EPAMedicationDispense

Das EPAMedicationDispense-Profil wird für die Abgabe von sowohl verschreibungspflichtigen als auch verschreibungsfreien Medikamenten (OTC, NEM, ...) verwendet. Sie dokumentiert den Prozess, durch den Medikamente an einen Versicherten abgegeben werden. Im Falle von verschreibungspflichtigen Medikamenten werden diese Abgaben durch den E-Rezept Fachdienst verwaltet und in den ePA Medication Service übertragen. Die Ressource enthält Informationen über die abgegebenen Medikamente, die Menge, die Anweisungen zur Anwendung sowie den Abgabezeitpunkt und die beteiligten Akteure.

Profil für gemeinsame Datengrundlage im ePA Medication Service

EPA MedicationDispense

EPAMedicationDispense (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. Data type MedicationDispense Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.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 or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.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]
id	Σ	0..1	string	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 string
meta	S 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 might 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() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
id		0..1	string	There are no (further) constraints on this element Element id MedicationDispense.meta.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id MedicationDispense.meta.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. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. 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() or (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
versionId	S Σ	0..1	id	There are no (further) constraints on this element Element id MedicationDispense.meta.versionId Short description Version specific identifier Definition The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted. Comments The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes. Data type id Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
lastUpdated	S Σ	0..1	instant	There are no (further) constraints on this element Element id MedicationDispense.meta.lastUpdated Short description When the resource version last changed Definition When the resource last changed - e.g. when the version changed. Comments This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction. Data type instant Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
source	Σ	0..1	uri	There are no (further) constraints on this element Element id MedicationDispense.meta.source Short description Identifies where the resource comes from Definition A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc. Comments In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
profile	Σ	0..*	canonical(StructureDefinition)	There are no (further) constraints on this element Element id MedicationDispense.meta.profile Short description Profiles this resource claims to conform to Definition A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url. Comments It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set. Data type canonical(StructureDefinition) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
security	Σ	0..*	CodingBinding	There are no (further) constraints on this element Element id MedicationDispense.meta.security Short description Security Labels applied to this resource Definition Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure. Comments The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored. Data type Coding Binding Security Labels from the Healthcare Privacy and Security Classification System. All Security Labels (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim: CV orim: fhir:Coding rdfs:subClassOf dt:CDCoding
tag	Σ	0..*	Coding	There are no (further) constraints on this element Element id MedicationDispense.meta.tag Short description Tags applied to this resource Definition Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource. Comments The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored. Data type Coding Binding Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". CommonTags (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim: CV orim: fhir:Coding rdfs:subClassOf dt:CDCoding
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. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Comments Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
text		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 can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Comments Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. 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. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. 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() or (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
rxPrescriptionProcessIdentifier	I	0..1	Extension(RxPrescriptionProcessIdentifier)	Element id MedicationDispense.extension:rxPrescriptionProcessIdentifier Short description Optional Extensions Element Alternate names extensions, user content Definition This extension is used to track medication prescription transactions between the E-Rezept-Fachdienst and the ePA. The RxPrescriptionProcessIdentifier is generated by the ePA Medication Service and consists of the PrescriptionId and the authoredOn date of the operation parameters request. It ensures consistent referencing and management of medication-related resources across different systems. 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(RxPrescriptionProcessIdentifier) Extension URL https://gematik.de/fhir/epa-medication/StructureDefinition/rx-prescription-process-identifier-extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` 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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. 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() or (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	Element id MedicationDispense.identifier Short description External identifier Definition Identifiers associated with this Medication Dispense that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server. Comments This is a business identifier, not a resource identifier. Data type Identifier Sliced: Unordered, Open, by $this(Pattern) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 - 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: Event.identifier w5: FiveWs.identifier rim: .id rx-dispense-rmim: CombinedMedicationDispense.id
RxOriginatorProcessIdentifier		0..1	RxOriginatorProcessIdentifierPattern	Element id MedicationDispense.identifier:RxOriginatorProcessIdentifier Short description An identifier intended for computation Definition An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers. Comments This is a business identifier, not a resource identifier. Data type RxOriginatorProcessIdentifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "system": "https://gematik.de/fhir/epa-medication/sid/rx-originator-process-identifier" } Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - 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: Event.identifier w5: FiveWs.identifier rim: .id rx-dispense-rmim: CombinedMedicationDispense.id
EPADispensationIdentifier		0..1	EPADispensationIdentifierPattern	Element id MedicationDispense.identifier:EPADispensationIdentifier Short description An identifier intended for computation Definition An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers. Comments This is a business identifier, not a resource identifier. Data type EPADispensationIdentifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "system": "https://gematik.de/fhir/epa-medication/sid/dispensation-identifier" } Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - 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: Event.identifier w5: FiveWs.identifier rim: .id rx-dispense-rmim: CombinedMedicationDispense.id
partOf	I	0..*	Reference(Procedure)	There are no (further) constraints on this element Element id MedicationDispense.partOf Short description Event that dispense is part of Definition The procedure that trigger the dispense. 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(Procedure) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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: Event.partOf rim: .outboundRelationship[typeCode=COMP]/target[classCode=PROC,moodCode=EVN]
status	Σ ?!	1..1	codeBinding	Element id MedicationDispense.status Short description Status of medication dispense 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. EPAMedicationDispenseStatusVS (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Event.status w5: FiveWs.status rim: .statusCode rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.statusCode
statusReason[x]		0..1		There are no (further) constraints on this element Element id MedicationDispense.statusReason[x] Short description Why a dispense was not performed Definition Indicates the reason why a dispense was not performed. Binding A code describing why a dispense was not performed. MedicationDispense Status Reason Codes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Event.statusReason rim: .outboundRelationship[typeCode=RSON]/target[classCode=OBS,moodCode=EVN, code="not done reason"].value
statusReasonCodeableConcept			CodeableConcept	There are no (further) constraints on this element Data type CodeableConcept
statusReasonReference			Reference(DetectedIssue)	There are no (further) constraints on this element Data type Reference(DetectedIssue)
category	S	0..1	CodeableConceptBinding	Element id MedicationDispense.category Short description Missing value indicates a prescription dispense. Definition Indicates the type of medication dispense (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)). Comments The category can be used to include where the medication is expected to be consumed or other types of dispenses. Invariants can be used to bind to different value sets when profiling to bind. Data type CodeableConcept Binding Defines the context of a Dispensation: prescription or non-prescription EPAMedicationDispenseCategoryVS (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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]	S Σ	1..1		There are no (further) constraints on this element 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. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Event.code w5: FiveWs.what[x] v2: RXD-2-Dispense/Give Code rim: .participation[typeCode=PRD].role rx-dispense-rmim: CombinedMedicationRequest.component1.AdministrationRequest.consumable
medicationReference			Reference(Medication)	Data type Reference(Medication)
subject	S Σ I	1..1	Reference(Patient)	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(Patient) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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: Event.subject w5: FiveWs.subject[x] v2: PID-3-Patient ID List rim: .participation[typeCode=SBJ].role[classCode=PAT] w5: FiveWs.subject
id		0..1	string	There are no (further) constraints on this element Element id MedicationDispense.subject.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id MedicationDispense.subject.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. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. 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() or (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
reference	Σ I	0..1	string	There are no (further) constraints on this element Element id MedicationDispense.subject.reference Short description Literal reference, Relative, internal or absolute URL Definition A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Comments Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
type	Σ	0..1	uriBinding	There are no (further) constraints on this element Element id MedicationDispense.subject.type Short description Type the reference refers to (e.g. "Patient") Definition The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). Comments This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Data type uri Binding Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
identifier	S Σ	1..1	IdentifierKvid10	Element id MedicationDispense.subject.identifier Short description An identifier intended for computation Definition An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers. Comments When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation\|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any). Data type IdentifierKvid10 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 - 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 rim: .identifier
display	Σ	0..1	string	There are no (further) constraints on this element Element id MedicationDispense.subject.display Short description Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference. Comments This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
context	I	0..1	Reference(Encounter \| EpisodeOfCare)	There are no (further) constraints on this element 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(Encounter \| EpisodeOfCare) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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: Event.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() or (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 %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.context 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)]
performer	S	1..1	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. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Event.performer rim: .participation[typeCode=PRF]
id		0..1	string	There are no (further) constraints on this element Element id MedicationDispense.performer.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string 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. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. 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() or (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 even if unrecognized 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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. 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() or (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
function		0..1	CodeableConcept	There are no (further) constraints on this element Element id MedicationDispense.performer.function Short description Who performed the dispense and what they did Definition Distinguishes the type of performer in the dispense. For example, date enterer, packager, final checker. Requirements Allows disambiguation of the types of involvement of different performers. 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 the role an individual played in dispensing a medication. MedicationDispense Performer Function Codes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD rim: participation[typeCode=PRF].functionCode
actor	I	1..1	Reference(Organization)	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(Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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: Event.performer.actor rim: .role
location	I	0..1	Reference(Location)	There are no (further) constraints on this element Element id MedicationDispense.location Short description Where the dispense occurred Definition The principal physical location where the dispense was performed. 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(Location) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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=LOC].role
authorizingPrescription	I	0..*	Reference(MedicationRequest)	There are no (further) constraints on this element 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(MedicationRequest) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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: Event.basedOn v2: ORC-2 Placer Order Number rim: .outboundRelationship[typeCode=FLFS].target[moodCode=RQO] rx-dispense-rmim: CombinedMedicationDispense.inFulfillmentOf
id		0..1	string	There are no (further) constraints on this element Element id MedicationDispense.authorizingPrescription.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id MedicationDispense.authorizingPrescription.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. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. 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() or (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
reference	S Σ I	1..1	string	There are no (further) constraints on this element Element id MedicationDispense.authorizingPrescription.reference Short description Literal reference, Relative, internal or absolute URL Definition A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Comments Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
type	Σ	0..1	uriBinding	There are no (further) constraints on this element Element id MedicationDispense.authorizingPrescription.type Short description Type the reference refers to (e.g. "Patient") Definition The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). Comments This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Data type uri Binding Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
identifier	Σ	0..1	Identifier	There are no (further) constraints on this element Element id MedicationDispense.authorizingPrescription.identifier Short description Logical reference, when literal reference is not known Definition An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. Comments When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation\|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any). Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 - 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 rim: .identifier
display	Σ	0..1	string	There are no (further) constraints on this element Element id MedicationDispense.authorizingPrescription.display Short description Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference. Comments This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
type		0..1	CodeableConcept	There are no (further) constraints on this element Element id MedicationDispense.type Short description Trial fill, partial fill, emergency fill, etc. 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 Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc. v3.ActPharmacySupplyType (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.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() or (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 rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.quantity
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() or (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() or (children().count() > id.count())` Mappings rim: n/a v2: RXD-3-Date/Time Dispensed rim: .effectiveTime[xmi:type=IVL_TS].low rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.effectiveTime
whenHandedOver	S	1..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() or (children().count() > id.count())` Mappings rim: n/a workflow: Event.occurrence[x] v2: RXD-3-Date/Time Dispensed rim: .effectiveTime[xmi:type=IVL_TS].high rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.effectiveTime
destination	I	0..1	Reference(Location)	There are no (further) constraints on this element 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(Location) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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 rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.destination
receiver	I	0..*	Reference(Patient \| Practitioner)	There are no (further) constraints on this element 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(Patient \| Practitioner) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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 rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.receiver
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() or (children().count() > id.count())` Mappings rim: n/a v2: N/A rim: Act workflow: Event.note v2: RXD-9 Dispense Notes rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=ACT,moodCode=EVN]
dosageInstruction	S	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() or (children().count() > id.count())` Mappings rim: n/a rim: .outboundRelationship[typeCode=COMP].target[classCode=SBADM, moodCode=INT]
substitution	S	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() or (children().count() > id.count())` Mappings rim: n/a rim: .outboundRelationship[typeCode=COMP].target[classCode=SUBST, moodCode=EVN] rx-dispense-rmim: CombinedMedicationDispense.substitutionMade
id		0..1	string	There are no (further) constraints on this element Element id MedicationDispense.substitution.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string 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. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. 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() or (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 even if unrecognized 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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. 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() or (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() or (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. v3.ActSubstanceAdminSubstitutionCode (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 rx-dispense-rmim: CombinedMedicationDispense.substitutionMade.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 (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. v3.SubstanceAdminSubstitutionReason (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD rim: .reasonCode rx-dispense-rmim: CombinedMedicationDispense.substitutionMade.reasonCode
responsibleParty	I	0..*	Reference(Practitioner \| PractitionerRole)	There are no (further) constraints on this element 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(Practitioner \| PractitionerRole) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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] rx-dispense-rmim: CombinedMedicationDispense.substitutionMade.ResponsibleParty
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 This element can include a detected issue that has been identified either by a decision support system or by a clinician and may include information on the steps that were taken to address the issue. Data type Reference(DetectedIssue) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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
eventHistory	I	0..*	Reference(Provenance)	There are no (further) constraints on this element Element id MedicationDispense.eventHistory Short description A list of relevant lifecycle events Definition A summary of the events of interest that have occurred, such as when the dispense was verified. Comments This might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.). Data type Reference(Provenance) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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...*
Invariants	dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.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 or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.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]
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	string
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.
MedicationDispense.meta
Definition	The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Cardinality	0...1
Type	Meta
Must Support	True
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: N/A
MedicationDispense.meta.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
Mappings	rim: n/a
MedicationDispense.meta.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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() or (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.meta.versionId
Definition	The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.
Cardinality	0...1
Type	id
Must Support	True
Summary	True
Comments	The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
MedicationDispense.meta.lastUpdated
Definition	When the resource last changed - e.g. when the version changed.
Cardinality	0...1
Type	instant
Must Support	True
Summary	True
Comments	This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
MedicationDispense.meta.source
Definition	A uri that identifies the source system of the resource. This provides a minimal amount of [Provenance](provenance.html#) information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.
Cardinality	0...1
Type	uri
Summary	True
Comments	In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
MedicationDispense.meta.profile
Definition	A list of profiles (references to [StructureDefinition](structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](structuredefinition-definitions.html#StructureDefinition.url).
Cardinality	0...*
Type	canonical(StructureDefinition)
Summary	True
Comments	It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
MedicationDispense.meta.security
Definition	Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.
Cardinality	0...*
Type	Coding
Binding	Security Labels from the Healthcare Privacy and Security Classification System. All Security Labels (extensible)
Summary	True
Comments	The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim: CV orim: fhir:Coding rdfs:subClassOf dt:CDCoding
MedicationDispense.meta.tag
Definition	Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.
Cardinality	0...*
Type	Coding
Binding	Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". CommonTags (example)
Summary	True
Comments	The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim: CV orim: fhir:Coding rdfs:subClassOf dt:CDCoding
MedicationDispense.implicitRules
Definition	A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (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. CommonLanguages (preferred)
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() or (children().count() > id.count())`
Mappings	rim: n/a
MedicationDispense.text
Definition	A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
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 information is added later.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
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. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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() or (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.extension:rxPrescriptionProcessIdentifier
Definition	This extension is used to track medication prescription transactions between the E-Rezept-Fachdienst and the ePA. The RxPrescriptionProcessIdentifier is generated by the ePA Medication Service and consists of the PrescriptionId and the authoredOn date of the operation parameters request. It ensures consistent referencing and management of medication-related resources across different systems.
Cardinality	0...1
Type	Extension(RxPrescriptionProcessIdentifier)
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() or (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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Alias	extensions, user content
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
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() or (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	Identifiers associated with this Medication Dispense that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server.
Cardinality	0...*
Type	Identifier
Comments	This is a business identifier, not a resource identifier.
Slicing	Unordered, Open, by $this(Pattern)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (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 - 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: Event.identifier w5: FiveWs.identifier rim: .id rx-dispense-rmim: CombinedMedicationDispense.id
MedicationDispense.identifier:RxOriginatorProcessIdentifier
Definition	An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.
Cardinality	0...1
Type	RxOriginatorProcessIdentifier
Comments	This is a business identifier, not a resource identifier.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Pattern	{ "system": "https://gematik.de/fhir/epa-medication/sid/rx-originator-process-identifier" }
Mappings	rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - 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: Event.identifier w5: FiveWs.identifier rim: .id rx-dispense-rmim: CombinedMedicationDispense.id
MedicationDispense.identifier:EPADispensationIdentifier
Definition	An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.
Cardinality	0...1
Type	EPADispensationIdentifier
Comments	This is a business identifier, not a resource identifier.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Pattern	{ "system": "https://gematik.de/fhir/epa-medication/sid/dispensation-identifier" }
Mappings	rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - 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: Event.identifier w5: FiveWs.identifier rim: .id rx-dispense-rmim: CombinedMedicationDispense.id
MedicationDispense.partOf
Definition	The procedure that trigger the dispense.
Cardinality	0...*
Type	Reference(Procedure)
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() or (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 %rootResource.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: Event.partOf rim: .outboundRelationship[typeCode=COMP]/target[classCode=PROC,moodCode=EVN]
MedicationDispense.status
Definition	A code specifying the state of the set of dispense events.
Cardinality	1...1
Type	code
Binding	A coded concept specifying the state of the dispense event. EPAMedicationDispenseStatusVS (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() or (children().count() > id.count())`
Mappings	rim: n/a workflow: Event.status w5: FiveWs.status rim: .statusCode rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.statusCode
MedicationDispense.statusReason[x]
Definition	Indicates the reason why a dispense was not performed.
Cardinality	0...1
Type	CodeableConcept
Binding	A code describing why a dispense was not performed. MedicationDispense Status Reason Codes (example)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a workflow: Event.statusReason rim: .outboundRelationship[typeCode=RSON]/target[classCode=OBS,moodCode=EVN, code="not done reason"].value
MedicationDispense.category
Definition	Indicates the type of medication dispense (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)).
Cardinality	0...1
Type	CodeableConcept
Binding	Defines the context of a Dispensation: prescription or non-prescription EPAMedicationDispenseCategoryVS (required)
Must Support	True
Comments	The category can be used to include where the medication is expected to be consumed or other types of dispenses. Invariants can be used to bind to different value sets when profiling to bind.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (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(Medication)
Must Support	True
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() or (children().count() > id.count())`
Mappings	rim: n/a workflow: Event.code w5: FiveWs.what[x] v2: RXD-2-Dispense/Give Code rim: .participation[typeCode=PRD].role rx-dispense-rmim: CombinedMedicationRequest.component1.AdministrationRequest.consumable
MedicationDispense.subject
Definition	A link to a resource representing the person or the group to whom the medication will be given.
Cardinality	1...1
Type	Reference(Patient)
Must Support	True
Summary	True
Comments	SubstanceAdministration->subject->Patient.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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: Event.subject w5: FiveWs.subject[x] v2: PID-3-Patient ID List rim: .participation[typeCode=SBJ].role[classCode=PAT] w5: FiveWs.subject
MedicationDispense.subject.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
Mappings	rim: n/a
MedicationDispense.subject.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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() or (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.subject.reference
Definition	A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Cardinality	0...1
Type	string
Summary	True
Comments	Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: N/A
MedicationDispense.subject.type
Definition	The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
Cardinality	0...1
Type	uri
Binding	Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible)
Summary	True
Comments	This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: N/A
MedicationDispense.subject.identifier
Definition	An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.
Cardinality	1...1
Type	IdentifierKvid10
Must Support	True
Summary	True
Comments	When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation\|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (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 - 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 rim: .identifier
MedicationDispense.subject.display
Definition	Plain text narrative that identifies the resource in addition to the resource reference.
Cardinality	0...1
Type	string
Summary	True
Comments	This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: N/A
MedicationDispense.context
Definition	The encounter or episode of care that establishes the context for this event.
Cardinality	0...1
Type	Reference(Encounter \| EpisodeOfCare)
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() or (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 %rootResource.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: Event.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() or (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 %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.context 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)]
MedicationDispense.performer
Definition	Indicates who or what performed the event.
Cardinality	1...1
Type	BackboneElement
Must Support	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a workflow: Event.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
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. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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() or (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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
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() or (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.function
Definition	Distinguishes the type of performer in the dispense. For example, date enterer, packager, final checker.
Cardinality	0...1
Type	CodeableConcept
Binding	A code describing the role an individual played in dispensing a medication. MedicationDispense Performer Function Codes (example)
Requirements	Allows disambiguation of the types of involvement of different performers.
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() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD rim: participation[typeCode=PRF].functionCode
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(Organization)
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() or (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 %rootResource.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: Event.performer.actor rim: .role
MedicationDispense.location
Definition	The principal physical location where the dispense was performed.
Cardinality	0...1
Type	Reference(Location)
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() or (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 %rootResource.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=LOC].role
MedicationDispense.authorizingPrescription
Definition	Indicates the medication order that is being dispensed against.
Cardinality	0...*
Type	Reference(MedicationRequest)
Comments	Maps to basedOn in Event logical model.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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: Event.basedOn v2: ORC-2 Placer Order Number rim: .outboundRelationship[typeCode=FLFS].target[moodCode=RQO] rx-dispense-rmim: CombinedMedicationDispense.inFulfillmentOf
MedicationDispense.authorizingPrescription.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
Mappings	rim: n/a
MedicationDispense.authorizingPrescription.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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() or (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.authorizingPrescription.reference
Definition	A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Cardinality	1...1
Type	string
Must Support	True
Summary	True
Comments	Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: N/A
MedicationDispense.authorizingPrescription.type
Definition	The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
Cardinality	0...1
Type	uri
Binding	Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible)
Summary	True
Comments	This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: N/A
MedicationDispense.authorizingPrescription.identifier
Definition	An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
Cardinality	0...1
Type	Identifier
Summary	True
Comments	When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation\|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (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 - 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 rim: .identifier
MedicationDispense.authorizingPrescription.display
Definition	Plain text narrative that identifies the resource in addition to the resource reference.
Cardinality	0...1
Type	string
Summary	True
Comments	This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: N/A
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	Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc. v3.ActPharmacySupplyType (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() or (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 rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.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() or (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 rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.quantity
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() or (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() or (children().count() > id.count())`
Mappings	rim: n/a v2: RXD-3-Date/Time Dispensed rim: .effectiveTime[xmi:type=IVL_TS].low rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.effectiveTime
MedicationDispense.whenHandedOver
Definition	The time the dispensed product was provided to the patient or their representative.
Cardinality	1...1
Type	dateTime
Must Support	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a workflow: Event.occurrence[x] v2: RXD-3-Date/Time Dispensed rim: .effectiveTime[xmi:type=IVL_TS].high rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.effectiveTime
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(Location)
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() or (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 %rootResource.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 rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.destination
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(Patient \| Practitioner)
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() or (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 %rootResource.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 rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.receiver
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() or (children().count() > id.count())`
Mappings	rim: n/a v2: N/A rim: Act workflow: Event.note v2: RXD-9 Dispense Notes rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=ACT,moodCode=EVN]
MedicationDispense.dosageInstruction
Definition	Indicates how the medication is to be used by the patient.
Cardinality	0...*
Type	Dosage
Must Support	True
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() or (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
Must Support	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: .outboundRelationship[typeCode=COMP].target[classCode=SUBST, moodCode=EVN] rx-dispense-rmim: CombinedMedicationDispense.substitutionMade
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
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. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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() or (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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
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() or (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() or (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. v3.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() or (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 rx-dispense-rmim: CombinedMedicationDispense.substitutionMade.code
MedicationDispense.substitution.reason
Definition	Indicates the reason for the substitution (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. v3.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() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD rim: .reasonCode rx-dispense-rmim: CombinedMedicationDispense.substitutionMade.reasonCode
MedicationDispense.substitution.responsibleParty
Definition	The person or organization that has primary responsibility for the substitution.
Cardinality	0...*
Type	Reference(Practitioner \| PractitionerRole)
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() or (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 %rootResource.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] rx-dispense-rmim: CombinedMedicationDispense.substitutionMade.ResponsibleParty
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	This element can include a detected issue that has been identified either by a decision support system or by a clinician and may include information on the steps that were taken to address the issue.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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.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 might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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]

<StructureDefinition xmlns="http://hl7.org/fhir">
    <id value="epa-medication-dispense" />
    <url value="https://gematik.de/fhir/epa-medication/StructureDefinition/epa-medication-dispense" />
    <version value="1.1.1" />
    <name value="EPAMedicationDispense" />
    <title value="EPA MedicationDispense" />
    <status value="active" />
    <experimental value="false" />
    <date value="2024-08-14" />
    <publisher value="gematik GmbH" />
    <description value="Defines the medication dispense resource for the Medication Service in the ePA system." />
    <fhirVersion value="4.0.1" />
    <kind value="resource" />
    <abstract value="false" />
    <type value="MedicationDispense" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/MedicationDispense" />
    <derivation value="constraint" />
    <differential>
        <element id="MedicationDispense.meta">
            <path value="MedicationDispense.meta" />
            <mustSupport value="true" />
        </element>
        <element id="MedicationDispense.meta.versionId">
            <path value="MedicationDispense.meta.versionId" />
            <mustSupport value="true" />
        </element>
        <element id="MedicationDispense.meta.lastUpdated">
            <path value="MedicationDispense.meta.lastUpdated" />
            <mustSupport value="true" />
        </element>
        <element id="MedicationDispense.extension:rxPrescriptionProcessIdentifier">
            <path value="MedicationDispense.extension" />
            <sliceName value="rxPrescriptionProcessIdentifier" />
            <min value="0" />
            <max value="1" />
            <type>
                <code value="Extension" />
                <profile value="https://gematik.de/fhir/epa-medication/StructureDefinition/rx-prescription-process-identifier-extension" />
            </type>
        </element>
        <element id="MedicationDispense.identifier">
            <path value="MedicationDispense.identifier" />
            <slicing>
                <discriminator>
                    <type value="pattern" />
                    <path value="$this" />
                </discriminator>
                <ordered value="false" />
                <rules value="open" />
            </slicing>
        </element>
        <element id="MedicationDispense.identifier:RxOriginatorProcessIdentifier">
            <path value="MedicationDispense.identifier" />
            <sliceName value="RxOriginatorProcessIdentifier" />
            <min value="0" />
            <max value="1" />
            <type>
                <code value="Identifier" />
                <profile value="https://gematik.de/fhir/epa-medication/StructureDefinition/rx-originator-process-identifier" />
            </type>
            <patternIdentifier>
                <system value="https://gematik.de/fhir/epa-medication/sid/rx-originator-process-identifier" />
            </patternIdentifier>
        </element>
        <element id="MedicationDispense.identifier:EPADispensationIdentifier">
            <path value="MedicationDispense.identifier" />
            <sliceName value="EPADispensationIdentifier" />
            <min value="0" />
            <max value="1" />
            <type>
                <code value="Identifier" />
                <profile value="https://gematik.de/fhir/epa-medication/StructureDefinition/dispensation-identifier" />
            </type>
            <patternIdentifier>
                <system value="https://gematik.de/fhir/epa-medication/sid/dispensation-identifier" />
            </patternIdentifier>
        </element>
        <element id="MedicationDispense.status">
            <path value="MedicationDispense.status" />
            <short value="Status of medication dispense" />
            <binding>
                <strength value="required" />
                <valueSet value="https://gematik.de/fhir/terminology/ValueSet/epa-medication-dispense-status-vs" />
            </binding>
        </element>
        <element id="MedicationDispense.category">
            <path value="MedicationDispense.category" />
            <short value="Missing value indicates a prescription dispense." />
            <mustSupport value="true" />
            <binding>
                <strength value="required" />
                <description value="Defines the context of a Dispensation: prescription or non-prescription" />
                <valueSet value="https://gematik.de/fhir/terminology/ValueSet/epa-medication-dispense-category-vs" />
            </binding>
        </element>
        <element id="MedicationDispense.medication[x]">
            <path value="MedicationDispense.medication[x]" />
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/Medication" />
            </type>
            <mustSupport value="true" />
        </element>
        <element id="MedicationDispense.subject">
            <path value="MedicationDispense.subject" />
            <min value="1" />
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient" />
            </type>
            <mustSupport value="true" />
        </element>
        <element id="MedicationDispense.subject.identifier">
            <path value="MedicationDispense.subject.identifier" />
            <min value="1" />
            <type>
                <code value="Identifier" />
                <profile value="http://fhir.de/StructureDefinition/identifier-kvid-10" />
            </type>
            <mustSupport value="true" />
        </element>
        <element id="MedicationDispense.performer">
            <path value="MedicationDispense.performer" />
            <min value="1" />
            <max value="1" />
            <mustSupport value="true" />
        </element>
        <element id="MedicationDispense.performer.actor">
            <path value="MedicationDispense.performer.actor" />
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" />
            </type>
        </element>
        <element id="MedicationDispense.authorizingPrescription.reference">
            <path value="MedicationDispense.authorizingPrescription.reference" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="MedicationDispense.whenHandedOver">
            <path value="MedicationDispense.whenHandedOver" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="MedicationDispense.dosageInstruction">
            <path value="MedicationDispense.dosageInstruction" />
            <mustSupport value="true" />
        </element>
        <element id="MedicationDispense.substitution">
            <path value="MedicationDispense.substitution" />
            <mustSupport value="true" />
        </element>
    </differential>
</StructureDefinition>

{
    "resourceType": "StructureDefinition",
    "id": "epa-medication-dispense",
    "url": "https://gematik.de/fhir/epa-medication/StructureDefinition/epa-medication-dispense",
    "version": "1.1.1",
    "name": "EPAMedicationDispense",
    "title": "EPA MedicationDispense",
    "status": "active",
    "experimental": false,
    "date": "2024-08-14",
    "publisher": "gematik GmbH",
    "description": "Defines the medication dispense resource for the Medication Service in the ePA system.",
    "fhirVersion": "4.0.1",
    "kind": "resource",
    "abstract": false,
    "type": "MedicationDispense",
    "baseDefinition": "http://hl7.org/fhir/StructureDefinition/MedicationDispense",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "MedicationDispense.meta",
                "path": "MedicationDispense.meta",
                "mustSupport": true
            },
            {
                "id": "MedicationDispense.meta.versionId",
                "path": "MedicationDispense.meta.versionId",
                "mustSupport": true
            },
            {
                "id": "MedicationDispense.meta.lastUpdated",
                "path": "MedicationDispense.meta.lastUpdated",
                "mustSupport": true
            },
            {
                "id": "MedicationDispense.extension:rxPrescriptionProcessIdentifier",
                "path": "MedicationDispense.extension",
                "sliceName": "rxPrescriptionProcessIdentifier",
                "min": 0,
                "max": "1",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://gematik.de/fhir/epa-medication/StructureDefinition/rx-prescription-process-identifier-extension"
                        ]
                    }
                ]
            },
            {
                "id": "MedicationDispense.identifier",
                "path": "MedicationDispense.identifier",
                "slicing": {
                    "discriminator":  [
                        {
                            "type": "pattern",
                            "path": "$this"
                        }
                    ],
                    "rules": "open",
                    "ordered": false
                }
            },
            {
                "id": "MedicationDispense.identifier:RxOriginatorProcessIdentifier",
                "path": "MedicationDispense.identifier",
                "sliceName": "RxOriginatorProcessIdentifier",
                "min": 0,
                "max": "1",
                "type":  [
                    {
                        "code": "Identifier",
                        "profile":  [
                            "https://gematik.de/fhir/epa-medication/StructureDefinition/rx-originator-process-identifier"
                        ]
                    }
                ],
                "patternIdentifier": {
                    "system": "https://gematik.de/fhir/epa-medication/sid/rx-originator-process-identifier"
                }
            },
            {
                "id": "MedicationDispense.identifier:EPADispensationIdentifier",
                "path": "MedicationDispense.identifier",
                "sliceName": "EPADispensationIdentifier",
                "min": 0,
                "max": "1",
                "type":  [
                    {
                        "code": "Identifier",
                        "profile":  [
                            "https://gematik.de/fhir/epa-medication/StructureDefinition/dispensation-identifier"
                        ]
                    }
                ],
                "patternIdentifier": {
                    "system": "https://gematik.de/fhir/epa-medication/sid/dispensation-identifier"
                }
            },
            {
                "id": "MedicationDispense.status",
                "path": "MedicationDispense.status",
                "short": "Status of medication dispense",
                "binding": {
                    "strength": "required",
                    "valueSet": "https://gematik.de/fhir/terminology/ValueSet/epa-medication-dispense-status-vs"
                }
            },
            {
                "id": "MedicationDispense.category",
                "path": "MedicationDispense.category",
                "short": "Missing value indicates a prescription dispense.",
                "mustSupport": true,
                "binding": {
                    "strength": "required",
                    "valueSet": "https://gematik.de/fhir/terminology/ValueSet/epa-medication-dispense-category-vs",
                    "description": "Defines the context of a Dispensation: prescription or non-prescription"
                }
            },
            {
                "id": "MedicationDispense.medication[x]",
                "path": "MedicationDispense.medication[x]",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "http://hl7.org/fhir/StructureDefinition/Medication"
                        ]
                    }
                ],
                "mustSupport": true
            },
            {
                "id": "MedicationDispense.subject",
                "path": "MedicationDispense.subject",
                "min": 1,
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "http://hl7.org/fhir/StructureDefinition/Patient"
                        ]
                    }
                ],
                "mustSupport": true
            },
            {
                "id": "MedicationDispense.subject.identifier",
                "path": "MedicationDispense.subject.identifier",
                "min": 1,
                "type":  [
                    {
                        "code": "Identifier",
                        "profile":  [
                            "http://fhir.de/StructureDefinition/identifier-kvid-10"
                        ]
                    }
                ],
                "mustSupport": true
            },
            {
                "id": "MedicationDispense.performer",
                "path": "MedicationDispense.performer",
                "min": 1,
                "max": "1",
                "mustSupport": true
            },
            {
                "id": "MedicationDispense.performer.actor",
                "path": "MedicationDispense.performer.actor",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "http://hl7.org/fhir/StructureDefinition/Organization"
                        ]
                    }
                ]
            },
            {
                "id": "MedicationDispense.authorizingPrescription.reference",
                "path": "MedicationDispense.authorizingPrescription.reference",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "MedicationDispense.whenHandedOver",
                "path": "MedicationDispense.whenHandedOver",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "MedicationDispense.dosageInstruction",
                "path": "MedicationDispense.dosageInstruction",
                "mustSupport": true
            },
            {
                "id": "MedicationDispense.substitution",
                "path": "MedicationDispense.substitution",
                "mustSupport": true
            }
        ]
    }
}

Profil für die Datenverwaltung im Kontext der Medikationsplanung

EPA Nonprescription Medication Dispense

EPANonPrescriptionMedicationDispense (MedicationDispense)	I		EPAMedicationDispense	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. Data type EPAMedicationDispense Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.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 or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.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]
id	Σ	0..1	string	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 string
meta	S 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 might 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() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
id		0..1	string	There are no (further) constraints on this element Element id MedicationDispense.meta.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id MedicationDispense.meta.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. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. 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() or (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
versionId	S Σ	0..1	id	There are no (further) constraints on this element Element id MedicationDispense.meta.versionId Short description Version specific identifier Definition The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted. Comments The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes. Data type id Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
lastUpdated	S Σ	0..1	instant	There are no (further) constraints on this element Element id MedicationDispense.meta.lastUpdated Short description When the resource version last changed Definition When the resource last changed - e.g. when the version changed. Comments This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction. Data type instant Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
source	Σ	0..1	uri	There are no (further) constraints on this element Element id MedicationDispense.meta.source Short description Identifies where the resource comes from Definition A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc. Comments In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
profile	Σ	0..*	canonical(StructureDefinition)	There are no (further) constraints on this element Element id MedicationDispense.meta.profile Short description Profiles this resource claims to conform to Definition A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url. Comments It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set. Data type canonical(StructureDefinition) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
security	Σ	0..*	CodingBinding	There are no (further) constraints on this element Element id MedicationDispense.meta.security Short description Security Labels applied to this resource Definition Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure. Comments The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored. Data type Coding Binding Security Labels from the Healthcare Privacy and Security Classification System. All Security Labels (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim: CV orim: fhir:Coding rdfs:subClassOf dt:CDCoding
tag	Σ	0..*	Coding	There are no (further) constraints on this element Element id MedicationDispense.meta.tag Short description Tags applied to this resource Definition Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource. Comments The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored. Data type Coding Binding Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". CommonTags (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim: CV orim: fhir:Coding rdfs:subClassOf dt:CDCoding
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. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Comments Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
text		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 can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Comments Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. 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. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. 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() or (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
rxPrescriptionProcessIdentifier	I	0..0	Extension(RxPrescriptionProcessIdentifier)	Element id MedicationDispense.extension:rxPrescriptionProcessIdentifier Short description Optional Extensions Element Alternate names extensions, user content Definition This extension is used to track medication prescription transactions between the E-Rezept-Fachdienst and the ePA. The RxPrescriptionProcessIdentifier is generated by the ePA Medication Service and consists of the PrescriptionId and the authoredOn date of the operation parameters request. It ensures consistent referencing and management of medication-related resources across different systems. 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(RxPrescriptionProcessIdentifier) Extension URL https://gematik.de/fhir/epa-medication/StructureDefinition/rx-prescription-process-identifier-extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` 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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. 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() or (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 Identifiers associated with this Medication Dispense that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server. Comments This is a business identifier, not a resource identifier. Data type Identifier Sliced: Unordered, Open, by $this(Pattern) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 - 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: Event.identifier w5: FiveWs.identifier rim: .id rx-dispense-rmim: CombinedMedicationDispense.id
RxOriginatorProcessIdentifier		0..0	RxOriginatorProcessIdentifierPattern	There are no (further) constraints on this element Element id MedicationDispense.identifier:RxOriginatorProcessIdentifier Short description An identifier intended for computation Definition An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers. Comments This is a business identifier, not a resource identifier. Data type RxOriginatorProcessIdentifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "system": "https://gematik.de/fhir/epa-medication/sid/rx-originator-process-identifier" } Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - 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: Event.identifier w5: FiveWs.identifier rim: .id rx-dispense-rmim: CombinedMedicationDispense.id
EPADispensationIdentifier		0..1	EPADispensationIdentifierPattern	There are no (further) constraints on this element Element id MedicationDispense.identifier:EPADispensationIdentifier Short description An identifier intended for computation Definition An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers. Comments This is a business identifier, not a resource identifier. Data type EPADispensationIdentifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "system": "https://gematik.de/fhir/epa-medication/sid/dispensation-identifier" } Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - 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: Event.identifier w5: FiveWs.identifier rim: .id rx-dispense-rmim: CombinedMedicationDispense.id
partOf	I	0..0	Reference(Procedure)	There are no (further) constraints on this element Element id MedicationDispense.partOf Short description Event that dispense is part of Definition The procedure that trigger the dispense. 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(Procedure) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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: Event.partOf rim: .outboundRelationship[typeCode=COMP]/target[classCode=PROC,moodCode=EVN]
status	Σ ?!	1..1	codeBinding	There are no (further) constraints on this element Element id MedicationDispense.status Short description Status of medication dispense 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. EPAMedicationDispenseStatusVS (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Event.status w5: FiveWs.status rim: .statusCode rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.statusCode
statusReason[x]		0..1		There are no (further) constraints on this element Element id MedicationDispense.statusReason[x] Short description Why a dispense was not performed Definition Indicates the reason why a dispense was not performed. Binding A code describing why a dispense was not performed. MedicationDispense Status Reason Codes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Event.statusReason rim: .outboundRelationship[typeCode=RSON]/target[classCode=OBS,moodCode=EVN, code="not done reason"].value
statusReasonCodeableConcept			CodeableConcept	There are no (further) constraints on this element Data type CodeableConcept
statusReasonReference			Reference(DetectedIssue)	There are no (further) constraints on this element Data type Reference(DetectedIssue)
category	S	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id MedicationDispense.category Short description Missing value indicates a prescription dispense. Definition Indicates the type of medication dispense (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)). Comments The category can be used to include where the medication is expected to be consumed or other types of dispenses. Invariants can be used to bind to different value sets when profiling to bind. Data type CodeableConcept Binding Defines the context of a Dispensation: prescription or non-prescription EPAMedicationDispenseCategoryVS (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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]	S Σ	1..1		There are no (further) constraints on this element 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. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Event.code w5: FiveWs.what[x] v2: RXD-2-Dispense/Give Code rim: .participation[typeCode=PRD].role rx-dispense-rmim: CombinedMedicationRequest.component1.AdministrationRequest.consumable
medicationReference			Reference(Medication)	There are no (further) constraints on this element Data type Reference(Medication)
subject	S Σ I	1..1	Reference(Patient)	There are no (further) constraints on this element 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(Patient) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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: Event.subject w5: FiveWs.subject[x] v2: PID-3-Patient ID List rim: .participation[typeCode=SBJ].role[classCode=PAT] w5: FiveWs.subject
id		0..1	string	There are no (further) constraints on this element Element id MedicationDispense.subject.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id MedicationDispense.subject.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. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. 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() or (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
reference	Σ I	0..1	string	There are no (further) constraints on this element Element id MedicationDispense.subject.reference Short description Literal reference, Relative, internal or absolute URL Definition A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Comments Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
type	Σ	0..1	uriBinding	There are no (further) constraints on this element Element id MedicationDispense.subject.type Short description Type the reference refers to (e.g. "Patient") Definition The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). Comments This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Data type uri Binding Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
identifier	S Σ	1..1	IdentifierKvid10	There are no (further) constraints on this element Element id MedicationDispense.subject.identifier Short description An identifier intended for computation Definition An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers. Comments When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation\|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any). Data type IdentifierKvid10 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 - 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 rim: .identifier
display	Σ	0..1	string	There are no (further) constraints on this element Element id MedicationDispense.subject.display Short description Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference. Comments This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
context	I	0..0	Reference(Encounter \| EpisodeOfCare)	There are no (further) constraints on this element 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(Encounter \| EpisodeOfCare) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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: Event.context rim: .inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code="type of encounter or episode"]
supportingInformation	I	0..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() or (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 %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.context 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)]
performer	S	1..1	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. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Event.performer rim: .participation[typeCode=PRF]
id		0..1	string	There are no (further) constraints on this element Element id MedicationDispense.performer.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string 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. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. 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() or (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 even if unrecognized 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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. 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() or (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
function		0..1	CodeableConcept	There are no (further) constraints on this element Element id MedicationDispense.performer.function Short description Who performed the dispense and what they did Definition Distinguishes the type of performer in the dispense. For example, date enterer, packager, final checker. Requirements Allows disambiguation of the types of involvement of different performers. 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 the role an individual played in dispensing a medication. MedicationDispense Performer Function Codes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD rim: participation[typeCode=PRF].functionCode
actor	I	1..1	Reference(Organization)	There are no (further) constraints on this element 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(Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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: Event.performer.actor rim: .role
location	I	0..0	Reference(Location)	There are no (further) constraints on this element Element id MedicationDispense.location Short description Where the dispense occurred Definition The principal physical location where the dispense was performed. 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(Location) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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=LOC].role
authorizingPrescription	I	0..0	Reference(MedicationRequest)	There are no (further) constraints on this element 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(MedicationRequest) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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: Event.basedOn v2: ORC-2 Placer Order Number rim: .outboundRelationship[typeCode=FLFS].target[moodCode=RQO] rx-dispense-rmim: CombinedMedicationDispense.inFulfillmentOf
type		0..0	CodeableConcept	There are no (further) constraints on this element Element id MedicationDispense.type Short description Trial fill, partial fill, emergency fill, etc. 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 Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc. v3.ActPharmacySupplyType (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.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() or (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 rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.quantity
daysSupply	I	0..0	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() or (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() or (children().count() > id.count())` Mappings rim: n/a v2: RXD-3-Date/Time Dispensed rim: .effectiveTime[xmi:type=IVL_TS].low rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.effectiveTime
whenHandedOver	S	1..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() or (children().count() > id.count())` Mappings rim: n/a workflow: Event.occurrence[x] v2: RXD-3-Date/Time Dispensed rim: .effectiveTime[xmi:type=IVL_TS].high rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.effectiveTime
destination	I	0..0	Reference(Location)	There are no (further) constraints on this element 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(Location) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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 rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.destination
receiver	I	0..0	Reference(Patient \| Practitioner)	There are no (further) constraints on this element 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(Patient \| Practitioner) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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 rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.receiver
note		0..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() or (children().count() > id.count())` Mappings rim: n/a v2: N/A rim: Act workflow: Event.note v2: RXD-9 Dispense Notes rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=ACT,moodCode=EVN]
dosageInstruction	S	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() or (children().count() > id.count())` Mappings rim: n/a rim: .outboundRelationship[typeCode=COMP].target[classCode=SBADM, moodCode=INT]
substitution	S	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() or (children().count() > id.count())` Mappings rim: n/a rim: .outboundRelationship[typeCode=COMP].target[classCode=SUBST, moodCode=EVN] rx-dispense-rmim: CombinedMedicationDispense.substitutionMade
id		0..1	string	There are no (further) constraints on this element Element id MedicationDispense.substitution.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string 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. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. 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() or (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 even if unrecognized 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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. 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() or (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() or (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. v3.ActSubstanceAdminSubstitutionCode (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 rx-dispense-rmim: CombinedMedicationDispense.substitutionMade.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 (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. v3.SubstanceAdminSubstitutionReason (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD rim: .reasonCode rx-dispense-rmim: CombinedMedicationDispense.substitutionMade.reasonCode
responsibleParty	I	0..*	Reference(Practitioner \| PractitionerRole)	There are no (further) constraints on this element 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(Practitioner \| PractitionerRole) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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] rx-dispense-rmim: CombinedMedicationDispense.substitutionMade.ResponsibleParty
detectedIssue	I	0..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 This element can include a detected issue that has been identified either by a decision support system or by a clinician and may include information on the steps that were taken to address the issue. Data type Reference(DetectedIssue) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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
eventHistory	I	0..0	Reference(Provenance)	There are no (further) constraints on this element Element id MedicationDispense.eventHistory Short description A list of relevant lifecycle events Definition A summary of the events of interest that have occurred, such as when the dispense was verified. Comments This might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.). Data type Reference(Provenance) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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...*
Invariants	dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.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 or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.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]
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	string
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.
MedicationDispense.meta
Definition	The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Cardinality	0...1
Type	Meta
Must Support	True
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: N/A
MedicationDispense.meta.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
Mappings	rim: n/a
MedicationDispense.meta.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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() or (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.meta.versionId
Definition	The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.
Cardinality	0...1
Type	id
Must Support	True
Summary	True
Comments	The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
MedicationDispense.meta.lastUpdated
Definition	When the resource last changed - e.g. when the version changed.
Cardinality	0...1
Type	instant
Must Support	True
Summary	True
Comments	This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
MedicationDispense.meta.source
Definition	A uri that identifies the source system of the resource. This provides a minimal amount of [Provenance](provenance.html#) information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.
Cardinality	0...1
Type	uri
Summary	True
Comments	In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
MedicationDispense.meta.profile
Definition	A list of profiles (references to [StructureDefinition](structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](structuredefinition-definitions.html#StructureDefinition.url).
Cardinality	0...*
Type	canonical(StructureDefinition)
Summary	True
Comments	It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
MedicationDispense.meta.security
Definition	Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.
Cardinality	0...*
Type	Coding
Binding	Security Labels from the Healthcare Privacy and Security Classification System. All Security Labels (extensible)
Summary	True
Comments	The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim: CV orim: fhir:Coding rdfs:subClassOf dt:CDCoding
MedicationDispense.meta.tag
Definition	Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.
Cardinality	0...*
Type	Coding
Binding	Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". CommonTags (example)
Summary	True
Comments	The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim: CV orim: fhir:Coding rdfs:subClassOf dt:CDCoding
MedicationDispense.implicitRules
Definition	A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (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. CommonLanguages (preferred)
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() or (children().count() > id.count())`
Mappings	rim: n/a
MedicationDispense.text
Definition	A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
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 information is added later.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
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. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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() or (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.extension:rxPrescriptionProcessIdentifier
Definition	This extension is used to track medication prescription transactions between the E-Rezept-Fachdienst and the ePA. The RxPrescriptionProcessIdentifier is generated by the ePA Medication Service and consists of the PrescriptionId and the authoredOn date of the operation parameters request. It ensures consistent referencing and management of medication-related resources across different systems.
Cardinality	0...0
Type	Extension(RxPrescriptionProcessIdentifier)
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() or (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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Alias	extensions, user content
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
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() or (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	Identifiers associated with this Medication Dispense that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server.
Cardinality	0...*
Type	Identifier
Comments	This is a business identifier, not a resource identifier.
Slicing	Unordered, Open, by $this(Pattern)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (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 - 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: Event.identifier w5: FiveWs.identifier rim: .id rx-dispense-rmim: CombinedMedicationDispense.id
MedicationDispense.identifier:RxOriginatorProcessIdentifier
Definition	An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.
Cardinality	0...0
Type	RxOriginatorProcessIdentifier
Comments	This is a business identifier, not a resource identifier.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Pattern	{ "system": "https://gematik.de/fhir/epa-medication/sid/rx-originator-process-identifier" }
Mappings	rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - 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: Event.identifier w5: FiveWs.identifier rim: .id rx-dispense-rmim: CombinedMedicationDispense.id
MedicationDispense.identifier:EPADispensationIdentifier
Definition	An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.
Cardinality	0...1
Type	EPADispensationIdentifier
Comments	This is a business identifier, not a resource identifier.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Pattern	{ "system": "https://gematik.de/fhir/epa-medication/sid/dispensation-identifier" }
Mappings	rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - 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: Event.identifier w5: FiveWs.identifier rim: .id rx-dispense-rmim: CombinedMedicationDispense.id
MedicationDispense.partOf
Definition	The procedure that trigger the dispense.
Cardinality	0...0
Type	Reference(Procedure)
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() or (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 %rootResource.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: Event.partOf rim: .outboundRelationship[typeCode=COMP]/target[classCode=PROC,moodCode=EVN]
MedicationDispense.status
Definition	A code specifying the state of the set of dispense events.
Cardinality	1...1
Type	code
Binding	A coded concept specifying the state of the dispense event. EPAMedicationDispenseStatusVS (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() or (children().count() > id.count())`
Mappings	rim: n/a workflow: Event.status w5: FiveWs.status rim: .statusCode rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.statusCode
MedicationDispense.statusReason[x]
Definition	Indicates the reason why a dispense was not performed.
Cardinality	0...1
Type	CodeableConcept
Binding	A code describing why a dispense was not performed. MedicationDispense Status Reason Codes (example)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a workflow: Event.statusReason rim: .outboundRelationship[typeCode=RSON]/target[classCode=OBS,moodCode=EVN, code="not done reason"].value
MedicationDispense.category
Definition	Indicates the type of medication dispense (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)).
Cardinality	0...1
Type	CodeableConcept
Binding	Defines the context of a Dispensation: prescription or non-prescription EPAMedicationDispenseCategoryVS (required)
Must Support	True
Comments	The category can be used to include where the medication is expected to be consumed or other types of dispenses. Invariants can be used to bind to different value sets when profiling to bind.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (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(Medication)
Must Support	True
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() or (children().count() > id.count())`
Mappings	rim: n/a workflow: Event.code w5: FiveWs.what[x] v2: RXD-2-Dispense/Give Code rim: .participation[typeCode=PRD].role rx-dispense-rmim: CombinedMedicationRequest.component1.AdministrationRequest.consumable
MedicationDispense.subject
Definition	A link to a resource representing the person or the group to whom the medication will be given.
Cardinality	1...1
Type	Reference(Patient)
Must Support	True
Summary	True
Comments	SubstanceAdministration->subject->Patient.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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: Event.subject w5: FiveWs.subject[x] v2: PID-3-Patient ID List rim: .participation[typeCode=SBJ].role[classCode=PAT] w5: FiveWs.subject
MedicationDispense.subject.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
Mappings	rim: n/a
MedicationDispense.subject.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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() or (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.subject.reference
Definition	A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Cardinality	0...1
Type	string
Summary	True
Comments	Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: N/A
MedicationDispense.subject.type
Definition	The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
Cardinality	0...1
Type	uri
Binding	Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible)
Summary	True
Comments	This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: N/A
MedicationDispense.subject.identifier
Definition	An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.
Cardinality	1...1
Type	IdentifierKvid10
Must Support	True
Summary	True
Comments	When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation\|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (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 - 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 rim: .identifier
MedicationDispense.subject.display
Definition	Plain text narrative that identifies the resource in addition to the resource reference.
Cardinality	0...1
Type	string
Summary	True
Comments	This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: N/A
MedicationDispense.context
Definition	The encounter or episode of care that establishes the context for this event.
Cardinality	0...0
Type	Reference(Encounter \| EpisodeOfCare)
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() or (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 %rootResource.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: Event.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...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() or (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 %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.context 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)]
MedicationDispense.performer
Definition	Indicates who or what performed the event.
Cardinality	1...1
Type	BackboneElement
Must Support	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a workflow: Event.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
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. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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() or (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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
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() or (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.function
Definition	Distinguishes the type of performer in the dispense. For example, date enterer, packager, final checker.
Cardinality	0...1
Type	CodeableConcept
Binding	A code describing the role an individual played in dispensing a medication. MedicationDispense Performer Function Codes (example)
Requirements	Allows disambiguation of the types of involvement of different performers.
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() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD rim: participation[typeCode=PRF].functionCode
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(Organization)
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() or (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 %rootResource.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: Event.performer.actor rim: .role
MedicationDispense.location
Definition	The principal physical location where the dispense was performed.
Cardinality	0...0
Type	Reference(Location)
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() or (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 %rootResource.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=LOC].role
MedicationDispense.authorizingPrescription
Definition	Indicates the medication order that is being dispensed against.
Cardinality	0...0
Type	Reference(MedicationRequest)
Comments	Maps to basedOn in Event logical model.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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: Event.basedOn v2: ORC-2 Placer Order Number rim: .outboundRelationship[typeCode=FLFS].target[moodCode=RQO] rx-dispense-rmim: CombinedMedicationDispense.inFulfillmentOf
MedicationDispense.authorizingPrescription.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
Mappings	rim: n/a
MedicationDispense.authorizingPrescription.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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() or (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.authorizingPrescription.reference
Definition	A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Cardinality	1...1
Type	string
Must Support	True
Summary	True
Comments	Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: N/A
MedicationDispense.authorizingPrescription.type
Definition	The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
Cardinality	0...1
Type	uri
Binding	Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible)
Summary	True
Comments	This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: N/A
MedicationDispense.authorizingPrescription.identifier
Definition	An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
Cardinality	0...1
Type	Identifier
Summary	True
Comments	When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation\|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (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 - 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 rim: .identifier
MedicationDispense.authorizingPrescription.display
Definition	Plain text narrative that identifies the resource in addition to the resource reference.
Cardinality	0...1
Type	string
Summary	True
Comments	This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: N/A
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...0
Type	CodeableConcept
Binding	Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc. v3.ActPharmacySupplyType (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() or (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 rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.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() or (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 rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.quantity
MedicationDispense.daysSupply
Definition	The amount of medication expressed as a timing amount.
Cardinality	0...0
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() or (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() or (children().count() > id.count())`
Mappings	rim: n/a v2: RXD-3-Date/Time Dispensed rim: .effectiveTime[xmi:type=IVL_TS].low rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.effectiveTime
MedicationDispense.whenHandedOver
Definition	The time the dispensed product was provided to the patient or their representative.
Cardinality	1...1
Type	dateTime
Must Support	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a workflow: Event.occurrence[x] v2: RXD-3-Date/Time Dispensed rim: .effectiveTime[xmi:type=IVL_TS].high rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.effectiveTime
MedicationDispense.destination
Definition	Identification of the facility/location where the medication was shipped to, as part of the dispense event.
Cardinality	0...0
Type	Reference(Location)
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() or (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 %rootResource.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 rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.destination
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...0
Type	Reference(Patient \| Practitioner)
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() or (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 %rootResource.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 rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.receiver
MedicationDispense.note
Definition	Extra information about the dispense that could not be conveyed in the other attributes.
Cardinality	0...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() or (children().count() > id.count())`
Mappings	rim: n/a v2: N/A rim: Act workflow: Event.note v2: RXD-9 Dispense Notes rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=ACT,moodCode=EVN]
MedicationDispense.dosageInstruction
Definition	Indicates how the medication is to be used by the patient.
Cardinality	0...*
Type	Dosage
Must Support	True
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() or (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
Must Support	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a rim: .outboundRelationship[typeCode=COMP].target[classCode=SUBST, moodCode=EVN] rx-dispense-rmim: CombinedMedicationDispense.substitutionMade
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
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. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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() or (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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
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() or (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() or (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. v3.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() or (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 rx-dispense-rmim: CombinedMedicationDispense.substitutionMade.code
MedicationDispense.substitution.reason
Definition	Indicates the reason for the substitution (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. v3.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() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD rim: .reasonCode rx-dispense-rmim: CombinedMedicationDispense.substitutionMade.reasonCode
MedicationDispense.substitution.responsibleParty
Definition	The person or organization that has primary responsibility for the substitution.
Cardinality	0...*
Type	Reference(Practitioner \| PractitionerRole)
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() or (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 %rootResource.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] rx-dispense-rmim: CombinedMedicationDispense.substitutionMade.ResponsibleParty
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...0
Type	Reference(DetectedIssue)
Alias	Contraindication, Drug Utilization Review (DUR), Alert
Comments	This element can include a detected issue that has been identified either by a decision support system or by a clinician and may include information on the steps that were taken to address the issue.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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.eventHistory
Definition	A summary of the events of interest that have occurred, such as when the dispense was verified.
Cardinality	0...0
Type	Reference(Provenance)
Comments	This might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (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 %rootResource.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]

<StructureDefinition xmlns="http://hl7.org/fhir">
    <id value="epa-nonrescription-medication-dispense" />
    <url value="https://gematik.de/fhir/epa-medication/StructureDefinition/epa-nonrescription-medication-dispense" />
    <version value="1.1.1" />
    <name value="EPANonPrescriptionMedicationDispense" />
    <title value="EPA Nonprescription Medication Dispense" />
    <status value="active" />
    <experimental value="false" />
    <date value="2024-08-14" />
    <publisher value="gematik GmbH" />
    <description value="This profile defines constraints on the MedicationDispense resource to represent the dispensing of nonprescription medications, including over-the-counter (OTC) drugs and dietary supplements." />
    <fhirVersion value="4.0.1" />
    <kind value="resource" />
    <abstract value="false" />
    <type value="MedicationDispense" />
    <baseDefinition value="https://gematik.de/fhir/epa-medication/StructureDefinition/epa-medication-dispense" />
    <derivation value="constraint" />
    <differential>
        <element id="MedicationDispense.extension:rxPrescriptionProcessIdentifier">
            <path value="MedicationDispense.extension" />
            <sliceName value="rxPrescriptionProcessIdentifier" />
            <max value="0" />
        </element>
        <element id="MedicationDispense.identifier:RxOriginatorProcessIdentifier">
            <path value="MedicationDispense.identifier" />
            <sliceName value="RxOriginatorProcessIdentifier" />
            <max value="0" />
        </element>
        <element id="MedicationDispense.partOf">
            <path value="MedicationDispense.partOf" />
            <max value="0" />
        </element>
        <element id="MedicationDispense.context">
            <path value="MedicationDispense.context" />
            <max value="0" />
        </element>
        <element id="MedicationDispense.supportingInformation">
            <path value="MedicationDispense.supportingInformation" />
            <max value="0" />
        </element>
        <element id="MedicationDispense.location">
            <path value="MedicationDispense.location" />
            <max value="0" />
        </element>
        <element id="MedicationDispense.authorizingPrescription">
            <path value="MedicationDispense.authorizingPrescription" />
            <max value="0" />
        </element>
        <element id="MedicationDispense.type">
            <path value="MedicationDispense.type" />
            <max value="0" />
        </element>
        <element id="MedicationDispense.daysSupply">
            <path value="MedicationDispense.daysSupply" />
            <max value="0" />
        </element>
        <element id="MedicationDispense.destination">
            <path value="MedicationDispense.destination" />
            <max value="0" />
        </element>
        <element id="MedicationDispense.receiver">
            <path value="MedicationDispense.receiver" />
            <max value="0" />
        </element>
        <element id="MedicationDispense.note">
            <path value="MedicationDispense.note" />
            <max value="0" />
        </element>
        <element id="MedicationDispense.detectedIssue">
            <path value="MedicationDispense.detectedIssue" />
            <max value="0" />
        </element>
        <element id="MedicationDispense.eventHistory">
            <path value="MedicationDispense.eventHistory" />
            <max value="0" />
        </element>
    </differential>
</StructureDefinition>

{
    "resourceType": "StructureDefinition",
    "id": "epa-nonrescription-medication-dispense",
    "url": "https://gematik.de/fhir/epa-medication/StructureDefinition/epa-nonrescription-medication-dispense",
    "version": "1.1.1",
    "name": "EPANonPrescriptionMedicationDispense",
    "title": "EPA Nonprescription Medication Dispense",
    "status": "active",
    "experimental": false,
    "date": "2024-08-14",
    "publisher": "gematik GmbH",
    "description": "This profile defines constraints on the MedicationDispense resource to represent the dispensing of nonprescription medications, including over-the-counter (OTC) drugs and dietary supplements.",
    "fhirVersion": "4.0.1",
    "kind": "resource",
    "abstract": false,
    "type": "MedicationDispense",
    "baseDefinition": "https://gematik.de/fhir/epa-medication/StructureDefinition/epa-medication-dispense",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "MedicationDispense.extension:rxPrescriptionProcessIdentifier",
                "path": "MedicationDispense.extension",
                "sliceName": "rxPrescriptionProcessIdentifier",
                "max": "0"
            },
            {
                "id": "MedicationDispense.identifier:RxOriginatorProcessIdentifier",
                "path": "MedicationDispense.identifier",
                "sliceName": "RxOriginatorProcessIdentifier",
                "max": "0"
            },
            {
                "id": "MedicationDispense.partOf",
                "path": "MedicationDispense.partOf",
                "max": "0"
            },
            {
                "id": "MedicationDispense.context",
                "path": "MedicationDispense.context",
                "max": "0"
            },
            {
                "id": "MedicationDispense.supportingInformation",
                "path": "MedicationDispense.supportingInformation",
                "max": "0"
            },
            {
                "id": "MedicationDispense.location",
                "path": "MedicationDispense.location",
                "max": "0"
            },
            {
                "id": "MedicationDispense.authorizingPrescription",
                "path": "MedicationDispense.authorizingPrescription",
                "max": "0"
            },
            {
                "id": "MedicationDispense.type",
                "path": "MedicationDispense.type",
                "max": "0"
            },
            {
                "id": "MedicationDispense.daysSupply",
                "path": "MedicationDispense.daysSupply",
                "max": "0"
            },
            {
                "id": "MedicationDispense.destination",
                "path": "MedicationDispense.destination",
                "max": "0"
            },
            {
                "id": "MedicationDispense.receiver",
                "path": "MedicationDispense.receiver",
                "max": "0"
            },
            {
                "id": "MedicationDispense.note",
                "path": "MedicationDispense.note",
                "max": "0"
            },
            {
                "id": "MedicationDispense.detectedIssue",
                "path": "MedicationDispense.detectedIssue",
                "max": "0"
            },
            {
                "id": "MedicationDispense.eventHistory",
                "path": "MedicationDispense.eventHistory",
                "max": "0"
            }
        ]
    }
}