US Quality Core Implementation Guide
1.0.0-ballot - STU 1 - ballot United States of America flag

US Quality Core Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 1.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-us-quality-core/ and changes regularly. See the Directory of published versions

Resource Profile: US Quality Core MedicationDispense Declined

Official URL: http://hl7.org/fhir/us/quality-core/StructureDefinition/us-quality-core-medicationdispensedeclined Version: 1.0.0-ballot
Standards status: Trial-use Maturity Level: 4 Computable Name: USQualityCoreMedicationDispenseDeclined
Other Identifiers: OID:2.16.840.1.113883.4.642.40.78.42.29

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

The MedicationDispense profile defines the conformance expectations for a MedicationDispense event, regardless of whether it is a positive or negative statement. The MedicationDispenseDone and MedicationDispenseDeclined profiles represent the positive and negative statements for a MedicationDispense event.

To create an expression indicating existence of a MedicationDispense event, use the profile USQualityCoreMedicationDispenseDone; to specifically request information that a MedicationDispense intentionally did not occur for a medical, patient or system reason, use the profile USQualityCoreMedicationDispenseDeclined.

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

USCDI+ Quality Element Support Expectations

Systems are expected to support this profile as part of implementing USCDI+ Quality V2 in FHIR and meeting the conformance requirements of this guide.

The following elements are specifically relevant to USCDI+ Quality V2 data classes and elements. Systems are expected to support these elements as applicable to their role in US Quality Core data exchange. See the Must Support section of this guide for more information. These elements are flagged as (USCDI+ Quality) in the formal profile views.

USCDI+ Quality Elements:

Profile element Description USCDI+ Quality Data Element(s)
extension:recorded Extension Healthcare Information Attributes: Reason Not Performed
medication[x] What medication was supplied Healthcare Information Attributes: Reason Not Performed
medication[x].extension:codeOptions Url of a value set of candidate medications Healthcare Information Attributes: Reason Not Performed
performer.actor Individual who was performing Provenance: Author
status declined Healthcare Information Attributes: Reason Not Performed, Medications: Dispense Status
statusReason[x] Why a dispense was not performed Healthcare Information Attributes: Reason Not Performed

Because this profile is derived directly or indirectly from US Core, systems are also expected to support the Must Support and Additional USCDI requirements specified by the US Core profile this profile inherits from. For more information about those requirements, refer to the US Core MedicationDispense Profile. The Formal Views section also provides the formal summary, definitions, terminology requirements, and mandatory element requirements.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. MedicationDispense C 0..* USQualityCoreMedicationDispense Dispensing a medication to a named patient
Constraints: mdd-1, us-core-20, mdp-1
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:recorded 1..1 dateTime (USCDI+ Quality) Extension
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationDispense.recorded
Constraints: ext-1
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... statusReason[x] 1..1 CodeableConcept (USCDI+ Quality) Why a dispense was not performed
Binding: US Quality Core Negation Reason Codes (extensible): The reason the event did not occur or was not performed
... medication[x] SΣ 1..1 (USCDI+ Quality) What medication was supplied
Binding: Medication Clinical Drug . (extensible): The set of RxNorm codes to represent medications
.... medication[x]All Types Content/Rules for all Types
..... Slices for extension Content/Rules for all slices
...... extension:codeOptions 0..1 canonical(ValueSet) (USCDI+ Quality) Url of a value set of candidate medications
URL: http://hl7.org/fhir/StructureDefinition/codeOptions
.... medicationCodeableConcept CodeableConcept
.... medicationReference Reference(US Quality Core Medication)
... subject SΣ 1..1 Reference(US Quality Core Patient) 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 | US Core Device Profile) (USCDI+ Quality) Individual who was performing
... authorizingPrescription S 0..* Reference(US Quality Core MedicationRequest) 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) (USCDI+ Quality) Amount dispensed
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodes Max Binding
... whenHandedOver SC 0..1 dateTime When product was given out or mailed
... dosageInstruction S 0..* Dosage (USCDI+ Quality) 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 SΣ 0..1 string (USCDI+ Quality) Free text dosage instructions e.g. SIG
.... timing SΣ 0..1 Timing (USCDI+ Quality) When medication should be administered
.... route SΣ 0..1 CodeableConcept (USCDI+ Quality) How drug should enter body
Binding: Route of Administration of Therapeutic Agents . (extensible): SNOMED CT and NCI Thesaurus SPL route of administration codes
.... doseAndRate SΣ 0..* Element (USCDI+ Quality) Amount of medication administered
..... dose[x] SΣ 0..1 (USCDI+ Quality) Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodes Max Binding
...... doseQuantity Quantity S(SimpleQuantity)
...... doseRange Range

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
MedicationDispense.status Base required Medication dispense status codes 📍4.0.1 FHIR Std.
MedicationDispense.statusReason[x] Base extensible US Quality Core Negation Reason Codes 📦1.0.0-ballot This IG
MedicationDispense.medication[x] Base extensible Medication Clinical Drug . ⏿20240606 tx.fhir.org
MedicationDispense.type Base extensible ActPharmacySupplyType 📦3.0.0 THO v7.2
MedicationDispense.quantity Base preferred Common UCUM units 📦4.0.1 FHIR Std.
MedicationDispense.dosageInstruction.​route Base extensible Route of Administration of Therapeutic Agents . ⏿20241015 tx.fhir.org
MedicationDispense.dosageInstruction.​doseAndRate.dose[x] Base preferred Common UCUM units 📦4.0.1 FHIR Std.

Constraints

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

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. MedicationDispense 0..* USQualityCoreMedicationDispense Dispensing a medication to a named patient
... extension 1..* Extension Extension
... Slices for extension Content/Rules for all slices
.... extension:recorded 1..1 R5 MedicationDispense.recorded (USCDI+ Quality) Extension
... status 1..1 code (USCDI+ Quality) declined
Fixed Value: declined
... medication[x]
.... Slices for extension Content/Rules for all slices
..... extension:codeOptions 0..1 CodeOptions(5.3.0) (USCDI+ Quality) Url of a value set of candidate medications

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
MedicationDispense.statusReason[x] Base extensible US Quality Core Negation Reason Codes 📦1.0.0-ballot This IG
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. MedicationDispense C 0..* USQualityCoreMedicationDispense Dispensing a medication to a named patient
Constraints: mdd-1, us-core-20, mdp-1
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:recorded 1..1 dateTime (USCDI+ Quality) Extension
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationDispense.recorded
Constraints: ext-1
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier 0..* Identifier External identifier
... partOf 0..* Reference(Procedure) Event that dispense is part of
... status ?!SΣC 1..1 code (USCDI+ Quality) declined
Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event.
Fixed Value: declined
... statusReason[x] 1..1 CodeableConcept (USCDI+ Quality) Why a dispense was not performed
Binding: US Quality Core Negation Reason Codes (extensible): The reason the event did not occur or was not performed
... category 0..1 CodeableConcept Type of medication dispense
Binding: MedicationDispense Category Codes (preferred): A code describing where the dispensed medication is expected to be consumed or administered.
... medication[x] SΣ 1..1 (USCDI+ Quality) What medication was supplied
Binding: Medication Clinical Drug . (extensible): The set of RxNorm codes to represent medications
.... medication[x]All Types Content/Rules for all Types
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... extension:codeOptions 0..1 canonical(ValueSet) (USCDI+ Quality) Url of a value set of candidate medications
URL: http://hl7.org/fhir/StructureDefinition/codeOptions
.... medicationCodeableConcept CodeableConcept
.... medicationReference Reference(US Quality Core Medication)
... subject SΣ 1..1 Reference(US Quality Core Patient) 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 | US Core Device Profile) (USCDI+ Quality) Individual who was performing
... location 0..1 Reference(Location) Where the dispense occurred
... authorizingPrescription S 0..* Reference(US Quality Core MedicationRequest) 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) (USCDI+ Quality) Amount dispensed
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodes Max Binding
... daysSupply 0..1 SimpleQuantity(4.0.1) (USCDI+ Quality) Amount of medication expressed as a timing amount
... whenPrepared Σ 0..1 dateTime When product was packaged and reviewed
... whenHandedOver SC 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 (USCDI+ Quality) 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 SΣ 0..1 string (USCDI+ Quality) 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 SΣ 0..1 Timing (USCDI+ Quality) 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 SΣ 0..1 CodeableConcept (USCDI+ Quality) 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 SΣ 0..* Element (USCDI+ Quality) 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] SΣ 0..1 (USCDI+ Quality) Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
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

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
MedicationDispense.language Base preferred Common Languages 📍4.0.1 FHIR Std.
MedicationDispense.status Base required Medication dispense status codes 📍4.0.1 FHIR Std.
MedicationDispense.statusReason[x] Base extensible US Quality Core Negation Reason Codes 📦1.0.0-ballot This IG
MedicationDispense.category Base preferred Medication dispense category codes 📍4.0.1 FHIR Std.
MedicationDispense.medication[x] Base extensible Medication Clinical Drug . ⏿20240606 tx.fhir.org
MedicationDispense.performer.​function Base example Medication dispense performer function codes 📍4.0.1 FHIR Std.
MedicationDispense.type Base extensible ActPharmacySupplyType 📦3.0.0 THO v7.2
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 tx.fhir.org
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 v7.2
MedicationDispense.substitution.​reason Base example SubstanceAdminSubstitutionReason 📦3.0.0 THO v7.2

Constraints

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

Summary

Mandatory: 3 elements
Fixed: 1 element

Maturity: 4

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. MedicationDispense C 0..* USQualityCoreMedicationDispense Dispensing a medication to a named patient
Constraints: mdd-1, us-core-20, mdp-1
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:recorded 1..1 dateTime (USCDI+ Quality) Extension
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationDispense.recorded
Constraints: ext-1
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... statusReason[x] 1..1 CodeableConcept (USCDI+ Quality) Why a dispense was not performed
Binding: US Quality Core Negation Reason Codes (extensible): The reason the event did not occur or was not performed
... medication[x] SΣ 1..1 (USCDI+ Quality) What medication was supplied
Binding: Medication Clinical Drug . (extensible): The set of RxNorm codes to represent medications
.... medication[x]All Types Content/Rules for all Types
..... Slices for extension Content/Rules for all slices
...... extension:codeOptions 0..1 canonical(ValueSet) (USCDI+ Quality) Url of a value set of candidate medications
URL: http://hl7.org/fhir/StructureDefinition/codeOptions
.... medicationCodeableConcept CodeableConcept
.... medicationReference Reference(US Quality Core Medication)
... subject SΣ 1..1 Reference(US Quality Core Patient) 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 | US Core Device Profile) (USCDI+ Quality) Individual who was performing
... authorizingPrescription S 0..* Reference(US Quality Core MedicationRequest) 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) (USCDI+ Quality) Amount dispensed
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodes Max Binding
... whenHandedOver SC 0..1 dateTime When product was given out or mailed
... dosageInstruction S 0..* Dosage (USCDI+ Quality) 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 SΣ 0..1 string (USCDI+ Quality) Free text dosage instructions e.g. SIG
.... timing SΣ 0..1 Timing (USCDI+ Quality) When medication should be administered
.... route SΣ 0..1 CodeableConcept (USCDI+ Quality) How drug should enter body
Binding: Route of Administration of Therapeutic Agents . (extensible): SNOMED CT and NCI Thesaurus SPL route of administration codes
.... doseAndRate SΣ 0..* Element (USCDI+ Quality) Amount of medication administered
..... dose[x] SΣ 0..1 (USCDI+ Quality) Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodes Max Binding
...... doseQuantity Quantity S(SimpleQuantity)
...... doseRange Range

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
MedicationDispense.status Base required Medication dispense status codes 📍4.0.1 FHIR Std.
MedicationDispense.statusReason[x] Base extensible US Quality Core Negation Reason Codes 📦1.0.0-ballot This IG
MedicationDispense.medication[x] Base extensible Medication Clinical Drug . ⏿20240606 tx.fhir.org
MedicationDispense.type Base extensible ActPharmacySupplyType 📦3.0.0 THO v7.2
MedicationDispense.quantity Base preferred Common UCUM units 📦4.0.1 FHIR Std.
MedicationDispense.dosageInstruction.​route Base extensible Route of Administration of Therapeutic Agents . ⏿20241015 tx.fhir.org
MedicationDispense.dosageInstruction.​doseAndRate.dose[x] Base preferred Common UCUM units 📦4.0.1 FHIR Std.

Constraints

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

Differential View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. MedicationDispense 0..* USQualityCoreMedicationDispense Dispensing a medication to a named patient
... extension 1..* Extension Extension
... Slices for extension Content/Rules for all slices
.... extension:recorded 1..1 R5 MedicationDispense.recorded (USCDI+ Quality) Extension
... status 1..1 code (USCDI+ Quality) declined
Fixed Value: declined
... medication[x]
.... Slices for extension Content/Rules for all slices
..... extension:codeOptions 0..1 CodeOptions(5.3.0) (USCDI+ Quality) Url of a value set of candidate medications

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
MedicationDispense.statusReason[x] Base extensible US Quality Core Negation Reason Codes 📦1.0.0-ballot This IG

Snapshot ViewView

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. MedicationDispense C 0..* USQualityCoreMedicationDispense Dispensing a medication to a named patient
Constraints: mdd-1, us-core-20, mdp-1
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:recorded 1..1 dateTime (USCDI+ Quality) Extension
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationDispense.recorded
Constraints: ext-1
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier 0..* Identifier External identifier
... partOf 0..* Reference(Procedure) Event that dispense is part of
... status ?!SΣC 1..1 code (USCDI+ Quality) declined
Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event.
Fixed Value: declined
... statusReason[x] 1..1 CodeableConcept (USCDI+ Quality) Why a dispense was not performed
Binding: US Quality Core Negation Reason Codes (extensible): The reason the event did not occur or was not performed
... category 0..1 CodeableConcept Type of medication dispense
Binding: MedicationDispense Category Codes (preferred): A code describing where the dispensed medication is expected to be consumed or administered.
... medication[x] SΣ 1..1 (USCDI+ Quality) What medication was supplied
Binding: Medication Clinical Drug . (extensible): The set of RxNorm codes to represent medications
.... medication[x]All Types Content/Rules for all Types
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... extension:codeOptions 0..1 canonical(ValueSet) (USCDI+ Quality) Url of a value set of candidate medications
URL: http://hl7.org/fhir/StructureDefinition/codeOptions
.... medicationCodeableConcept CodeableConcept
.... medicationReference Reference(US Quality Core Medication)
... subject SΣ 1..1 Reference(US Quality Core Patient) 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 | US Core Device Profile) (USCDI+ Quality) Individual who was performing
... location 0..1 Reference(Location) Where the dispense occurred
... authorizingPrescription S 0..* Reference(US Quality Core MedicationRequest) 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) (USCDI+ Quality) Amount dispensed
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodes Max Binding
... daysSupply 0..1 SimpleQuantity(4.0.1) (USCDI+ Quality) Amount of medication expressed as a timing amount
... whenPrepared Σ 0..1 dateTime When product was packaged and reviewed
... whenHandedOver SC 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 (USCDI+ Quality) 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 SΣ 0..1 string (USCDI+ Quality) 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 SΣ 0..1 Timing (USCDI+ Quality) 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 SΣ 0..1 CodeableConcept (USCDI+ Quality) 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 SΣ 0..* Element (USCDI+ Quality) 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] SΣ 0..1 (USCDI+ Quality) Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
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

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
MedicationDispense.language Base preferred Common Languages 📍4.0.1 FHIR Std.
MedicationDispense.status Base required Medication dispense status codes 📍4.0.1 FHIR Std.
MedicationDispense.statusReason[x] Base extensible US Quality Core Negation Reason Codes 📦1.0.0-ballot This IG
MedicationDispense.category Base preferred Medication dispense category codes 📍4.0.1 FHIR Std.
MedicationDispense.medication[x] Base extensible Medication Clinical Drug . ⏿20240606 tx.fhir.org
MedicationDispense.performer.​function Base example Medication dispense performer function codes 📍4.0.1 FHIR Std.
MedicationDispense.type Base extensible ActPharmacySupplyType 📦3.0.0 THO v7.2
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 tx.fhir.org
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 v7.2
MedicationDispense.substitution.​reason Base example SubstanceAdminSubstitutionReason 📦3.0.0 THO v7.2

Constraints

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

Summary

Mandatory: 3 elements
Fixed: 1 element

Maturity: 4

 

Other representations of profile: CSV, Excel, Schematron

Notes:

Element Conformance Indicators by Profile Layer

Badges identify the profile layer where each conformance indicator is first introduced. Indicators introduced in an earlier layer remain applicable in later derived profiles.

Element conformance indicators organized by the profile layer where they are first introduced
Profile element FHIR US Core US Quality Core
extension Mandatory
extension:recorded Mandatory USCDI+ Quality
status Mandatory Must Support USCDI+ Quality
statusReason[x] Mandatory USCDI+ Quality
medication[x] Mandatory Must Support USCDI+ Quality
medication[x].extension:codeOptions USCDI+ Quality
subject Mandatory Must Support
context Must Support
performer Must Support
performer.actor Mandatory Must Support USCDI+ Quality
authorizingPrescription Must Support
type Must Support
quantity Must Support USCDI+ Quality
daysSupply USCDI+ Quality
whenHandedOver Must Support
dosageInstruction Must Support USCDI+ Quality
dosageInstruction.text Must Support USCDI+ Quality
dosageInstruction.timing Must Support USCDI+ Quality
dosageInstruction.route Must Support USCDI+ Quality
dosageInstruction.doseAndRate Must Support USCDI+ Quality
dosageInstruction.doseAndRate.dose[x] Must Support USCDI+ Quality
substitution.wasSubstituted Mandatory

Cardinality note: “Mandatory” means the element has a minimum cardinality greater than zero. For nested elements, the cardinality indicator applies when the containing element is present.

Mandatory US Quality Core Server Search Parameters

The searches below are the focused set identified by US Quality Core as needed to retrieve USCDI+ Quality data for quality measurement and reporting. See the US Core FHIR RESTful Search API Requirements for detailed information on requirements by search parameter type.

Because this profile derives directly or indirectly from US Core, servers SHALL also support all mandatory searches described in the US Core Server CapabilityStatement requirements for MedicationDispense. When possible, this guide reuses mandatory searches from US Core and notes them with the EXISTING US CORE REQUIREMENT flag. While US Quality Core may restate US Core requirements to highlight searches directly relevant to USCDI+ Quality data access, US Core requirements not restated here remain applicable.

See the US Quality Core Server CapabilityStatement for complete requirements for the underlying MedicationDispense resource and Search Requirement Selection for how this focused set was selected.

Servers supporting this profile SHALL support the following search parameters and search parameter combinations:

  1. SHALL support searching for all MedicationDispense resources for a patient using the patient search parameter. EXISTING US CORE REQUIREMENT

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

    Example:

    GET [base]/MedicationDispense?patient=Patient/example

    Implementation Notes: Fetches a bundle of US Quality Core MedicationDispense Declined resources matching the specified search criteria. See how to search by reference.

    Rationale for inclusion: Supports patient-scoped retrieval of MedicationDispense resources for USCDI+ Quality workflows.

  2. SHALL support searching for all MedicationDispense resources for a patient using the combination of the patient and status search parameters.

    • Including support for OR search on status (e.g.status=[status],[status],...).

    GET [base]/MedicationDispense?patient={Patient/}[id]&status=[status]

    Example:

    GET [base]/MedicationDispense?patient=Patient/example&status=declined

    Implementation Notes: Fetches a bundle of US Quality Core MedicationDispense Declined resources matching the specified search criteria. See how to search by reference and how to search by token.

    Rationale for inclusion: Supports patient-scoped retrieval of MedicationDispense resources filtered by status; status is used to indicate negation.