Please note: This guidance has been superseded by the Implementation guide for digitial medicines, which contains up-to-date information.

MedicationDispense

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CareConnect-MedicationDispense-1 (MedicationDispense)	I		MedicationDispense	There are no (further) constraints on this element Element id MedicationDispense Short description Dispensing a medication to a named patient 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. Comments The WG will be updating the MedicationDispense resource to adjust each affected resource to align with the workflow pattern (see workflow.html). Data type MedicationDispense Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative `contained.text.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-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource `contained.where(('#'+id in %resource.descendants().reference).not()).empty()` mdd-1: whenHandedOver cannot be before whenPrepared `whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared` Mappings rim: Entity. Role, or Act workflow: ..Event rim: Supply[moodCode=EVN] w5: clinical.medication
id	Σ	0..1	id	There are no (further) constraints on this element Element id MedicationDispense.id Short description Logical id of this artifact Definition The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. 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. Data type id Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id MedicationDispense.meta Short description Metadata about the resource Definition The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a rim: N/A
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id MedicationDispense.implicitRules Short description A set of rules under which this content was created 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. 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. This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a
language		0..1	codeBinding	There are no (further) constraints on this element Element id MedicationDispense.language Short description Language of the resource content Definition The base language in which the resource is written. 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). Data type code Binding A human language. Common Languages (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a
text	I	0..1	Narrative	There are no (further) constraints on this element Element id MedicationDispense.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display Definition A human-readable narrative that contains a summary of the resource, and may 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. 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 in formation is added later. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a rim: N/A rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id MedicationDispense.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources 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. 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. Data type Resource Mappings rim: Entity. Role, or Act rim: N/A
extension	I	0..*	Extension	There are no (further) constraints on this element Element id MedicationDispense.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource. In order 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. 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id MedicationDispense.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content Definition 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. Usually modifier elements provide negation or qualification. In order 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. 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
identifier		0..*	Identifier	There are no (further) constraints on this element Element id MedicationDispense.identifier Short description External identifier Definition Identifier assigned by the dispensing facility - this is an identifier assigned outside FHIR. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd: Identifier workflow: …identifier rim: .id w5: id
id		0..1	string	There are no (further) constraints on this element Element id MedicationDispense.identifier.id Short description xml:id (or equivalent in JSON) Definition unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Comments Note that FHIR strings may not exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id MedicationDispense.identifier.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order 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. 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element id MedicationDispense.identifier.use Short description usual \| official \| temp \| secondary (If known) Definition The purpose of this identifier. Requirements Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. Comments This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Data type code Binding Identifies the purpose for this identifier, if known . IdentifierUse (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: N/A rim: Role.code or implied by context
type	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id MedicationDispense.identifier.type Short description Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Requirements Allows users to make use of identifiers when the identifier system is not known. Comments This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. Data type CodeableConcept Binding A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Identifier Type Codes (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD v2: CX.5 rim: Role.code or implied by context
system	Σ	1..1	uri	There are no (further) constraints on this element Element id MedicationDispense.identifier.system Short description The namespace for the identifier value Definition Establishes the namespace for the value - that is, a URL that describes a set values that are unique. Requirements There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. Comments see http://en.wikipedia.org/wiki/Uniform_resource_identifier Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples General http://www.acme.com/identifiers/patient Mappings rim: n/a v2: CX.4 / EI-2-4 rim: II.root or Role.id.root servd: ./IdentifierType
value	Σ	1..1	string	There are no (further) constraints on this element Element id MedicationDispense.identifier.value Short description The value that is unique Definition The portion of the identifier typically relevant to the user and which is unique within the context of the system. Comments If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Examples General 123456 Mappings rim: n/a v2: CX.1 / EI.1 rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root) servd: ./Value
period	Σ I	0..1	Period	There are no (further) constraints on this element Element id MedicationDispense.identifier.period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Comments This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval\|Duration. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` per-1: If present, start SHALL have a lower value than end `start.empty() or end.empty() or (start <= end)` Mappings rim: n/a v2: DR rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2: CX.7 + CX.8 rim: Role.effectiveTime or implied by context servd: ./StartDate and ./EndDate
assigner	Σ I	0..1	Reference()	Element id MedicationDispense.identifier.assigner Short description Organization that issued id (may be just text) Definition Organization that issued/manages the identifier. Comments The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization. Data type Reference() Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2: CX.4 / (CX.4,CX.9,CX.10) rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper servd: ./IdentifierIssuingAuthority
partOf	I	0..*	Reference()	Element id MedicationDispense.partOf Short description Event that dispense is part of Definition The procedure that the dispense is done because of. Comments 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. Data type Reference() Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: …part of rim: .outboundRelationship[typeCode=COMP]/target[classCode=PROC,moodCode=EVN]
status	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element id MedicationDispense.status Short description preparation \| in-progress \| on-hold \| completed \| entered-in-error \| stopped Definition A code specifying the state of the set of dispense events. Comments This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. Data type code Binding A coded concept specifying the state of the dispense event. MedicationDispenseStatus (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a workflow: …status rim: .statusCode w5: status
category		0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id MedicationDispense.category Short description Type of medication dispense Definition Indicates type of medication dispense and where the medication is expected to be consumed or administered. Comments 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. Data type CodeableConcept Binding A code describing where the dispensed medication is expected to be consumed or administered MedicationDispenseCategory (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD rim: .inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="type of medication dispense"].value
medication[x]	Σ	1..1		Element id MedicationDispense.medication[x] Short description What medication was supplied 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. 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. . Binding A coded concept identifying which substance or product can be dispensed SNOMED CT Medication Codes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a workflow: …code v2: RXD-2-Dispense/Give Code rim: .participation[typeCode=PRD].role w5: what
medicationCodeableConcept			CodeableConcept	Data type CodeableConcept
medicationReference			Reference()	Data type Reference()
subject	Σ I	0..1	Reference(Group \| )	Element id MedicationDispense.subject Short description Who the dispense is for Definition A link to a resource representing the person or the group to whom the medication will be given. Comments SubstanceAdministration->subject->Patient. Data type Reference(Group \| ) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: …subject v2: PID-3-Patient ID List rim: .participation[typeCode=SBJ].role[classCode=PAT] w5: who.focus
context	I	0..1	Reference( \| https://fhir.hl7.org.uk/STU3/StructureDefinition/CareConnect-Encounter-1)	Element id MedicationDispense.context Short description Encounter / Episode associated with event Definition The encounter or episode of care that establishes the context for this event. Comments 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. Data type Reference( \| https://fhir.hl7.org.uk/STU3/StructureDefinition/CareConnect-Encounter-1) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: …context rim: .inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code="type of encounter or episode"]
supportingInformation	I	0..*	Reference(Resource)	There are no (further) constraints on this element Element id MedicationDispense.supportingInformation Short description Information that supports the dispensing of the medication Definition Additional information that supports the medication being dispensed. Comments 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. Data type Reference(Resource) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim: .outboundRelationship[typeCode=PERT].target[A_SupportingClinicalStatement CMET minimal with many different choices of classCodes(ORG, ENC, PROC, SPLY, SBADM, OBS) and each of the act class codes draws from one or more of the following moodCodes (EVN, DEF, INT PRMS, RQO, PRP, APT, ARQ, GOL)] w5: context
performer		0..*	BackboneElement	There are no (further) constraints on this element Element id MedicationDispense.performer Short description Who performed event Definition Indicates who or what performed the event. It should be assumed that the performer is the dispenser of the medication. Comments The performer will be reviewed as part of STU4. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a workflow: …performer rim: .participation[typeCode=PRF]
id		0..1	string	There are no (further) constraints on this element Element id MedicationDispense.performer.id Short description xml:id (or equivalent in JSON) Definition unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Comments Note that FHIR strings may not exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id MedicationDispense.performer.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order 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. 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id MedicationDispense.performer.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content, modifiers Definition May 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 that contains it. Usually modifier elements provide negation or qualification. In order 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. 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
actor	I	1..1	Reference(Device \| \| \| \| )	Element id MedicationDispense.performer.actor Short description Individual who was performing Definition The device, practitioner, etc. who performed the action. It should be assumed that the actor is the dispenser of the medication. Comments 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. Data type Reference(Device \| \| \| \| ) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: ….actor rim: .role
onBehalfOf	I	0..1	Reference()	Element id MedicationDispense.performer.onBehalfOf Short description Organization organization was acting for Definition The organization the device or practitioner was acting on behalf of. Comments 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. Data type Reference() Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: ….onBehalfOf rim: .role.scopingOrganization
authorizingPrescription	I	0..*	Reference()	Element id MedicationDispense.authorizingPrescription Short description Medication order that authorizes the dispense Definition Indicates the medication order that is being dispensed against. Comments Maps to basedOn in Event logical model. Data type Reference() Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: …basedOn v2: ORC-2 Placer Order Number rim: .outboundRelationship[typeCode=FLFS].target[moodCode=RQO]
type		0..1	CodeableConceptBinding	Element id MedicationDispense.type Short description To identify the type of medication supply. Definition Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc. Comments 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. Data type CodeableConcept Binding A ValueSet to identify the type of medication supply. (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD v2: RXD-33-Dispense Type rim: .code
quantity	I	0..1	SimpleQuantity	There are no (further) constraints on this element Element id MedicationDispense.quantity Short description Amount dispensed Definition The amount of medication that has been dispensed. Includes unit of measure. Comments 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. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` qty-3: If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()` sqty-1: The comparator is not used on a SimpleQuantity `comparator.empty()` Mappings rim: n/a v2: SN (see also Range) or CQ rim: PQ, IVL<PQ>, MO, CO, depending on the values v2: RXD-4-Actual Dispense Amount / RXD-5.1-Actual Dispense Units.code / RXD-5.3-Actual Dispense Units.name of coding system rim: .quantity
id		0..1	string	There are no (further) constraints on this element Element id MedicationDispense.quantity.id Short description xml:id (or equivalent in JSON) Definition unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Comments Note that FHIR strings may not exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a
extension	I	0..*	Extension	Element id MedicationDispense.quantity.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order 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. 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
quantityText	I	0..1	Extension(string)	Element id MedicationDispense.quantity.extension:quantityText Short description Quantity representation Alternate names extensions, user content Definition Quantity representation. 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. Data type Extension(string) Extension URL https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-MedicationQuantityText-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
value	Σ	0..1	decimal	There are no (further) constraints on this element Element id MedicationDispense.quantity.value Short description Numerical value (with implicit precision) Definition The value of the measured amount. The value includes an implicit precision in the presentation of the value. Requirements Precision is handled implicitly in almost all cases of measurement. Comments The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books). Data type decimal Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: SN.2 / CQ - N/A rim: PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value
comparator	Σ ?!	0..0	codeBinding	There are no (further) constraints on this element Element id MedicationDispense.quantity.comparator Short description < \| <= \| >= \| > - how to understand the value Definition Not allowed to be used in this context Requirements Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology. Comments This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value. Meaning when missing If there is no comparator, then there is no modification of the value Data type code Binding How the Quantity should be understood and represented. QuantityComparator (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: SN.1 / CQ.1 rim: IVL properties
unit	Σ	0..1	string	There are no (further) constraints on this element Element id MedicationDispense.quantity.unit Short description Unit representation Definition A human-readable form of the unit. Requirements There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms. Comments Note that FHIR strings may not exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: (see OBX.6 etc.) / CQ.2 rim: PQ.unit
system	Σ I	0..1	uri	There are no (further) constraints on this element Element id MedicationDispense.quantity.system Short description System that defines coded unit form Definition The identification of the system that provides the coded form of the unit. Requirements Need to know the system that defines the coded form of the unit. Comments see http://en.wikipedia.org/wiki/Uniform_resource_identifier Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: (see OBX.6 etc.) / CQ.2 rim: CO.codeSystem, PQ.translation.codeSystem
code	Σ	0..1	code	There are no (further) constraints on this element Element id MedicationDispense.quantity.code Short description Coded form of the unit Definition A computer processable form of the unit in some unit representation system. Requirements Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest. Comments The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system. Data type code Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: (see OBX.6 etc.) / CQ.2 rim: PQ.code, MO.currency, PQ.translation.code
daysSupply	I	0..1	SimpleQuantity	There are no (further) constraints on this element Element id MedicationDispense.daysSupply Short description Amount of medication expressed as a timing amount Definition The amount of medication expressed as a timing amount. Comments 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. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` qty-3: If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()` sqty-1: The comparator is not used on a SimpleQuantity `comparator.empty()` Mappings rim: n/a v2: SN (see also Range) or CQ rim: PQ, IVL<PQ>, MO, CO, depending on the values v2: TQ1.6 Timing/Quantity Segment Service Duration. Prior to v2.5, ORC.7.3 Common Order Segment / Quantity/Timing / Duration component. This is a formatted string, first character for the time unit (e.g., D=days), followed by the value. For example, “D14” represents “14 days supply” From v2.5 on, TQ1.6 Timing/Quantity Segment / Service Duration. This is a CQ data type (<Quantity (NM)> ^ <Units (CWE)>), thus for days supply, assuming the unit of measure is “days”, the numeric value is TQ1.6.1 (…\|14^ For backwards compatibility, ORC.7 was permitted through v2.6. Both forms (field and segment) may be present in v2.5, v2.5.1, and v2.6 rim: effectiveUseTime
whenPrepared	Σ	0..1	dateTime	There are no (further) constraints on this element Element id MedicationDispense.whenPrepared Short description When product was packaged and reviewed Definition The time when the dispensed product was packaged and reviewed. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: RXD-3-Date/Time Dispensed rim: .effectiveTime[xmi:type=IVL_TS].low
whenHandedOver		0..1	dateTime	There are no (further) constraints on this element Element id MedicationDispense.whenHandedOver Short description When product was given out Definition The time the dispensed product was provided to the patient or their representative. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a workflow: …occurrenceDateTime v2: RXD-3-Date/Time Dispensed rim: .effectiveTime[xmi:type=IVL_TS].high
destination	I	0..1	Reference()	Element id MedicationDispense.destination Short description Where the medication was sent Definition Identification of the facility/location where the medication was shipped to, as part of the dispense event. Comments 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. Data type Reference() Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2: RXD-13 Dispense-to Location; RXD-30 Dispense to Pharmacy; RXD-31 Dispense to Pharmacy Address rim: .participation[typeCode=DST].role
receiver	I	0..*	Reference( \| )	Element id MedicationDispense.receiver Short description Who collected the medication 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. Comments 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. Data type Reference( \| ) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim: .participation[typeCode=RCV].role
note		0..*	Annotation	There are no (further) constraints on this element Element id MedicationDispense.note Short description Information about the dispense Definition Extra information about the dispense that could not be conveyed in the other attributes. Comments 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). Data type Annotation Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: N/A rim: Act workflow: …note v2: RXD-9 Dispense Notes rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=ACT,moodCode=EVN]
id		0..1	string	There are no (further) constraints on this element Element id MedicationDispense.note.id Short description xml:id (or equivalent in JSON) Definition unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Comments Note that FHIR strings may not exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id MedicationDispense.note.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order 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. 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
author[x]	Σ	0..1		There are no (further) constraints on this element Element id MedicationDispense.note.author[x] Short description Individual responsible for the annotation Definition The individual responsible for making the annotation. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: N/A rim: Act.participant[typeCode=AUT].role
authorString			string	Data type string
authorReference			Reference( \| \| )	Data type Reference( \| \| )
time	Σ	0..1	dateTime	There are no (further) constraints on this element Element id MedicationDispense.note.time Short description When the annotation was made Definition Indicates when this particular annotation was made. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: N/A rim: Act.effectiveTime
text		1..1	string	There are no (further) constraints on this element Element id MedicationDispense.note.text Short description The annotation - text content Definition The text of the annotation. Comments Note that FHIR strings may not exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: N/A rim: Act.text
dosageInstruction		0..*	Dosage	There are no (further) constraints on this element Element id MedicationDispense.dosageInstruction Short description How the medication is to be used by the patient or administered by the caregiver Definition Indicates how the medication is to be used by the patient. 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. Data type Dosage Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a rim: .outboundRelationship[typeCode=COMP].target[classCode=SBADM, moodCode=INT]
substitution		0..1	BackboneElement	There are no (further) constraints on this element Element id MedicationDispense.substitution Short description Whether a substitution was performed on the dispense 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. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a rim: .outboundRelationship[typeCode=COMP].target[classCode=SUBST, moodCode=EVN]
id		0..1	string	There are no (further) constraints on this element Element id MedicationDispense.substitution.id Short description xml:id (or equivalent in JSON) Definition unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Comments Note that FHIR strings may not exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id MedicationDispense.substitution.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. In order 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. 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id MedicationDispense.substitution.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content, modifiers Definition May 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 that contains it. Usually modifier elements provide negation or qualification. In order 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. 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
wasSubstituted		1..1	boolean	There are no (further) constraints on this element Element id MedicationDispense.substitution.wasSubstituted Short description Whether a substitution was or was not performed on the dispense Definition True if the dispenser dispensed a different drug or product from what was prescribed. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a rim: .actionNegationInd
type		0..1	CodeableConcept	There are no (further) constraints on this element Element id MedicationDispense.substitution.type Short description Code signifying whether a different drug was dispensed from what was prescribed Definition A code signifying whether a different drug was dispensed from what was prescribed. Comments 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. Data type CodeableConcept Binding A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription ActSubstanceAdminSubstitutionCode (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD v2: RXO-9-Allow Substitutions / RXE-9-Substitution Status rim: .code
reason		0..*	CodeableConcept	There are no (further) constraints on this element Element id MedicationDispense.substitution.reason Short description Why was substitution made Definition Indicates the reason for the substitution of (or lack of substitution) from what was prescribed. Comments 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. Data type CodeableConcept Binding A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed SubstanceAdminSubstitutionReason (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD rim: .reasonCode
responsibleParty	I	0..*	Reference()	Element id MedicationDispense.substitution.responsibleParty Short description Who is responsible for the substitution Definition The person or organization that has primary responsibility for the substitution. Comments 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. Data type Reference() Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim: .participation[typeCode=PFM].role[classCode=ASSIGN]
detectedIssue	I	0..*	Reference(DetectedIssue)	There are no (further) constraints on this element Element id MedicationDispense.detectedIssue Short description Clinical issue with action Alternate names Contraindication, Drug Utilization Review (DUR), Alert 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. Comments 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. Data type Reference(DetectedIssue) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=ALRT,moodCode=EVN].value
notDone		0..1	boolean	There are no (further) constraints on this element Element id MedicationDispense.notDone Short description Whether the dispense was or was not performed Definition True if the dispense was not performed for some reason. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a workflow: …notDone rim: .actionNegationInd
notDoneReason[x]		0..1		There are no (further) constraints on this element Element id MedicationDispense.notDoneReason[x] Short description Why a dispense was not performed Definition Indicates the reason why a dispense was not performed. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` Mappings rim: n/a workflow: …notDoneReason rim: .outboundRelationship[typeCode=RSON]/target[classCode=OBS,moodCode=EVN, code="not done reason"].value
notDoneReasonCodeableConcept			CodeableConcept	There are no (further) constraints on this element Data type CodeableConcept
notDoneReasonReference			Reference(DetectedIssue)	There are no (further) constraints on this element Data type Reference(DetectedIssue)
eventHistory	I	0..*	Reference(Provenance)	There are no (further) constraints on this element Element id MedicationDispense.eventHistory Short description A list of releveant lifecycle events Definition A summary of the events of interest that have occurred, such as when the dispense was verified. Comments This may 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.). Data type Reference(Provenance) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim: .inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]

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.
Cardinality	0...*
Comments	The WG will be updating the MedicationDispense resource to adjust each affected resource to align with the workflow pattern (see workflow.html).
Invariants	dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative `contained.text.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-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource `contained.where(('#'+id in %resource.descendants().reference).not()).empty()` mdd-1: whenHandedOver cannot be before whenPrepared `whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared`
Mappings	rim: Entity. Role, or Act workflow: ..Event rim: Supply[moodCode=EVN] w5: clinical.medication
MedicationDispense.id
Definition	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality	0...1
Type	id
Summary	True
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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a
MedicationDispense.meta
Definition	The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.
Cardinality	0...1
Type	Meta
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a rim: N/A
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.
Cardinality	0...1
Type	uri
Modifier	True
Summary	True
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. This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a
MedicationDispense.language
Definition	The base language in which the resource is written.
Cardinality	0...1
Type	code
Binding	A human language. Common Languages (extensible)
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).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a
MedicationDispense.text
Definition	A human-readable narrative that contains a summary of the resource, and may 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.
Cardinality	0...1
Type	Narrative
Alias	narrative, html, xhtml, display
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 in formation is added later.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a rim: N/A rim: Act.text?
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.
Cardinality	0...*
Type	Resource
Alias	inline resources, anonymous resources, contained 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.
Mappings	rim: Entity. Role, or Act rim: N/A
MedicationDispense.extension
Definition	May be used to represent additional information that is not part of the basic definition of the resource. In order 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.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationDispense.modifierExtension
Definition	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. Usually modifier elements provide negation or qualification. In order 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.
Cardinality	0...*
Type	Extension
Modifier	True
Alias	extensions, user content
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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationDispense.identifier
Definition	Identifier assigned by the dispensing facility - this is an identifier assigned outside FHIR.
Cardinality	0...*
Type	Identifier
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd: Identifier workflow: …identifier rim: .id w5: id
MedicationDispense.identifier.id
Definition	unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Comments	Note that FHIR strings may not exceed 1MB in size
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a
MedicationDispense.identifier.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. In order 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.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationDispense.identifier.use
Definition	The purpose of this identifier.
Cardinality	0...1
Type	code
Binding	Identifies the purpose for this identifier, if known . IdentifierUse (required)
Modifier	True
Summary	True
Requirements	Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Comments	This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a v2: N/A rim: Role.code or implied by context
MedicationDispense.identifier.type
Definition	A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Cardinality	0...1
Type	CodeableConcept
Binding	A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Identifier Type Codes (extensible)
Summary	True
Requirements	Allows users to make use of identifiers when the identifier system is not known.
Comments	This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD v2: CX.5 rim: Role.code or implied by context
MedicationDispense.identifier.system
Definition	Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
Cardinality	1...1
Type	uri
Summary	True
Requirements	There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Comments	see http://en.wikipedia.org/wiki/Uniform_resource_identifier
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Examples	General http://www.acme.com/identifiers/patient
Mappings	rim: n/a v2: CX.4 / EI-2-4 rim: II.root or Role.id.root servd: ./IdentifierType
MedicationDispense.identifier.value
Definition	The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Cardinality	1...1
Type	string
Summary	True
Comments	If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Examples	General 123456
Mappings	rim: n/a v2: CX.1 / EI.1 rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root) servd: ./Value
MedicationDispense.identifier.period
Definition	Time period during which identifier is/was valid for use.
Cardinality	0...1
Type	Period
Summary	True
Comments	This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval\|Duration.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` per-1: If present, start SHALL have a lower value than end `start.empty() or end.empty() or (start <= end)`
Mappings	rim: n/a v2: DR rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2: CX.7 + CX.8 rim: Role.effectiveTime or implied by context servd: ./StartDate and ./EndDate
MedicationDispense.identifier.assigner
Definition	Organization that issued/manages the identifier.
Cardinality	0...1
Type	Reference()
Summary	True
Comments	The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2: CX.4 / (CX.4,CX.9,CX.10) rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper servd: ./IdentifierIssuingAuthority
MedicationDispense.partOf
Definition	The procedure that the dispense is done because of.
Cardinality	0...*
Type	Reference()
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: …part of rim: .outboundRelationship[typeCode=COMP]/target[classCode=PROC,moodCode=EVN]
MedicationDispense.status
Definition	A code specifying the state of the set of dispense events.
Cardinality	0...1
Type	code
Binding	A coded concept specifying the state of the dispense event. MedicationDispenseStatus (required)
Modifier	True
Summary	True
Comments	This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a workflow: …status rim: .statusCode w5: status
MedicationDispense.category
Definition	Indicates type of medication dispense and where the medication is expected to be consumed or administered.
Cardinality	0...1
Type	CodeableConcept
Binding	A code describing where the dispensed medication is expected to be consumed or administered MedicationDispenseCategory (preferred)
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD rim: .inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="type of medication dispense"].value
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.
Cardinality	1...1
Type	Reference(), CodeableConcept
Binding	A coded concept identifying which substance or product can be dispensed SNOMED CT Medication Codes (example)
Summary	True
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. .
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a workflow: …code v2: RXD-2-Dispense/Give Code rim: .participation[typeCode=PRD].role w5: what
MedicationDispense.subject
Definition	A link to a resource representing the person or the group to whom the medication will be given.
Cardinality	0...1
Type	Reference(Group \| )
Summary	True
Comments	SubstanceAdministration->subject->Patient.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: …subject v2: PID-3-Patient ID List rim: .participation[typeCode=SBJ].role[classCode=PAT] w5: who.focus
MedicationDispense.context
Definition	The encounter or episode of care that establishes the context for this event.
Cardinality	0...1
Type	Reference( \| https://fhir.hl7.org.uk/STU3/StructureDefinition/CareConnect-Encounter-1)
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: …context rim: .inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code="type of encounter or episode"]
MedicationDispense.supportingInformation
Definition	Additional information that supports the medication being dispensed.
Cardinality	0...*
Type	Reference(Resource)
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim: .outboundRelationship[typeCode=PERT].target[A_SupportingClinicalStatement CMET minimal with many different choices of classCodes(ORG, ENC, PROC, SPLY, SBADM, OBS) and each of the act class codes draws from one or more of the following moodCodes (EVN, DEF, INT PRMS, RQO, PRP, APT, ARQ, GOL)] w5: context
MedicationDispense.performer
Definition	Indicates who or what performed the event. It should be assumed that the performer is the dispenser of the medication.
Cardinality	0...*
Type	BackboneElement
Comments	The performer will be reviewed as part of STU4.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a workflow: …performer rim: .participation[typeCode=PRF]
MedicationDispense.performer.id
Definition	unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Comments	Note that FHIR strings may not exceed 1MB in size
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a
MedicationDispense.performer.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. In order 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.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationDispense.performer.modifierExtension
Definition	May 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 that contains it. Usually modifier elements provide negation or qualification. In order 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.
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationDispense.performer.actor
Definition	The device, practitioner, etc. who performed the action. It should be assumed that the actor is the dispenser of the medication.
Cardinality	1...1
Type	Reference(Device \| \| \| \| )
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: ….actor rim: .role
MedicationDispense.performer.onBehalfOf
Definition	The organization the device or practitioner was acting on behalf of.
Cardinality	0...1
Type	Reference()
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: ….onBehalfOf rim: .role.scopingOrganization
MedicationDispense.authorizingPrescription
Definition	Indicates the medication order that is being dispensed against.
Cardinality	0...*
Type	Reference()
Comments	Maps to basedOn in Event logical model.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: …basedOn v2: ORC-2 Placer Order Number rim: .outboundRelationship[typeCode=FLFS].target[moodCode=RQO]
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.
Cardinality	0...1
Type	CodeableConcept
Binding	A ValueSet to identify the type of medication supply. (preferred)
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD v2: RXD-33-Dispense Type rim: .code
MedicationDispense.quantity
Definition	The amount of medication that has been dispensed. Includes unit of measure.
Cardinality	0...1
Type	SimpleQuantity
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` qty-3: If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()` sqty-1: The comparator is not used on a SimpleQuantity `comparator.empty()`
Mappings	rim: n/a v2: SN (see also Range) or CQ rim: PQ, IVL<PQ>, MO, CO, depending on the values v2: RXD-4-Actual Dispense Amount / RXD-5.1-Actual Dispense Units.code / RXD-5.3-Actual Dispense Units.name of coding system rim: .quantity
MedicationDispense.quantity.id
Definition	unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Comments	Note that FHIR strings may not exceed 1MB in size
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a
MedicationDispense.quantity.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. In order 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.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationDispense.quantity.extension:quantityText
Definition	Quantity representation.
Cardinality	0...1
Type	Extension(string)
Alias	extensions, user content
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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationDispense.quantity.value
Definition	The value of the measured amount. The value includes an implicit precision in the presentation of the value.
Cardinality	0...1
Type	decimal
Summary	True
Requirements	Precision is handled implicitly in almost all cases of measurement.
Comments	The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a v2: SN.2 / CQ - N/A rim: PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value
MedicationDispense.quantity.comparator
Definition	Not allowed to be used in this context
Cardinality	0...0
Type	code
Binding	How the Quantity should be understood and represented. QuantityComparator (required)
Modifier	True
Summary	True
Requirements	Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.
Comments	This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a v2: SN.1 / CQ.1 rim: IVL properties
MedicationDispense.quantity.unit
Definition	A human-readable form of the unit.
Cardinality	0...1
Type	string
Summary	True
Requirements	There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.
Comments	Note that FHIR strings may not exceed 1MB in size
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a v2: (see OBX.6 etc.) / CQ.2 rim: PQ.unit
MedicationDispense.quantity.system
Definition	The identification of the system that provides the coded form of the unit.
Cardinality	0...1
Type	uri
Summary	True
Requirements	Need to know the system that defines the coded form of the unit.
Comments	see http://en.wikipedia.org/wiki/Uniform_resource_identifier
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a v2: (see OBX.6 etc.) / CQ.2 rim: CO.codeSystem, PQ.translation.codeSystem
MedicationDispense.quantity.code
Definition	A computer processable form of the unit in some unit representation system.
Cardinality	0...1
Type	code
Summary	True
Requirements	Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.
Comments	The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a v2: (see OBX.6 etc.) / CQ.2 rim: PQ.code, MO.currency, PQ.translation.code
MedicationDispense.daysSupply
Definition	The amount of medication expressed as a timing amount.
Cardinality	0...1
Type	SimpleQuantity
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` qty-3: If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()` sqty-1: The comparator is not used on a SimpleQuantity `comparator.empty()`
Mappings	rim: n/a v2: SN (see also Range) or CQ rim: PQ, IVL<PQ>, MO, CO, depending on the values v2: TQ1.6 Timing/Quantity Segment Service Duration. Prior to v2.5, ORC.7.3 Common Order Segment / Quantity/Timing / Duration component. This is a formatted string, first character for the time unit (e.g., D=days), followed by the value. For example, “D14” represents “14 days supply” From v2.5 on, TQ1.6 Timing/Quantity Segment / Service Duration. This is a CQ data type (<Quantity (NM)> ^ <Units (CWE)>), thus for days supply, assuming the unit of measure is “days”, the numeric value is TQ1.6.1 (…\|14^ For backwards compatibility, ORC.7 was permitted through v2.6. Both forms (field and segment) may be present in v2.5, v2.5.1, and v2.6 rim: effectiveUseTime
MedicationDispense.whenPrepared
Definition	The time when the dispensed product was packaged and reviewed.
Cardinality	0...1
Type	dateTime
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a v2: RXD-3-Date/Time Dispensed rim: .effectiveTime[xmi:type=IVL_TS].low
MedicationDispense.whenHandedOver
Definition	The time the dispensed product was provided to the patient or their representative.
Cardinality	0...1
Type	dateTime
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a workflow: …occurrenceDateTime v2: RXD-3-Date/Time Dispensed rim: .effectiveTime[xmi:type=IVL_TS].high
MedicationDispense.destination
Definition	Identification of the facility/location where the medication was shipped to, as part of the dispense event.
Cardinality	0...1
Type	Reference()
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2: RXD-13 Dispense-to Location; RXD-30 Dispense to Pharmacy; RXD-31 Dispense to Pharmacy Address rim: .participation[typeCode=DST].role
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.
Cardinality	0...*
Type	Reference( \| )
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim: .participation[typeCode=RCV].role
MedicationDispense.note
Definition	Extra information about the dispense that could not be conveyed in the other attributes.
Cardinality	0...*
Type	Annotation
Comments	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).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a v2: N/A rim: Act workflow: …note v2: RXD-9 Dispense Notes rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=ACT,moodCode=EVN]
MedicationDispense.note.id
Definition	unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Comments	Note that FHIR strings may not exceed 1MB in size
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a
MedicationDispense.note.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. In order 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.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationDispense.note.author[x]
Definition	The individual responsible for making the annotation.
Cardinality	0...1
Type	Reference( \| \| ), string
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a v2: N/A rim: Act.participant[typeCode=AUT].role
MedicationDispense.note.time
Definition	Indicates when this particular annotation was made.
Cardinality	0...1
Type	dateTime
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a v2: N/A rim: Act.effectiveTime
MedicationDispense.note.text
Definition	The text of the annotation.
Cardinality	1...1
Type	string
Comments	Note that FHIR strings may not exceed 1MB in size
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a v2: N/A rim: Act.text
MedicationDispense.dosageInstruction
Definition	Indicates how the medication is to be used by the patient.
Cardinality	0...*
Type	Dosage
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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a rim: .outboundRelationship[typeCode=COMP].target[classCode=SBADM, moodCode=INT]
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.
Cardinality	0...1
Type	BackboneElement
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a rim: .outboundRelationship[typeCode=COMP].target[classCode=SUBST, moodCode=EVN]
MedicationDispense.substitution.id
Definition	unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Comments	Note that FHIR strings may not exceed 1MB in size
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a
MedicationDispense.substitution.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. In order 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.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationDispense.substitution.modifierExtension
Definition	May 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 that contains it. Usually modifier elements provide negation or qualification. In order 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.
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
MedicationDispense.substitution.wasSubstituted
Definition	True if the dispenser dispensed a different drug or product from what was prescribed.
Cardinality	1...1
Type	boolean
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a rim: .actionNegationInd
MedicationDispense.substitution.type
Definition	A code signifying whether a different drug was dispensed from what was prescribed.
Cardinality	0...1
Type	CodeableConcept
Binding	A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription ActSubstanceAdminSubstitutionCode (example)
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD v2: RXO-9-Allow Substitutions / RXE-9-Substitution Status rim: .code
MedicationDispense.substitution.reason
Definition	Indicates the reason for the substitution of (or lack of substitution) from what was prescribed.
Cardinality	0...*
Type	CodeableConcept
Binding	A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed SubstanceAdminSubstitutionReason (example)
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD rim: .reasonCode
MedicationDispense.substitution.responsibleParty
Definition	The person or organization that has primary responsibility for the substitution.
Cardinality	0...*
Type	Reference()
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim: .participation[typeCode=PFM].role[classCode=ASSIGN]
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.
Cardinality	0...*
Type	Reference(DetectedIssue)
Alias	Contraindication, Drug Utilization Review (DUR), Alert
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=ALRT,moodCode=EVN].value
MedicationDispense.notDone
Definition	True if the dispense was not performed for some reason.
Cardinality	0...1
Type	boolean
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a workflow: …notDone rim: .actionNegationInd
MedicationDispense.notDoneReason[x]
Definition	Indicates the reason why a dispense was not performed.
Cardinality	0...1
Type	Reference(DetectedIssue), CodeableConcept
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())`
Mappings	rim: n/a workflow: …notDoneReason rim: .outboundRelationship[typeCode=RSON]/target[classCode=OBS,moodCode=EVN, code="not done reason"].value
MedicationDispense.eventHistory
Definition	A summary of the events of interest that have occurred, such as when the dispense was verified.
Cardinality	0...*
Type	Reference(Provenance)
Comments	This may 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.).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() \| (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim: .inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]

FHIR Resource Relationships

This implementation guidance defines a Minimum Viable Product (MVP) for each FHIR Resource required to support the target use case of medication requests from a hospital ePMA system to a hospital pharmacy system.

An implementation is recommended to adhere to the MVP but can also choose to implement other elements from the chosen FHIR standard. For the purposes of this guidance, an “implementation” is the partnership between an ePMA system supplier and a hospital pharmacy system supplier within a given Trust.

The MVP requires the implementation of four FHIR Resources, profiled within CareConnect implementation of FHIR STU3:

medication-request

The MedicationRequest can reference many other FHIR resources but the four above are required for the recommended MVP.

Minimum Viable Product

Links to the definitions of MedicationRequest covered within this guidance:

Element	MVP	STU3	CareConnect	GP Connect
identifier
definition
basedOn
groupIdentifier
status
intent
category
priority
medication[x]
subject
context
supportingInformation
authoredOn
requester
recorder
reasonCode
reasonReference
note
dosageInstruction
dispenseRequest
substitution
priorPrescription
detectedIssue
eventHistory
id
text
repeatInformation
statusReason
prescriptionType

Element: `identifier`

Use if a local implementation requires bespoke identifiers to track medication requests between the ePMA and dispensing systems.

Element: `partOf`

It is recommended this element is optional for an MVP implementation.

This element could be useful in two scenarios:

sending a bag of medicines to a ward for discharge, as this could indicate whether there is partOf the order elsewhere
could also be used to interpret as 'owings' in the event of a partial supply being dispensed

Element: `status`

Important: the cardinality of status has been changed from 0..1 in STU3 to 1..1 in R4.

When used it must be populated with a fixed valueset defined within the FHIR standard.

It is expected that most implementations will require the use of status to support workflow.

Can the status be used in place of prescription tracking software?

The status can be used to determine the overall status of dispense request; however, it does not cater for the granularity that prescription tracking software can offer.

It is recommended that the MedicationDispenseStatus is used to indicate the status at a high-level so that integrated systems can determine how to represent this information.

Status	FHIR Definition	Recommendation
`preparation`	The core event has not started yet, but some staging activities have begun (e.g. initial compounding or packaging of medication). Preparation stages may be tracked for billing purposes.	Exposing this status could be beneficial to the requesting system to indicate the current status of the dispensing activity, if the architecture of the dispensing system allows other systems to query for medication dispense records. Note: Consider how the status `preparation` is presented to the end-user to avoid confusion with `in-progress`.
`in-progress`	The dispense has started but has not yet completed.	Exposing this status could be beneficial to the requesting system to indicate the current status of the dispensing activity, if the architecture of the dispensing system allows other systems to query for medication dispense records.
`on-hold`	Actions implied by the administration have been temporarily halted, but are expected to continue later. May also be called "suspended"	Exposing this status could be beneficial to the requesting system to indicate the current status of the dispensing activity, if the architecture of the dispensing system allows other systems to query for medication dispense records.
`completed`	All actions that are implied by the dispense have occurred.	Recommended for MVP This would be a suitable trigger to post / share the medication dispense with the requesting ePMA system.
`entered-in-error`	The dispense was entered in error and therefore nullified.	Not to be used unless specific use-cases can be identified.
`stopped`	Actions implied by the dispense have been permanently halted, before all of them occurred.	Recommended for MVP This would be a suitable trigger to post / share the medication dispense with the requesting ePMA system.

medication-dispense-status-flow

Element: `category`

It is recommended this element is optional for an MVP implementation.

Could be used for month-end finance reporting.

Routing (such as inpatient, outpatient pharmacy, homecare, community pharmacy etc) should be catered for within the initial MedicationRequest.

Element: `medication[x]`

This is a mandatory element and is recommended to be used to represent the medication that was supplied - even if it differs to the original MedicationRequest.

Where the requested medication is contained within the NHS dm+d then it must be recorded using the dm+d standard

Recommendation: implementation via a referenced Medication resource.

The Referencing FHIR Resources page has guidance regarding the usage FHIR References.

Note: At the time of writing an alpha implementation of a dm+d FHIR Medication Resource Server is available from the North East CSU as a demonstrator and associated API.

It is recommended that the medicationReference.display is populated with the medication description as selected by the clinician. This may be slightly different to the medication described as returned by a SNOMED/dm+d terminology FHIR server if the ePMA system has not fully implemented dm+d into their medication picking list.

Requested medication with no dm+d code

Medication not published within the dm+d may be requested in the Acute care setting.

In this scenario it is recommended to use the CodeableConcept variant for this element. Software logic can then clearly distinguish this from nationally coded dm+d medication.

If the ePMA system has both a locally assigned code and description for the medication then;

The medicationCodeableConcept.text should be the description for the medication.
The medicationCodeableConcept.coding.code should be the code for the medication.
The medicationCodeableConcept.coding.display should be the description for the medication, i.e. the same value as medicationCodeableConcept.text.

If the ePMA system only has a description for the medication then;

The medicationCodeableConcept.text should be the locally assigned description for the medication.

Multiple dispense requests for a single medication request

In the event that multiple dispense requests are required to fulfil a MedicationRequest, the same requesting identifier should be used with the appropriate status.

An example of this could be the Cosopt medication where one medication request would be received; however, two dispense messages would be returned for Dorzolamide and Timolol.

Element: `subject`

It is recommended this element is mandatory for an MVP implementation.

Note: It is acknowledged that a typical Hospital Patient Administration System (PAS) available today will not expose a FHIR interface so referencing by URL will most likely not be available for some time; however, this should be a target architecture so that the FHIR-enabled PAS can be used as a trusted source of Patient resources across multiple hospital systems.

See population of a Patient resource.

Element: `context`

It is recommended this element is optional for an MVP implementation.

Element: `supportingInformation`

It is recommended this element is optional for an MVP implementation.

Element: `performer`

It is recommended this element is mandatory for an MVP implementation and that the performer.actor element either references a practioner or organization resource.

Warning: The option to define a performer.onBehalfOf has been removed from the FHIR R4 standard; therefore, it is recommended not to use in an STU3 implementation.

Element: `authorizingPrescription`

This is a required element where the prescription is known and available when constructing the MedicationDispense resource.

Supply Events

Examples of where medications can be supplied without as a prescription below:

Emergency supply
Over The Counter (OTC)
Patient Group Directions (PGD)
Minor Ailment Schemes.

Dispense Events

Important: Where the prescription is available, it is recommended to reference via a URL - using the identifier element rather than adding the medicationRequest as a bundle - to avoid duplication.

Element: `type`

It is recommended this element is required for an MVP implementation.

Element: `quantity`

It is recommended this element is mandatory for an MVP implementation.

This element could be useful in particular for discharge prescriptions (TTO) when representing "1 of something" - for example:

1 pack
1 tablet
1 bottle.

It may be simpler to always express as dose units.

Element: daysSupply

It is recommended this element is optional for an MVP implementation.

Element: whenPrepared

It is recommended this element is mandatory for an MVP implementation.

Element: whenHandedOver

It is recommended this element is optional for an MVP implementation.

Element: `destination`

It is recommended this element is optional for an MVP implementation.

If used, consider interpreting as the Intended Destination as in the real world, this could change between being marked as "dispensed" and the patient receiving the medication.

Example

Within an Inpatient Setting - the patient could have been transferred before the medication is delivered.

intended-destination

Element: `receiver`

It is recommended this element is optional for an MVP implementation.

Element: `note`

It is recommended this element is optional for an MVP implementation.

Not required as part of a minimum viable product; however, if this field is populated, the receiving system must consume the information in the event that it contains important information (and should be treat as required)

Important: If the system offers an end-user the option to create a note, it is advised that the scope of the note should be the dispense event only.

Element: `dosageInstruction`

It is recommended this element is required for an MVP implementation.

An example instance where this could be used is if a substitution has taken place where the dosage instruction differs to the one in the MedicationRequest.

If the dosageInstruction element is used then it should be represented as a structured dose where possible in the event that the receiving system is required to interpret the content.

In this instance, population of just the dosageInstruction.text element would be unacceptable for a successful implementation.

Refer to FHIR Dose Syntax Implementation Guidance (or any subsequent version) for guidance.

View the R4 FHIR Dose Syntax Guidance

Element: `substitution`

It is recommended this element is required for an MVP implementation.

Note: If omitted or has a value of false then substitution has not occured.

Important: A suitable definition and example use-cases for a substitution need to be defined.

For example:

Is a sugar-free variant classed as a substitution?

Is a generic variant of a drug classed as a substitution?

Can a substitution be an entirely different medication, or should it be a new request?
Should a substitution only be used, for example, if supplied in a different strength than requested?

Element: `detectedIssue`

It is recommended this element is avoided for an MVP implementation.

Element: `notDone`

Warning: This element has been removed from the FHIR R4 standard

It is recommended this element is not implemented as part of an MVP.

Element: `notDoneReason`

Warning: This element has been removed from the FHIR R4 standard

It is recommended this element is not implemented as part of an MVP.

Element: `eventHistory`

It is recommended this element is optional for an MVP implementation.

This element could be used to indicate when something has been verified.

Element: `id`

It is highly recommended that the logical id value is a Universally Unique Identifier (UUID) using a standard UUID generator available in most programming languages. The most comprehensive current definition of the logical id is within the FHIR R4 standard.

Optional as this is an internally facing unique identifier. The unique business identifier essential for interoperability is an identifier.

Element: `text`

It is recommended this element is not implemented as part of an MVP.

ePMA Implementation Guidance for FHIR STU3

MedicationDispense

FHIR Resource Relationships

Minimum Viable Product

Element: identifier

Element: partOf

Element: status

Can the status be used in place of prescription tracking software?

Element: category

Element: medication[x]

Requested medication with no dm+d code

Multiple dispense requests for a single medication request

Element: subject

Element: context

Element: supportingInformation

Element: performer

Element: authorizingPrescription

Element: type

Element: quantity

Element: daysSupply

Element: whenPrepared

Element: whenHandedOver

Element: destination

Example

Element: receiver

Element: note

Element: dosageInstruction

Element: substitution

Element: detectedIssue

Element: notDone

Element: notDoneReason

Element: eventHistory

Element: id

Element: text

Element: `identifier`

Element: `partOf`

Element: `status`

Element: `category`

Element: `medication[x]`

Element: `subject`

Element: `context`

Element: `supportingInformation`

Element: `performer`

Element: `authorizingPrescription`

Element: `type`

Element: `quantity`

Element: `destination`

Element: `receiver`

Element: `note`

Element: `dosageInstruction`

Element: `substitution`

Element: `detectedIssue`

Element: `notDone`

Element: `notDoneReason`

Element: `eventHistory`

Element: `id`

Element: `text`