?patient=14676&_include=MedicationDispense:medication

   Implementation Notes: Fetches a bundle of all MedicationDispense resources for the specified patient. (how to search by reference)

#### Optional Search Parameters:

The following search parameter combinations SHOULD be supported:

1. SHOULD support searching using the combination of the `patient` and `status` search parameters:
   - including optional support for these `_include` parameters: `MedicationDispense:medication`
   - including support for OR search on `status` (e.g.`status={system|}[code],{system|}[code],...`)

   `GET [base]/MedicationDispense?patient={Type/}[id]&status={system|}[code]{,{system|}[code],...}`

   Example:

   1. GET [base]/MedicationDispense?patient=1137192&status=completed
   2. GET [base]/MedicationDispense?patient=1137192&status=completed&_include=MedicationDispense:medication

   Implementation Notes: Fetches a bundle of all MedicationDispense resources for the specified patient that have a given dispense status (e.g., dispensed, not dispensed)). (how to search by reference and how to search by token)

2. SHOULD support searching using the combination of the `patient` and `status` and `type` search parameters:
   - including optional support for these `_include` parameters: `MedicationDispense:medication`
   - including support for OR search on `status` (e.g.`status={system|}[code],{system|}[code],...`)
   - including support for OR search on `type` (e.g.`type={system|}[code],{system|}[code],...`)

   `GET [base]/MedicationDispense?patient={Type/}[id]&status={system|}[code]{,{system|}[code],...}&type={system|}[code]{,{system|}[code],...}`

   Example:

   1. GET [base]/MedicationDispense?patient=1137192&status=&type=
   2. GET [base]/MedicationDispense?patient=1137192&status=&type=FFP&_include=MedicationDispense:medication

   Implementation Notes: Fetches a bundle of all MedicationDispense resources for the specified patient that have a given dispense status (e.g., dispensed, not dispensed) and type of dispense (e.g., partially dispensed). (how to search by reference and how to search by token)