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This guidance is under active development by NHS England and content may be added or updated on a regular basis.UKCore-MedicationDispense
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| UKCoreMedicationDispense (MedicationDispense) | C | MedicationDispense | There are no (further) constraints on this element Element idMedicationDispenseShort description Dispensing a medication to a named patient DefinitionIndicates 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.
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| id | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationDispense.idShort description Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation. | ||
| meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idMedicationDispense.metaShort description Metadata about the resource DefinitionThe 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idMedicationDispense.implicitRulesShort description A set of rules under which this content was created DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| language | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedicationDispense.languageShort description Language of the resource content DefinitionThe base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). A human language.
The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| text | 0..1 | Narrative | There are no (further) constraints on this element Element idMedicationDispense.textShort description Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| contained | 0..* | Resource | There are no (further) constraints on this element Element idMedicationDispense.containedShort description Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
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| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationDispense.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| modifierExtension | ?! C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationDispense.modifierExtensionShort description Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay 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). 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| identifier | S | 0..* | Identifier | Element idMedicationDispense.identifierShort description Allows the resource to be referenced within / by other resources. DefinitionIdentifiers associated with this Medication Dispense that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server. This is a business identifier, not a resource identifier. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| partOf | C | 0..* | Reference(Procedure) | There are no (further) constraints on this element Element idMedicationDispense.partOfShort description Event that dispense is part of DefinitionThe procedure that trigger the dispense. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| status | S Σ ?! | 1..1 | codeBinding | Element idMedicationDispense.statusShort description A code that describes the status of the dispensing event. DefinitionA code specifying the state of the set of dispense events. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. A coded concept specifying the state of the dispense event. MedicationDispense Status Codes (required) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| statusReason[x] | 0..1 | There are no (further) constraints on this element Element idMedicationDispense.statusReason[x]Short description Why a dispense was not performed DefinitionIndicates the reason why a dispense was not performed. A code describing why a dispense was not performed. MedicationDispense Status Reason Codes (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| statusReasonCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data type | ||||
| statusReasonReference | Reference(DetectedIssue) | There are no (further) constraints on this element Data type | ||||
| category | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idMedicationDispense.categoryShort description Type of medication dispense DefinitionIndicates the type of medication dispense (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)). The category can be used to include where the medication is expected to be consumed or other types of dispenses. Invariants can be used to bind to different value sets when profiling to bind. A code describing where the dispensed medication is expected to be consumed or administered. MedicationDispense Category Codes (preferred) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| medication[x] | S Σ | 1..1 | Binding | Element idMedicationDispense.medication[x]Short description What medication was supplied. DefinitionIdentifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications. If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended. For example, if you require form or lot number, then you must reference the Medication resource. A coded concept identifying which substance or product can be dispensed. UKCoreMedicationCode (preferred) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| medicationCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data type | ||||
| medicationReference | Reference(Medication) | There are no (further) constraints on this element Data type | ||||
| subject | S Σ C | 0..1 | Reference(Group | Patient) | Element idMedicationDispense.subjectShort description Identifies the patient. DefinitionA link to a resource representing the person or the group to whom the medication will be given. SubstanceAdministration->subject->Patient. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| context | C | 0..1 | Reference(Encounter | EpisodeOfCare) | There are no (further) constraints on this element Element idMedicationDispense.contextShort description Encounter / Episode associated with event DefinitionThe encounter or episode of care that establishes the context for this event. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Encounter | EpisodeOfCare) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| supportingInformation | C | 0..* | Reference(Resource) | There are no (further) constraints on this element Element idMedicationDispense.supportingInformationShort description Information that supports the dispensing of the medication DefinitionAdditional information that supports the medication being dispensed. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| performer | S | 0..* | BackboneElement | Element idMedicationDispense.performerShort description Who or what performed the dispensing event. DefinitionIndicates who or what performed the event. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationDispense.performer.idShort description Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationDispense.performer.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationDispense.performer.modifierExtensionShort description Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 can 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). 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| function | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idMedicationDispense.performer.functionShort description Who performed the dispense and what they did DefinitionDistinguishes the type of performer in the dispense. For example, date enterer, packager, final checker. Allows disambiguation of the types of involvement of different performers. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. A code describing the role an individual played in dispensing a medication. MedicationDispense Performer Function Codes (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| actor | C | 1..1 | Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson) | There are no (further) constraints on this element Element idMedicationDispense.performer.actorShort description Individual who was performing DefinitionThe device, practitioner, etc. who performed the action. It should be assumed that the actor is the dispenser of the medication. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| location | C | 0..1 | Reference(Location) | There are no (further) constraints on this element Element idMedicationDispense.locationShort description Where the dispense occurred DefinitionThe principal physical location where the dispense was performed. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| authorizingPrescription | C | 0..* | Reference(MedicationRequest) | There are no (further) constraints on this element Element idMedicationDispense.authorizingPrescriptionShort description Medication order that authorizes the dispense DefinitionIndicates the medication order that is being dispensed against. Maps to basedOn in Event logical model. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| type | 0..1 | CodeableConceptBinding | Element idMedicationDispense.typeShort description Trial fill, partial fill, emergency fill, etc. DefinitionIndicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc. UKCoreMedicationSupplyType (extensible) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| quantity | S C | 0..1 | SimpleQuantity | Element idMedicationDispense.quantityShort description Quantity of medication dispensed. DefinitionThe amount of medication that has been dispensed. Includes unit of measure. The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| daysSupply | C | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idMedicationDispense.daysSupplyShort description Amount of medication expressed as a timing amount DefinitionThe amount of medication expressed as a timing amount. The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| whenPrepared | S Σ | 0..1 | dateTime | Element idMedicationDispense.whenPreparedShort description Timestamp for when the medication was prepared. DefinitionThe time when the dispensed product was packaged and reviewed. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| whenHandedOver | 0..1 | dateTime | There are no (further) constraints on this element Element idMedicationDispense.whenHandedOverShort description When product was given out DefinitionThe time the dispensed product was provided to the patient or their representative. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| destination | C | 0..1 | Reference(Location) | There are no (further) constraints on this element Element idMedicationDispense.destinationShort description Where the medication was sent DefinitionIdentification of the facility/location where the medication was shipped to, as part of the dispense event. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| receiver | C | 0..* | Reference(Patient | Practitioner) | There are no (further) constraints on this element Element idMedicationDispense.receiverShort description Who collected the medication DefinitionIdentifies 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. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Patient | Practitioner) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| note | 0..* | Annotation | There are no (further) constraints on this element Element idMedicationDispense.noteShort description Information about the dispense DefinitionExtra information about the dispense that could not be conveyed in the other attributes. For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible). The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| dosageInstruction | S | 0..* | Dosage | Element idMedicationDispense.dosageInstructionShort description Dosage instruction for the dispensed medication. DefinitionIndicates how the medication is to be used by the patient. When the dose or rate is intended to change over the entire administration period (e.g. Tapering dose prescriptions), multiple instances of dosage instructions will need to be supplied to convey the different doses/rates. The pharmacist reviews the medication order prior to dispense and updates the dosageInstruction based on the actual product being dispensed. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.idShort description Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.modifierExtensionShort description Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 can 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). 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| sequence | Σ | 0..1 | integer | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.sequenceShort description The order of the dosage instructions DefinitionIndicates the order in which the dosage instructions should be applied or interpreted. 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. 32 bit number; for values larger than this, use decimal The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| text | S Σ | 0..1 | string | Element idMedicationDispense.dosageInstruction.textShort description Free text dosage instructions. DefinitionFree text dosage instructions e.g. SIG. 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. Note that FHIR strings SHALL NOT exceed 1MB in size The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| additionalInstruction | Σ | 0..* | CodeableConcept | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.additionalInstructionShort description Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness" DefinitionSupplemental 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"). 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. 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. A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery". SNOMEDCTAdditionalDosageInstructions (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| patientInstruction | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.patientInstructionShort description Patient or consumer oriented instructions DefinitionInstructions in terms that are understood by the patient or consumer. Note that FHIR strings SHALL NOT exceed 1MB in size The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| timing | S Σ | 0..1 | Timing | Element idMedicationDispense.dosageInstruction.timingShort description When medication should be administered. DefinitionWhen medication should be administered. 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. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| asNeeded[x] | Σ | 0..1 | Binding | Element idMedicationDispense.dosageInstruction.asNeeded[x]Short description Take "as needed" (for x) DefinitionIndicates 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). 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". 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. SNOMEDCTMedicationAsNeededReasonCodes (preferred) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| asNeededBoolean | boolean | There are no (further) constraints on this element Data type | ||||
| asNeededCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data type | ||||
| site | Σ | 0..1 | CodeableConceptBinding | Element idMedicationDispense.dosageInstruction.siteShort description Body site to administer to DefinitionBody site to administer to. A coded specification of the anatomic site where the medication first enters the body. 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. A coded concept describing the site location the medicine enters into or onto the body. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| route | Σ | 0..1 | CodeableConceptBinding | Element idMedicationDispense.dosageInstruction.routeShort description How drug should enter body DefinitionHow drug should enter body. A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject. UKCoreSubstanceOrProductAdministrationRoute (preferred) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| method | Σ | 0..1 | CodeableConceptBinding | Element idMedicationDispense.dosageInstruction.methodShort description Technique for administering medication DefinitionTechnique for administering medication. 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. Terminologies used often pre-coordinate this term with the route and or form of administration. A coded concept describing the technique by which the medicine is administered. UKCoreMedicationDosageMethod (preferred) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| doseAndRate | S Σ | 0..* | Element | Element idMedicationDispense.dosageInstruction.doseAndRateShort description Dosage instructions for the medication. DefinitionThe amount of medication administered. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.doseAndRate.idShort description Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.doseAndRate.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| type | Σ | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.doseAndRate.typeShort description The kind of dose or rate specified DefinitionThe kind of dose or rate specified, for example, ordered or calculated. If the type is not populated, assume to be "ordered". Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. The kind of dose or rate specified. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| dose[x] | S Σ | 0..1 | Element idMedicationDispense.dosageInstruction.doseAndRate.dose[x]Short description Quantity of medication administered. DefinitionAmount of medication per dose. The amount of therapeutic or other substance given at one administration event. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| doseQuantity | SimpleQuantity | There are no (further) constraints on this element Data type | ||||
| doseRange | Range | There are no (further) constraints on this element Data type | ||||
| rate[x] | S Σ | 0..1 | Element idMedicationDispense.dosageInstruction.doseAndRate.rate[x]Short description Rate at which the medication is to be administered. DefinitionAmount of medication per unit of time. 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. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| rateQuantity | SimpleQuantity | There are no (further) constraints on this element Data type | ||||
| rateRange | Range | There are no (further) constraints on this element Data type | ||||
| rateRatio | Ratio | There are no (further) constraints on this element Data type | ||||
| maxDosePerPeriod | Σ C | 0..1 | Ratio | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.maxDosePerPeriodShort description Upper limit on medication per unit of time DefinitionUpper limit on medication per unit of time. 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. 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". The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| maxDosePerAdministration | Σ C | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.maxDosePerAdministrationShort description Upper limit on medication per administration DefinitionUpper limit on medication per administration. The maximum total quantity of a therapeutic substance that may be administered to a subject per administration. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| maxDosePerLifetime | Σ C | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.maxDosePerLifetimeShort description Upper limit on medication per lifetime of the patient DefinitionUpper limit on medication per lifetime of the patient. The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject. The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| substitution | 0..1 | BackboneElement | There are no (further) constraints on this element Element idMedicationDispense.substitutionShort description Whether a substitution was performed on the dispense DefinitionIndicates 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idMedicationDispense.substitution.idShort description Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationDispense.substitution.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationDispense.substitution.modifierExtensionShort description Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 can 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). 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. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| wasSubstituted | 1..1 | boolean | There are no (further) constraints on this element Element idMedicationDispense.substitution.wasSubstitutedShort description Whether a substitution was or was not performed on the dispense DefinitionTrue if the dispenser dispensed a different drug or product from what was prescribed. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| type | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idMedicationDispense.substitution.typeShort description Code signifying whether a different drug was dispensed from what was prescribed DefinitionA code signifying whether a different drug was dispensed from what was prescribed. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription. v3.ActSubstanceAdminSubstitutionCode (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| reason | 0..* | CodeableConcept | There are no (further) constraints on this element Element idMedicationDispense.substitution.reasonShort description Why was substitution made DefinitionIndicates the reason for the substitution (or lack of substitution) from what was prescribed. Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed. v3.SubstanceAdminSubstitutionReason (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| responsibleParty | C | 0..* | Reference(Practitioner | PractitionerRole) | There are no (further) constraints on this element Element idMedicationDispense.substitution.responsiblePartyShort description Who is responsible for the substitution DefinitionThe person or organization that has primary responsibility for the substitution. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Practitioner | PractitionerRole) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| detectedIssue | C | 0..* | Reference(DetectedIssue) | There are no (further) constraints on this element Element idMedicationDispense.detectedIssueShort description Clinical issue with action Alternate namesContraindication, Drug Utilization Review (DUR), Alert DefinitionIndicates 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. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| eventHistory | C | 0..* | Reference(Provenance) | There are no (further) constraints on this element Element idMedicationDispense.eventHistoryShort description A list of relevant lifecycle events DefinitionA summary of the events of interest that have occurred, such as when the dispense was verified. 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.). The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
|
Example - Completed Dispensing
{
"resource": {
"resourceType": "MedicationDispense",
"meta": {
"profile": [
"https://fhir.nhs.uk/StructureDefinition/UKCore-MedicationDispense"
]
},
"id": "312d757e-21f1-4f10-9f02-1746768bc31d",
"status": "completed",
"medicationCodeableConcept": {
"coding": [
{
"system": "http://dmd-nhs.uk",
"code": "42234211000001100",
"display": "ProSource 20 liquid red berry (Nutrinovo Ltd)"
}
]
},
"subject": {
"identifier": {
"system": "https://fhir.nhs.uk/Id/nhs-number",
"value": "9449304130"
},
"display": "Mr Michael Mouser"
},
"performer": [
{
"actor": {
"reference": "urn:uuid:7535862a-d46b-43a3-9d7f-2f489861e24c"
}
}
],
"authorizingPrescription": [
{
"reference": "urn:uuid:7dc0390a-f416-4d8a-9751-257bfa6294cd"
}
],
"quantity": {
"value": 60,
"unit": "tablets",
"system": "http://snomed.info/sct",
"code": "428673006"
},
"whenPrepared": "2025-11-07T11:45:00+00:00",
"dosageInstruction": [
{
"text": "Swallow 2 tablets - 3 times a day - for 1 week"
}
]
}
}
Example - Stopped / Non-Dispensing
{
"resource": {
"resourceType": "MedicationDispense",
"meta": {
"profile": [
"https://fhir.nhs.uk/StructureDefinition/UKCore-MedicationDispense"
]
},
"id": "312d757e-21f1-4f10-9f02-1746768bc31d",
"status": "stopped",
"statusReasonCodeableConcept": {
"text": "Cannot be hub assembled as per regulations as a Controlled Drug medication"
},
"medicationCodeableConcept": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
"valueCode": "not-applicable"
}
]
},
"subject": {
"identifier": {
"system": "https://fhir.nhs.uk/Id/nhs-number",
"value": "9449304130"
},
"display": "Mr Michael Mouser"
},
"performer": [
{
"actor": {
"reference": "urn:uuid:7535862a-d46b-43a3-9d7f-2f489861e24c"
}
}
],
"authorizingPrescription": [
{
"reference": "urn:uuid:7dc0390a-f416-4d8a-9751-257bfa6294cd"
}
]
}
}
Required / Minimum Dataset
The required fields that represent the minimum dataset to be shared with the spoke pharmacy (the requester) for medication assembled, labelled and shipped to the spoke pharmacy are as follows.
| Element | Implementation Requirements |
|---|---|
id |
A locally generated UUID |
status |
Fixed value completed |
medicationCodeableConcept |
The dm+d code, display and system for the dispensed medication. If the dispensed medication cannot be mapped to a valid dm+d concept then use .text. |
subject |
An identifier for the patient using NHS Number. Where NHS Number is not known use the unique identifier as provided by the requestor. |
performer |
A reference to an Organization resource for the hub pharmacy. |
authorizingPrescription |
A reference to the UKCore-MedicationRequest that is being dispensed against. |
quantity |
The quantity of medication dispensed. |
whenPrepared |
Date and time of medication assembly and labelling. |
dosageInstruction.patientInstruction |
The dosing instruction as printed on the medication dispensing label. |
Failed / Non-Dispensing
If the hub dispensing process has failed and no medication is to be shipped to the spoke pharmacy then a MedicationDispense resource should still be posted to the spoke pharmacy with the following data.
| Element | Implementation Requirements |
|---|---|
id |
A locally generated UUID |
status |
Fixed value stopped |
statusReasonCodeableConcept.text |
The reason the medication could not be assembled by the hub pharmacy. |
medicationCodeableConcept |
A mandatory element within the UKCore profile so populate with the extension data-absent-reason. |
subject |
An identifier for the patient using NHS Number. Where NHS Number is not known use the unique identifier as provided by the requestor. |
performer |
A reference to an Organization resource for the hub pharmacy. |
authorizingPrescription |
A reference to the UKCore-MedicationRequest that is being dispensed against. |