NHDR Implementation Guide Release 1.0
0.1.0 - ci-build

NHDR Implementation Guide Release 1.0, published by NHDR. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/PROJ-PHILHEALTH-EA-NHDR/PhilHealth-NHDR-IG-Review/ and changes regularly. See the Directory of published versions

Resource Profile: PH_MedicationDispense - Detailed Descriptions

Page standards status: Draft

Definitions for the PH-MedicationDispense resource profile.

Guidance on how to interpret the contents of this table can be foundhere

0. MedicationDispense
Definition

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

ShortDispensing a medication to a named patient
Control0..*
Is Modifierfalse
Summaryfalse
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
mdd-1: whenHandedOver cannot be before whenPrepared (whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared)
mdd-1: whenHandedOver cannot be before whenPrepared (whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared)
2. MedicationDispense.implicitRules
Definition

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

ShortA set of rules under which this content was created
Comments

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

Control0..01
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. MedicationDispense.language
Definition

The base language in which the resource is written.

ShortLanguage of the resource content
Comments

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

Control0..01
BindingThe codes SHOULD be taken from CommonLanguageshttp://hl7.org/fhir/ValueSet/languages
(preferred to http://hl7.org/fhir/ValueSet/languages)

A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
Typecode
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
6. MedicationDispense.text
Definition

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

ShortText summary of the resource, for human interpretation
Comments

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

Control0..01
TypeNarrative
Is Modifierfalse
Summaryfalse
Alternate Namesnarrative, html, xhtml, display
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
8. MedicationDispense.contained
Definition

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

ShortContained, inline Resources
Comments

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

Control0..0*
TypeResource
Is Modifierfalse
Summaryfalse
Alternate Namesinline resources, anonymous resources, contained resources
10. MedicationDispense.extension
Definition

An Extension


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

ShortExtensionAdditional content defined by implementations
Comments

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

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on MedicationDispense.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 12. MedicationDispense.extension:cost
    Slice Namecost
    Definition

    Cost of the medication.

    ShortCost
    Control0..*
    This element is affected by the following invariants: ele-1
    TypeExtension(Cost) (Extension Type: string)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    14. MedicationDispense.modifierExtension
    Definition

    An Extension


    May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

    ShortExtensionExtensions that cannot be ignored
    Comments

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

    Control0..0*
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
    Summaryfalse
    Requirements

    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    16. MedicationDispense.identifier
    Definition

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

    ShortExternal identifier
    Comments

    This is a business identifier, not a resource identifier.

    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control0..0*
    TypeIdentifier
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    18. MedicationDispense.partOf
    Definition

    The procedure that trigger the dispense.

    ShortEvent that dispense is part of
    Control0..0*
    TypeReference(Procedure)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    20. MedicationDispense.status
    Definition

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

    Shortpreparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
    Comments

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

    Control1..1
    BindingThe codes SHALL be taken from MedicationDispense Status Codeshttp://hl7.org/fhir/ValueSet/medicationdispense-status|4.0.1
    (required to http://hl7.org/fhir/ValueSet/medicationdispense-status|4.0.1)

    A coded concept specifying the state of the dispense event.

    Typecode
    Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    22. MedicationDispense.statusReason[x]
    Definition

    Indicates the reason why a dispense was not performed.

    ShortWhy a dispense was not performed
    Control0..01
    BindingFor example codes, see MedicationDispense Status Reason Codeshttp://hl7.org/fhir/ValueSet/medicationdispense-status-reason
    (example to http://hl7.org/fhir/ValueSet/medicationdispense-status-reason)

    A code describing why a dispense was not performed.

    TypeChoice of: CodeableConcept, Reference(DetectedIssue)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    24. MedicationDispense.category
    Definition

    Indicates the type of medication dispense (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)).

    ShortType of medication dispense
    Comments

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

    Control0..01
    BindingThe codes SHOULD be taken from MedicationDispense Category Codeshttp://hl7.org/fhir/ValueSet/medicationdispense-category
    (preferred to http://hl7.org/fhir/ValueSet/medicationdispense-category)

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

    TypeCodeableConcept
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    26. MedicationDispense.medication[x]
    Definition

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

    ShortWhat medication was supplied
    Comments

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

    Control1..1
    BindingFor example codes, see SNOMEDCTMedicationCodeshttp://hl7.org/fhir/ValueSet/medication-codes
    (example to http://hl7.org/fhir/ValueSet/medication-codes)

    A coded concept identifying which substance or product can be dispensed.

    TypeChoice of: CodeableConcept, Reference(Medication)
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Is Modifierfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    28. MedicationDispense.subject
    Definition

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

    ShortWho the dispense is for
    Comments

    SubstanceAdministration->subject->Patient.

    Control0..01
    TypeReference(Patient, Group)
    Is Modifierfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    30. MedicationDispense.context
    Definition

    The encounter or episode of care that establishes the context for this event.

    ShortEncounter / Episode associated with event
    Control0..01
    TypeReference(Encounter, EpisodeOfCare)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    32. MedicationDispense.supportingInformation
    Definition

    Additional information that supports the medication being dispensed.

    ShortInformation that supports the dispensing of the medication
    Control0..0*
    TypeReference(Resource)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    34. MedicationDispense.performer
    Definition

    Indicates who or what performed the event.

    ShortWho performed event
    Control0..0*
    TypeBackboneElement
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    38. MedicationDispense.location
    Definition

    The principal physical location where the dispense was performed.

    ShortWhere the dispense occurred
    Control0..01
    TypeReference(Location)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    40. MedicationDispense.authorizingPrescription
    Definition

    Indicates the medication order that is being dispensed against.

    ShortMedication order that authorizes the dispense
    Comments

    Maps to basedOn in Event logical model.

    Control0..0*
    TypeReference(MedicationRequest)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    42. MedicationDispense.type
    Definition

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

    ShortTrial fill, partial fill, emergency fill, etc.
    Control0..01
    BindingFor example codes, see ActPharmacySupplyTypehttp://terminology.hl7.org/ValueSet/v3-ActPharmacySupplyType
    (example to http://terminology.hl7.org/ValueSet/v3-ActPharmacySupplyType)

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

    TypeCodeableConcept
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    44. MedicationDispense.daysSupply
    Definition

    The amount of medication expressed as a timing amount.

    ShortAmount of medication expressed as a timing amount
    Control0..01
    TypeQuantity(SimpleQuantity)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    46. MedicationDispense.whenPrepared
    Definition

    The time when the dispensed product was packaged and reviewed.

    ShortWhen product was packaged and reviewed
    Control0..01
    TypedateTime
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    48. MedicationDispense.destination
    Definition

    Identification of the facility/location where the medication was shipped to, as part of the dispense event.

    ShortWhere the medication was sent
    Control0..01
    TypeReference(Location)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    50. MedicationDispense.receiver
    Definition

    Identifies the person who picked up the medication. This will usually be a patient or their caregiver, but some cases exist where it can be a healthcare professional.

    ShortWho collected the medication
    Control0..0*
    TypeReference(Patient, Practitioner)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    52. MedicationDispense.note
    Definition

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

    ShortInformation about the dispense
    Control0..0*
    TypeAnnotation
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    54. MedicationDispense.substitution
    Definition

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

    ShortWhether a substitution was performed on the dispense
    Control0..01
    TypeBackboneElement
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    58. MedicationDispense.detectedIssue
    Definition

    Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. drug-drug interaction, duplicate therapy, dosage alert etc.

    ShortClinical issue with action
    Comments

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

    Control0..0*
    TypeReference(DetectedIssue)
    Is Modifierfalse
    Summaryfalse
    Alternate NamesContraindication, Drug Utilization Review (DUR), Alert
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    60. MedicationDispense.eventHistory
    Definition

    A summary of the events of interest that have occurred, such as when the dispense was verified.

    ShortA list of relevant lifecycle events
    Comments

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

    Control0..0*
    TypeReference(Provenance)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

    Guidance on how to interpret the contents of this table can be foundhere

    0. MedicationDispense
    2. MedicationDispense.implicitRules
    Control0..0
    4. MedicationDispense.language
    Control0..0
    6. MedicationDispense.text
    Control0..0
    8. MedicationDispense.contained
    Control0..0
    10. MedicationDispense.extension
    SlicingThis element introduces a set of slices on MedicationDispense.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 12. MedicationDispense.extension:cost
      Slice Namecost
      Control0..*
      TypeExtension(Cost) (Extension Type: string)
      14. MedicationDispense.modifierExtension
      Control0..0
      16. MedicationDispense.identifier
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..0
      18. MedicationDispense.partOf
      Control0..0
      20. MedicationDispense.statusReason[x]
      Control0..0
      22. MedicationDispense.category
      Control0..0
      24. MedicationDispense.subject
      Control0..0
      26. MedicationDispense.context
      Control0..0
      28. MedicationDispense.supportingInformation
      Control0..0
      30. MedicationDispense.performer
      Control0..0
      32. MedicationDispense.location
      Control0..0
      34. MedicationDispense.authorizingPrescription
      Control0..0
      36. MedicationDispense.type
      Control0..0
      38. MedicationDispense.daysSupply
      Control0..0
      40. MedicationDispense.whenPrepared
      Control0..0
      42. MedicationDispense.destination
      Control0..0
      44. MedicationDispense.receiver
      Control0..0
      46. MedicationDispense.note
      Control0..0
      48. MedicationDispense.dosageInstruction
      50. MedicationDispense.dosageInstruction.extension
      Control0..0
      52. MedicationDispense.dosageInstruction.modifierExtension
      Control0..0
      54. MedicationDispense.dosageInstruction.sequence
      Control0..0
      56. MedicationDispense.dosageInstruction.text
      Control0..0
      58. MedicationDispense.dosageInstruction.additionalInstruction
      Control0..0
      60. MedicationDispense.dosageInstruction.patientInstruction
      Control0..0
      62. MedicationDispense.dosageInstruction.timing
      64. MedicationDispense.dosageInstruction.timing.id
      Control0..0
      66. MedicationDispense.dosageInstruction.timing.extension
      Control0..0
      68. MedicationDispense.dosageInstruction.timing.modifierExtension
      Control0..0
      70. MedicationDispense.dosageInstruction.timing.event
      Control0..0
      72. MedicationDispense.dosageInstruction.timing.repeat
      74. MedicationDispense.dosageInstruction.timing.repeat.id
      Control0..0
      76. MedicationDispense.dosageInstruction.timing.repeat.extension
      Control0..0
      78. MedicationDispense.dosageInstruction.timing.repeat.bounds[x]
      Control0..0
      80. MedicationDispense.dosageInstruction.timing.repeat.count
      Control0..0
      82. MedicationDispense.dosageInstruction.timing.repeat.countMax
      Control0..0
      84. MedicationDispense.dosageInstruction.timing.repeat.duration
      Control0..0
      86. MedicationDispense.dosageInstruction.timing.repeat.durationMax
      Control0..0
      88. MedicationDispense.dosageInstruction.timing.repeat.durationUnit
      Control0..0
      90. MedicationDispense.dosageInstruction.timing.repeat.frequencyMax
      Control0..0
      92. MedicationDispense.dosageInstruction.timing.repeat.period
      Control0..0
      94. MedicationDispense.dosageInstruction.timing.repeat.periodMax
      Control0..0
      96. MedicationDispense.dosageInstruction.timing.repeat.periodUnit
      Control0..0
      98. MedicationDispense.dosageInstruction.timing.repeat.dayOfWeek
      Control0..0
      100. MedicationDispense.dosageInstruction.timing.repeat.timeOfDay
      Control0..0
      102. MedicationDispense.dosageInstruction.timing.repeat.when
      Control0..0
      104. MedicationDispense.dosageInstruction.timing.repeat.offset
      Control0..0
      106. MedicationDispense.dosageInstruction.timing.code
      Control0..0
      108. MedicationDispense.dosageInstruction.asNeeded[x]
      Control0..0
      110. MedicationDispense.dosageInstruction.site
      Control0..0
      112. MedicationDispense.dosageInstruction.method
      Control0..0
      114. MedicationDispense.dosageInstruction.doseAndRate
      116. MedicationDispense.dosageInstruction.doseAndRate.id
      Control0..0
      118. MedicationDispense.dosageInstruction.doseAndRate.extension
      Control0..0
      120. MedicationDispense.dosageInstruction.doseAndRate.type
      Control0..0
      122. MedicationDispense.dosageInstruction.doseAndRate.rate[x]
      Control0..0
      124. MedicationDispense.dosageInstruction.maxDosePerPeriod
      Control0..0
      126. MedicationDispense.dosageInstruction.maxDosePerAdministration
      Control0..0
      128. MedicationDispense.dosageInstruction.maxDosePerLifetime
      Control0..0
      130. MedicationDispense.substitution
      Control0..0
      132. MedicationDispense.detectedIssue
      Control0..0
      134. MedicationDispense.eventHistory
      Control0..0

      Guidance on how to interpret the contents of this table can be foundhere

      0. MedicationDispense
      Definition

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

      ShortDispensing a medication to a named patient
      Control0..*
      Is Modifierfalse
      Summaryfalse
      Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
      dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
      dom-6: A resource should have narrative for robust management (text.`div`.exists())
      mdd-1: whenHandedOver cannot be before whenPrepared (whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared)
      2. MedicationDispense.id
      Definition

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

      ShortLogical id of this artifact
      Comments

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

      Control0..1
      Typeid
      Is Modifierfalse
      Summarytrue
      4. MedicationDispense.meta
      Definition

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

      ShortMetadata about the resource
      Control0..1
      TypeMeta
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      6. MedicationDispense.implicitRules
      Definition

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

      ShortA set of rules under which this content was created
      Comments

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

      Control0..0
      Typeuri
      Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      8. MedicationDispense.language
      Definition

      The base language in which the resource is written.

      ShortLanguage of the resource content
      Comments

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

      Control0..0
      BindingThe codes SHOULD be taken from CommonLanguages
      (preferred to http://hl7.org/fhir/ValueSet/languages)

      A human language.

      Additional BindingsPurpose
      AllLanguagesMax Binding
      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      10. MedicationDispense.text
      Definition

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

      ShortText summary of the resource, for human interpretation
      Comments

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

      Control0..0
      TypeNarrative
      Is Modifierfalse
      Summaryfalse
      Alternate Namesnarrative, html, xhtml, display
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      12. MedicationDispense.contained
      Definition

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

      ShortContained, inline Resources
      Comments

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

      Control0..0
      TypeResource
      Is Modifierfalse
      Summaryfalse
      Alternate Namesinline resources, anonymous resources, contained resources
      14. MedicationDispense.extension
      Definition

      An Extension

      ShortExtension
      Control0..*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      SlicingThis element introduces a set of slices on MedicationDispense.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 16. MedicationDispense.extension:cost
        Slice Namecost
        Definition

        Cost of the medication.

        ShortCost
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(Cost) (Extension Type: string)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        18. MedicationDispense.modifierExtension
        Definition

        An Extension

        ShortExtension
        Control0..0
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        20. MedicationDispense.identifier
        Definition

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

        ShortExternal identifier
        Comments

        This is a business identifier, not a resource identifier.

        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control0..0
        TypeIdentifier
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        22. MedicationDispense.partOf
        Definition

        The procedure that trigger the dispense.

        ShortEvent that dispense is part of
        Control0..0
        TypeReference(Procedure)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        24. MedicationDispense.status
        Definition

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

        Shortpreparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
        Comments

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

        Control1..1
        BindingThe codes SHALL be taken from MedicationDispense Status Codes
        (required to http://hl7.org/fhir/ValueSet/medicationdispense-status|4.0.1)

        A coded concept specifying the state of the dispense event.

        Typecode
        Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        26. MedicationDispense.statusReason[x]
        Definition

        Indicates the reason why a dispense was not performed.

        ShortWhy a dispense was not performed
        Control0..0
        BindingFor example codes, see MedicationDispense Status Reason Codes
        (example to http://hl7.org/fhir/ValueSet/medicationdispense-status-reason)

        A code describing why a dispense was not performed.

        TypeChoice of: CodeableConcept, Reference(DetectedIssue)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        28. MedicationDispense.category
        Definition

        Indicates the type of medication dispense (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)).

        ShortType of medication dispense
        Comments

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

        Control0..0
        BindingThe codes SHOULD be taken from MedicationDispense Category Codes
        (preferred to http://hl7.org/fhir/ValueSet/medicationdispense-category)

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

        TypeCodeableConcept
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        30. MedicationDispense.medication[x]
        Definition

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

        ShortWhat medication was supplied
        Comments

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

        Control1..1
        BindingFor example codes, see SNOMEDCTMedicationCodes
        (example to http://hl7.org/fhir/ValueSet/medication-codes)

        A coded concept identifying which substance or product can be dispensed.

        TypeChoice of: CodeableConcept, Reference(Medication)
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        32. MedicationDispense.subject
        Definition

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

        ShortWho the dispense is for
        Comments

        SubstanceAdministration->subject->Patient.

        Control0..0
        TypeReference(Patient, Group)
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        34. MedicationDispense.context
        Definition

        The encounter or episode of care that establishes the context for this event.

        ShortEncounter / Episode associated with event
        Control0..0
        TypeReference(Encounter, EpisodeOfCare)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        36. MedicationDispense.supportingInformation
        Definition

        Additional information that supports the medication being dispensed.

        ShortInformation that supports the dispensing of the medication
        Control0..0
        TypeReference(Resource)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        38. MedicationDispense.performer
        Definition

        Indicates who or what performed the event.

        ShortWho performed event
        Control0..0
        TypeBackboneElement
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        45. MedicationDispense.location
        Definition

        The principal physical location where the dispense was performed.

        ShortWhere the dispense occurred
        Control0..0
        TypeReference(Location)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        47. MedicationDispense.authorizingPrescription
        Definition

        Indicates the medication order that is being dispensed against.

        ShortMedication order that authorizes the dispense
        Comments

        Maps to basedOn in Event logical model.

        Control0..0
        TypeReference(MedicationRequest)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        49. MedicationDispense.type
        Definition

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

        ShortTrial fill, partial fill, emergency fill, etc.
        Control0..0
        BindingFor example codes, see ActPharmacySupplyType
        (example to http://terminology.hl7.org/ValueSet/v3-ActPharmacySupplyType)

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

        TypeCodeableConcept
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        51. MedicationDispense.quantity
        Definition

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

        ShortAmount dispensed
        Control0..1
        TypeQuantity(SimpleQuantity)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        53. MedicationDispense.daysSupply
        Definition

        The amount of medication expressed as a timing amount.

        ShortAmount of medication expressed as a timing amount
        Control0..0
        TypeQuantity(SimpleQuantity)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        55. MedicationDispense.whenPrepared
        Definition

        The time when the dispensed product was packaged and reviewed.

        ShortWhen product was packaged and reviewed
        Control0..0
        TypedateTime
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        57. MedicationDispense.whenHandedOver
        Definition

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

        ShortWhen product was given out
        Control0..1
        TypedateTime
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        59. MedicationDispense.destination
        Definition

        Identification of the facility/location where the medication was shipped to, as part of the dispense event.

        ShortWhere the medication was sent
        Control0..0
        TypeReference(Location)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        61. MedicationDispense.receiver
        Definition

        Identifies the person who picked up the medication. This will usually be a patient or their caregiver, but some cases exist where it can be a healthcare professional.

        ShortWho collected the medication
        Control0..0
        TypeReference(Patient, Practitioner)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        63. MedicationDispense.note
        Definition

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

        ShortInformation about the dispense
        Control0..0
        TypeAnnotation
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        65. MedicationDispense.dosageInstruction
        Definition

        Indicates how the medication is to be used by the patient.

        ShortHow the medication is to be used by the patient or administered by the caregiver
        Comments

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

        Control0..*
        TypeDosage
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        67. MedicationDispense.dosageInstruction.id
        Definition

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

        ShortUnique id for inter-element referencing
        Control0..1
        Typestring
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        69. MedicationDispense.dosageInstruction.extension
        Definition

        An Extension

        ShortExtension
        Control0..0
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        SlicingThis element introduces a set of slices on MedicationDispense.dosageInstruction.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 71. MedicationDispense.dosageInstruction.modifierExtension
          Definition

          An Extension

          ShortExtension
          Control0..0
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          73. MedicationDispense.dosageInstruction.sequence
          Definition

          Indicates the order in which the dosage instructions should be applied or interpreted.

          ShortThe order of the dosage instructions
          Control0..0
          Typeinteger
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. If the sequence number is different, then the Dosages are intended to be sequential.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          75. MedicationDispense.dosageInstruction.text
          Definition

          Free text dosage instructions e.g. SIG.

          ShortFree text dosage instructions e.g. SIG
          Control0..0
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing. Additional information about administration or preparation of the medication should be included as text.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          77. MedicationDispense.dosageInstruction.additionalInstruction
          Definition

          Supplemental instructions to the patient on how to take the medication (e.g. "with meals" or"take half to one hour before food") or warnings for the patient about the medication (e.g. "may cause drowsiness" or "avoid exposure of skin to direct sunlight or sunlamps").

          ShortSupplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
          Comments

          Information about administration or preparation of the medication (e.g. "infuse as rapidly as possibly via intraperitoneal port" or "immediately following drug x") should be populated in dosage.text.

          Control0..0
          BindingFor example codes, see SNOMEDCTAdditionalDosageInstructions
          (example to http://hl7.org/fhir/ValueSet/additional-instruction-codes)

          A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".

          TypeCodeableConcept
          Is Modifierfalse
          Summarytrue
          Requirements

          Additional instruction is intended to be coded, but where no code exists, the element could include text. For example, "Swallow with plenty of water" which might or might not be coded.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          79. MedicationDispense.dosageInstruction.patientInstruction
          Definition

          Instructions in terms that are understood by the patient or consumer.

          ShortPatient or consumer oriented instructions
          Control0..0
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          81. MedicationDispense.dosageInstruction.timing
          Definition

          When medication should be administered.

          ShortWhen medication should be administered
          Comments

          This attribute might not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.

          Control0..1
          TypeTiming
          Is Modifierfalse
          Summarytrue
          Requirements

          The timing schedule for giving the medication to the patient. This data type allows many different expressions. For example: "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          83. MedicationDispense.dosageInstruction.timing.id
          Definition

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

          ShortUnique id for inter-element referencing
          Control0..0
          Typestring
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          85. MedicationDispense.dosageInstruction.timing.extension
          Definition

          An Extension

          ShortExtension
          Control0..0
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          SlicingThis element introduces a set of slices on MedicationDispense.dosageInstruction.timing.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 87. MedicationDispense.dosageInstruction.timing.modifierExtension
            Definition

            An Extension

            ShortExtension
            Control0..0
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            89. MedicationDispense.dosageInstruction.timing.event
            Definition

            Identifies specific times when the event occurs.

            ShortWhen the event occurs
            Control0..0
            TypedateTime
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            In a Medication Administration Record, for instance, you need to take a general specification, and turn it into a precise specification.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            91. MedicationDispense.dosageInstruction.timing.repeat
            Definition

            A set of rules that describe when the event is scheduled.

            ShortWhen the event is to occur
            Control0..1
            TypeElement
            Is Modifierfalse
            Summarytrue
            Requirements

            Many timing schedules are determined by regular repetitions.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            tim-1: if there's a duration, there needs to be duration units (duration.empty() or durationUnit.exists())
            tim-2: if there's a period, there needs to be period units (period.empty() or periodUnit.exists())
            tim-4: duration SHALL be a non-negative value (duration.exists() implies duration >= 0)
            tim-5: period SHALL be a non-negative value (period.exists() implies period >= 0)
            tim-6: If there's a periodMax, there must be a period (periodMax.empty() or period.exists())
            tim-7: If there's a durationMax, there must be a duration (durationMax.empty() or duration.exists())
            tim-8: If there's a countMax, there must be a count (countMax.empty() or count.exists())
            tim-9: If there's an offset, there must be a when (and not C, CM, CD, CV) (offset.empty() or (when.exists() and ((when in ('C' | 'CM' | 'CD' | 'CV')).not())))
            tim-10: If there's a timeOfDay, there cannot be a when, or vice versa (timeOfDay.empty() or when.empty())
            93. MedicationDispense.dosageInstruction.timing.repeat.id
            Definition

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

            ShortUnique id for inter-element referencing
            Control0..0
            Typestring
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            95. MedicationDispense.dosageInstruction.timing.repeat.extension
            Definition

            An Extension

            ShortExtension
            Control0..0
            TypeExtension
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            SlicingThis element introduces a set of slices on MedicationDispense.dosageInstruction.timing.repeat.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 97. MedicationDispense.dosageInstruction.timing.repeat.bounds[x]
              Definition

              Either a duration for the length of the timing schedule, a range of possible length, or outer bounds for start and/or end limits of the timing schedule.

              ShortLength/Range of lengths, or (Start and/or end) limits
              Control0..0
              TypeChoice of: Duration, Range, Period
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              99. MedicationDispense.dosageInstruction.timing.repeat.count
              Definition

              A total count of the desired number of repetitions across the duration of the entire timing specification. If countMax is present, this element indicates the lower bound of the allowed range of count values.

              ShortNumber of times to repeat
              Comments

              If you have both bounds and count, then this should be understood as within the bounds period, until count times happens.

              Control0..0
              TypepositiveInt
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              Repetitions may be limited by end time or total occurrences.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              101. MedicationDispense.dosageInstruction.timing.repeat.countMax
              Definition

              If present, indicates that the count is a range - so to perform the action between [count] and [countMax] times.

              ShortMaximum number of times to repeat
              Control0..0
              TypepositiveInt
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              103. MedicationDispense.dosageInstruction.timing.repeat.duration
              Definition

              How long this thing happens for when it happens. If durationMax is present, this element indicates the lower bound of the allowed range of the duration.

              ShortHow long when it happens
              Comments

              For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).

              Control0..0
              Typedecimal
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              Some activities are not instantaneous and need to be maintained for a period of time.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              105. MedicationDispense.dosageInstruction.timing.repeat.durationMax
              Definition

              If present, indicates that the duration is a range - so to perform the action between [duration] and [durationMax] time length.

              ShortHow long when it happens (Max)
              Comments

              For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).

              Control0..0
              Typedecimal
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              Some activities are not instantaneous and need to be maintained for a period of time.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              107. MedicationDispense.dosageInstruction.timing.repeat.durationUnit
              Definition

              The units of time for the duration, in UCUM units.

              Shorts | min | h | d | wk | mo | a - unit of time (UCUM)
              Control0..0
              BindingThe codes SHALL be taken from UnitsOfTime
              (required to http://hl7.org/fhir/ValueSet/units-of-time|4.0.1)

              A unit of time (units from UCUM).

              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              109. MedicationDispense.dosageInstruction.timing.repeat.frequency
              Definition

              The number of times to repeat the action within the specified period. If frequencyMax is present, this element indicates the lower bound of the allowed range of the frequency.

              ShortEvent occurs frequency times per period
              Control0..1
              TypepositiveInt
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Meaning if MissingIf no frequency is stated, the assumption is that the event occurs once per period, but systems SHOULD always be specific about this
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              111. MedicationDispense.dosageInstruction.timing.repeat.frequencyMax
              Definition

              If present, indicates that the frequency is a range - so to repeat between [frequency] and [frequencyMax] times within the period or period range.

              ShortEvent occurs up to frequencyMax times per period
              Control0..0
              TypepositiveInt
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              113. MedicationDispense.dosageInstruction.timing.repeat.period
              Definition

              Indicates the duration of time over which repetitions are to occur; e.g. to express "3 times per day", 3 would be the frequency and "1 day" would be the period. If periodMax is present, this element indicates the lower bound of the allowed range of the period length.

              ShortEvent occurs frequency times per period
              Control0..0
              Typedecimal
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              115. MedicationDispense.dosageInstruction.timing.repeat.periodMax
              Definition

              If present, indicates that the period is a range from [period] to [periodMax], allowing expressing concepts such as "do this once every 3-5 days.

              ShortUpper limit of period (3-4 hours)
              Control0..0
              Typedecimal
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              117. MedicationDispense.dosageInstruction.timing.repeat.periodUnit
              Definition

              The units of time for the period in UCUM units.

              Shorts | min | h | d | wk | mo | a - unit of time (UCUM)
              Control0..0
              BindingThe codes SHALL be taken from UnitsOfTime
              (required to http://hl7.org/fhir/ValueSet/units-of-time|4.0.1)

              A unit of time (units from UCUM).

              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              119. MedicationDispense.dosageInstruction.timing.repeat.dayOfWeek
              Definition

              If one or more days of week is provided, then the action happens only on the specified day(s).

              Shortmon | tue | wed | thu | fri | sat | sun
              Comments

              If no days are specified, the action is assumed to happen every day as otherwise specified. The elements frequency and period cannot be used as well as dayOfWeek.

              Control0..0
              BindingThe codes SHALL be taken from DaysOfWeek
              (required to http://hl7.org/fhir/ValueSet/days-of-week|4.0.1)
              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              121. MedicationDispense.dosageInstruction.timing.repeat.timeOfDay
              Definition

              Specified time of day for action to take place.

              ShortTime of day for action
              Comments

              When time of day is specified, it is inferred that the action happens every day (as filtered by dayofWeek) on the specified times. The elements when, frequency and period cannot be used as well as timeOfDay.

              Control0..0
              Typetime
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              123. MedicationDispense.dosageInstruction.timing.repeat.when
              Definition

              An approximate time period during the day, potentially linked to an event of daily living that indicates when the action should occur.

              ShortCode for time period of occurrence
              Comments

              When more than one event is listed, the event is tied to the union of the specified events.

              Control0..0
              BindingThe codes SHALL be taken from EventTiming
              (required to http://hl7.org/fhir/ValueSet/event-timing|4.0.1)

              Real world event relating to the schedule.

              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              Timings are frequently determined by occurrences such as waking, eating and sleep.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              125. MedicationDispense.dosageInstruction.timing.repeat.offset
              Definition

              The number of minutes from the event. If the event code does not indicate whether the minutes is before or after the event, then the offset is assumed to be after the event.

              ShortMinutes from event (before or after)
              Control0..0
              TypeunsignedInt
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              127. MedicationDispense.dosageInstruction.timing.code
              Definition

              A code for the timing schedule (or just text in code.text). Some codes such as BID are ubiquitous, but many institutions define their own additional codes. If a code is provided, the code is understood to be a complete statement of whatever is specified in the structured timing data, and either the code or the data may be used to interpret the Timing, with the exception that .repeat.bounds still applies over the code (and is not contained in the code).

              ShortBID | TID | QID | AM | PM | QD | QOD | +
              Comments

              BID etc. are defined as 'at institutionally specified times'. For example, an institution may choose that BID is "always at 7am and 6pm". If it is inappropriate for this choice to be made, the code BID should not be used. Instead, a distinct organization-specific code should be used in place of the HL7-defined BID code and/or a structured representation should be used (in this case, specifying the two event times).

              Control0..0
              BindingThe codes SHOULD be taken from TimingAbbreviation
              (preferred to http://hl7.org/fhir/ValueSet/timing-abbreviation)

              Code for a known / defined timing pattern.

              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              129. MedicationDispense.dosageInstruction.asNeeded[x]
              Definition

              Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept).

              ShortTake "as needed" (for x)
              Comments

              Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not "prn" or "as needed".

              Control0..0
              BindingFor example codes, see SNOMEDCTMedicationAsNeededReasonCodes
              (example to http://hl7.org/fhir/ValueSet/medication-as-needed-reason)

              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.

              TypeChoice of: boolean, CodeableConcept
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              131. MedicationDispense.dosageInstruction.site
              Definition

              Body site to administer to.

              ShortBody site to administer to
              Comments

              If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.

              Control0..0
              BindingFor example codes, see SNOMEDCTAnatomicalStructureForAdministrationSiteCodes
              (example to http://hl7.org/fhir/ValueSet/approach-site-codes)

              A coded concept describing the site location the medicine enters into or onto the body.

              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Requirements

              A coded specification of the anatomic site where the medication first enters the body.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              133. MedicationDispense.dosageInstruction.route
              Definition

              How drug should enter body.

              ShortHow drug should enter body
              Control0..1
              BindingFor example codes, see SNOMEDCTRouteCodes
              (example to http://hl7.org/fhir/ValueSet/route-codes)

              A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Requirements

              A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              135. MedicationDispense.dosageInstruction.method
              Definition

              Technique for administering medication.

              ShortTechnique for administering medication
              Comments

              Terminologies used often pre-coordinate this term with the route and or form of administration.

              Control0..0
              BindingFor example codes, see SNOMEDCTAdministrationMethodCodes
              (example to http://hl7.org/fhir/ValueSet/administration-method-codes)

              A coded concept describing the technique by which the medicine is administered.

              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Requirements

              A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              137. MedicationDispense.dosageInstruction.doseAndRate
              Definition

              The amount of medication administered.

              ShortAmount of medication administered
              Control0..*
              TypeElement
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              139. MedicationDispense.dosageInstruction.doseAndRate.id
              Definition

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

              ShortUnique id for inter-element referencing
              Control0..0
              Typestring
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              141. MedicationDispense.dosageInstruction.doseAndRate.extension
              Definition

              An Extension

              ShortExtension
              Control0..0
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              SlicingThis element introduces a set of slices on MedicationDispense.dosageInstruction.doseAndRate.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 143. MedicationDispense.dosageInstruction.doseAndRate.type
                Definition

                The kind of dose or rate specified, for example, ordered or calculated.

                ShortThe kind of dose or rate specified
                Control0..0
                BindingFor example codes, see DoseAndRateType
                (example to http://hl7.org/fhir/ValueSet/dose-rate-type)

                The kind of dose or rate specified.

                TypeCodeableConcept
                Is Modifierfalse
                Summarytrue
                Requirements

                If the type is not populated, assume to be "ordered".

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                145. MedicationDispense.dosageInstruction.doseAndRate.dose[x]
                Definition

                Amount of medication per dose.

                ShortAmount of medication per dose
                Comments

                Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.

                Control0..1
                TypeChoice of: Range, Quantity(SimpleQuantity)
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Is Modifierfalse
                Summarytrue
                Requirements

                The amount of therapeutic or other substance given at one administration event.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                147. MedicationDispense.dosageInstruction.doseAndRate.rate[x]
                Definition

                Amount of medication per unit of time.

                ShortAmount of medication per unit of time
                Comments

                It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate.

                It is possible to specify a rate over time (for example, 100 ml/hour) using either the rateRatio and rateQuantity. The rateQuantity approach requires systems to have the capability to parse UCUM grammer where ml/hour is included rather than a specific ratio where the time is specified as the denominator. Where a rate such as 500ml over 2 hours is specified, the use of rateRatio may be more semantically correct than specifying using a rateQuantity of 250 mg/hour.

                Control0..0
                TypeChoice of: Ratio, Range, Quantity(SimpleQuantity)
                Is Modifierfalse
                Summarytrue
                Requirements

                Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                149. MedicationDispense.dosageInstruction.maxDosePerPeriod
                Definition

                Upper limit on medication per unit of time.

                ShortUpper limit on medication per unit of time
                Comments

                This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".

                Control0..0
                TypeRatio
                Is Modifierfalse
                Summarytrue
                Requirements

                The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                151. MedicationDispense.dosageInstruction.maxDosePerAdministration
                Definition

                Upper limit on medication per administration.

                ShortUpper limit on medication per administration
                Comments

                This is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg.

                Control0..0
                TypeQuantity(SimpleQuantity)
                Is Modifierfalse
                Summarytrue
                Requirements

                The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                153. MedicationDispense.dosageInstruction.maxDosePerLifetime
                Definition

                Upper limit on medication per lifetime of the patient.

                ShortUpper limit on medication per lifetime of the patient
                Control0..0
                TypeQuantity(SimpleQuantity)
                Is Modifierfalse
                Summarytrue
                Requirements

                The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                155. MedicationDispense.substitution
                Definition

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

                ShortWhether a substitution was performed on the dispense
                Control0..0
                TypeBackboneElement
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                164. MedicationDispense.detectedIssue
                Definition

                Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. drug-drug interaction, duplicate therapy, dosage alert etc.

                ShortClinical issue with action
                Comments

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

                Control0..0
                TypeReference(DetectedIssue)
                Is Modifierfalse
                Summaryfalse
                Alternate NamesContraindication, Drug Utilization Review (DUR), Alert
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                166. MedicationDispense.eventHistory
                Definition

                A summary of the events of interest that have occurred, such as when the dispense was verified.

                ShortA list of relevant lifecycle events
                Comments

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

                Control0..0
                TypeReference(Provenance)
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))