{
  "resourceType": "StructureDefinition",
  "id": "fd471b8d-3b37-46a3-af00-568de477864a",
  "url": "https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationDispense",
  "name": "NHSDigitalMedicationDispense",
  "status": "draft",
  "fhirVersion": "4.0.1",
  "kind": "resource",
  "abstract": false,
  "type": "MedicationDispense",
  "baseDefinition": "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationDispense",
  "derivation": "constraint",
  "differential": {
    "element": [
      {
        "id": "MedicationDispense.extension",
        "path": "MedicationDispense.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "open"
        },
        "min": 1
      },
      {
        "id": "MedicationDispense.extension:prescriptionStatus",
        "path": "MedicationDispense.extension",
        "sliceName": "prescriptionStatus",
        "short": "This is the overall status of the `prescription-order`",
        "definition": "This is the overall status of the `prescription-order`, it is not the status of the individual prescription item. This is a code from {{pagelink:DM-Task-Status-Reason-duplicate-2}}, all prescription status reasons in a `dispense-notification` FHIR Message Bundle must be the same.\r\n\r\n```json\r\n\"extension\": [\r\n    {\r\n        \"url\": \"https://fhir.nhs.uk/StructureDefinition/Extension-EPS-TaskBusinessStatus\",\r\n        \"valueCoding\": {\r\n            \"system\": \"https://fhir.nhs.uk/CodeSystem/EPS-task-business-status\",\r\n            \"code\": \"0003\",\r\n            \"display\": \"With Dispenser - Active\"\r\n        }\r\n    }\r\n]\r\n```",
        "min": 1,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.nhs.uk/StructureDefinition/Extension-EPS-TaskBusinessStatus"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "MedicationDispense.extension:repeatInformation",
        "path": "MedicationDispense.extension",
        "sliceName": "repeatInformation",
        "short": "Repeat Prescribing and Dispensing",
        "definition": "The extension is mandatory for `continuous` and `continuous-repeat-dispensing`. The following elements **MUST** be populated \r\n\r\n- numberofRepeatsAllowed \r\n- numberOfRepeatsIssued \r\n\r\n```json\r\n\"extension\": [\r\n    {\r\n        \"url\": \"https://fhir.nhs.uk/StructureDefinition/Extension-EPS-RepeatInformation\",\r\n        \"extension\": [\r\n            {\r\n                \"url\" : \"numberOfRepeatsAllowed\",\r\n                \"valueInteger\" : 3\r\n            },\r\n            {\r\n                \"url\" : \"numberOfRepeatsIssued\",\r\n                \"valueInteger\" : 2\r\n            }\r\n        ]\r\n    }\r\n]\r\n```",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.nhs.uk/StructureDefinition/Extension-EPS-RepeatInformation"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "MedicationDispense.identifier",
        "path": "MedicationDispense.identifier",
        "definition": "Each MedicationDispense **MUST** be identified by an Universal Unique Identifiers (UUIDs) with a system of `https://fhir.nhs.uk/Id/prescription-dispense-item-number`\r\n\r\nUUID example (for illustration purposes only);\r\n\r\n**4509B70D-D8B8-EA03-1105-64557CB54A29**\r\n\r\n\r\n```json\r\n \"identifier\":  [\r\n    {\r\n        \"system\": \"https://fhir.nhs.uk/Id/prescription-dispense-item-number\",\r\n        \"value\": \"4509B70D-D8B8-EA03-1105-64557CB54A29\"\r\n    }\r\n]\r\n```",
        "mustSupport": true
      },
      {
        "id": "MedicationDispense.identifier.system",
        "path": "MedicationDispense.identifier.system",
        "min": 1
      },
      {
        "id": "MedicationDispense.identifier.value",
        "path": "MedicationDispense.identifier.value",
        "min": 1
      },
      {
        "id": "MedicationDispense.status",
        "path": "MedicationDispense.status",
        "definition": "The status of the individual medication item, this will normally indicate whether the medication has been picked up or not. \r\n\r\n| Code | Display | Definition |\r\n|--|--|--|\r\n| completed | Completed | The dispensed product has been picked up. |\r\n| in-progress | In Progress | The dispensed product is ready for pickup. |\r\n\r\n\r\n<img src=\"https://raw.githubusercontent.com/NHSDigital/NHSDigital-FHIR-Medicines-ImplementationGuide/master/Diagrams/medication-dispense-status-flow.png\" width=\"100%\" hieght=\"auto\"/>",
        "mustSupport": true
      },
      {
        "id": "MedicationDispense.statusReason[x]",
        "path": "MedicationDispense.statusReason[x]",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "MedicationDispense.statusReason[x].coding",
        "path": "MedicationDispense.statusReason[x].coding",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "system"
            }
          ],
          "rules": "open"
        },
        "min": 1
      },
      {
        "id": "MedicationDispense.statusReason[x].coding.system",
        "path": "MedicationDispense.statusReason[x].coding.system",
        "min": 1
      },
      {
        "id": "MedicationDispense.statusReason[x].coding.code",
        "path": "MedicationDispense.statusReason[x].coding.code",
        "min": 1
      },
      {
        "id": "MedicationDispense.statusReason[x].coding:notDispensedStatusReason",
        "path": "MedicationDispense.statusReason[x].coding",
        "sliceName": "notDispensedStatusReason",
        "mustSupport": true,
        "binding": {
          "strength": "required",
          "valueSet": "https://fhir.nhs.uk/ValueSet/DM-medicationdispense-status-reason"
        }
      },
      {
        "id": "MedicationDispense.statusReason[x].coding:notDispensedStatusReason.system",
        "path": "MedicationDispense.statusReason[x].coding.system",
        "fixedUri": "https://fhir.nhs.uk/CodeSystem/medicationdispense-status-reason"
      },
      {
        "id": "MedicationDispense.statusReason[x].coding:amendmentStatusReason",
        "path": "MedicationDispense.statusReason[x].coding",
        "sliceName": "amendmentStatusReason",
        "mustSupport": true,
        "binding": {
          "strength": "required",
          "valueSet": "https://fhir.nhs.uk/ValueSet/DM-task-reason-code"
        }
      },
      {
        "id": "MedicationDispense.statusReason[x].coding:amendmentStatusReason.system",
        "path": "MedicationDispense.statusReason[x].coding.system",
        "fixedUri": "https://fhir.nhs.uk/CodeSystem/EPS-task-dispense-withdraw-reason"
      },
      {
        "id": "MedicationDispense.category.coding.system",
        "path": "MedicationDispense.category.coding.system",
        "min": 1
      },
      {
        "id": "MedicationDispense.category.coding.code",
        "path": "MedicationDispense.category.coding.code",
        "min": 1
      },
      {
        "id": "MedicationDispense.medication[x]",
        "path": "MedicationDispense.medication[x]",
        "definition": "Actual Medical Product Packs (AMPP) SHOULD be used. \r\nIt is valid to include a FHIR Medication resource within the FHIR Message, this practice is discouraged to simplify handling of the event messages.\r\n\r\n<table>\r\n<thead>\r\n<th data-no-sort width=\"25%\">\r\ndm+d Category\r\n</th>\r\n<th data-no-sort width=\"50%\">\r\ndm+d Description\r\n</th>\r\n<th data-no-sort width=\"25%\">\r\nUK SNOMED Members Of\r\n</th>\r\n\r\n</thead>\r\n<tr>\r\n<td>\r\nVMPP\r\n</td>\r\n<td>\r\nVirtual Medical Product Pack\r\n</td>\r\n<td>\r\n<a href=\"https://termbrowser.nhs.uk/?perspective=full&conceptId1=999000571000001104\" target=\"_blank\">999000571000001104</a>\r\n</td>\r\n\r\n</tr>\r\n<tr>\r\n<td>\r\nAMPP\r\n</td>\r\n<td>\r\nActual Medical Product Pack\r\n</td>\r\n<td>\r\n<a href=\"https://termbrowser.nhs.uk/?perspective=full&conceptId1=999000551000001106\" target=\"_blank\">999000551000001106</a>\r\n</td>\r\n</tr>\r\n<tr>\r\n<td>\r\nVMP\r\n</td>\r\n<td>\r\nVirtual Medical Product\r\n</td>\r\n<td>\r\n<a href=\"https://termbrowser.nhs.uk/?perspective=full&conceptId1=999000561000001109\" target=\"_blank\">999000561000001109</a>\r\n</td>\r\n</tr>\r\n<tr>\r\n<td>\r\nAMP\r\n</td>\r\n<td>\r\nActual Medical Product\r\n</td>\r\n<td>\r\n<a href=\"https://termbrowser.nhs.uk/?perspective=full&conceptId1=999000541000001108\" target=\"_blank\">999000541000001108</a>\r\n</td>\r\n</tr>\r\n</table>\r\n\r\n<br>\r\n\r\n```json\r\n\"medicationCodeableConcept\": {\r\n        \"coding\":  [\r\n        {\r\n            \"system\": \"http://snomed.info/sct\",\r\n            \"code\": \"10460811000001109\",\r\n            \"display\": \"Amoxil 500mg capsules (Dowelhurst Ltd) 12 capsule\"\r\n        }\r\n    ]\r\n}\r\n```",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationDispense-CodeableConcept"
            ]
          },
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationDispense-Medication"
            ],
            "aggregation": [
              "bundled"
            ]
          }
        ],
        "mustSupport": true,
        "binding": {
          "strength": "extensible",
          "valueSet": "https://fhir.nhs.uk/ValueSet/NHSDigital-MedicationCode"
        }
      },
      {
        "id": "MedicationDispense.subject",
        "path": "MedicationDispense.subject",
        "definition": "A reference to the patient via a traced NHS Number is required, an untraced NHS Number MUST NOT be used. This can be sent in two ways, first option is via a `identifier reference`. Only the NHS Number:\r\n\r\n```json\r\n\"subject\": {\r\n    \"type\": \"Patient\",\r\n    \"identifier\": {\r\n        \"system\": \"https://fhir.nhs.uk/Id/nhs-number\",\r\n        \"value\": \"2300992742\"\r\n    }\r\n}\r\n```\r\n\r\nSecond option uses a FHIR Patient resource to convey the NHS Number.  \r\n\r\nThe reference in the MedicationDispesnse is now a `resource reference`. \r\n\r\n```json\r\n \"subject\": {\r\n                    \"type\": \"Patient\",\r\n                    \"reference\": \"urn:uuid:bde9eba6-079f-4210-8108-6ea8db58de8c\",\r\n                    \"display\": \"Miss Bernie Kanfeld\"\r\n                }\r\n```\r\n\r\nThe NHS Number has moved to the Patient resource alongside other patient identifiers such as MRN. E.g. \r\n\r\n```json\r\n\"fullUrl\": \"urn:uuid:bde9eba6-079f-4210-8108-6ea8db58de8c\",\r\n\"resource\": {\r\n                \"resourceType\": \"Patient\",\r\n                \"identifier\": [\r\n                    {\r\n                        \"extension\": [\r\n                            {\r\n                                \"url\": \"https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-NHSNumberVerificationStatus\",\r\n                                \"valueCodeableConcept\": {\r\n                                    \"coding\": [\r\n                                        {\r\n                                            \"system\": \"https://fhir.hl7.org.uk/CodeSystem/UKCore-NHSNumberVerificationStatus\",\r\n                                            \"code\": \"01\",\r\n                                            \"display\": \"Number present and verified\"\r\n                                        }\r\n                                    ]\r\n                                }\r\n                            }\r\n                        ],\r\n                        \"system\": \"https://fhir.nhs.uk/Id/nhs-number\",\r\n                        \"value\": \"9876543210\"\r\n                    },\r\n                    {\r\n                        \"system\": \"https://fhir.leedsth.nhs.uk/Id/pas-number\",\r\n                        \"value\": \"ABC8650149\"\r\n                    },\r\n                    {\r\n                        \"system\": \"https://fhir.leedsth.nhs.uk/Id/PPMIdentifier\",\r\n                        \"value\": \"1\"\r\n                    }\r\n                ],\r\n               ... other elements removed from example.\r\n            }\r\n```\r\n\r\nIt is anticipated that hospital pharmacies will prefer the later option for compatibility with other systems. Community pharmacies are anticipated to prefer the former option.",
        "min": 1,
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.nhs.uk/StructureDefinition/NHSDigital-Patient-PDS"
            ],
            "aggregation": [
              "referenced",
              "bundled"
            ]
          }
        ],
        "constraint": [
          {
            "key": "eps-2",
            "severity": "warning",
            "human": "subject - An identifier reference or resource reference must be provided",
            "expression": "(reference.exists() or (identifier.exists()))",
            "source": "https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationDispense"
          },
          {
            "key": "patient-nhs",
            "severity": "error",
            "human": "Supplied NHS Number is outside the English and Welsh NHS Number range or length of the number is wrong.",
            "expression": "identifier.where(system='https://fhir.nhs.uk/Id/nhs-number').exists().not() or (identifier.where(system='https://fhir.nhs.uk/Id/nhs-number').exists()  and identifier.where(system='https://fhir.nhs.uk/Id/nhs-number').value.matches('^([456789]{1}[0-9]{9})$'))",
            "source": "https://fhir.nhs.uk/StructureDefinition/NHSDigital-Claim"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "MedicationDispense.subject.identifier.system",
        "path": "MedicationDispense.subject.identifier.system",
        "min": 1,
        "fixedUri": "https://fhir.nhs.uk/Id/nhs-number"
      },
      {
        "id": "MedicationDispense.subject.identifier.value",
        "path": "MedicationDispense.subject.identifier.value",
        "min": 1
      },
      {
        "id": "MedicationDispense.context",
        "path": "MedicationDispense.context",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/EpisodeOfCare",
              "https://fhir.nhs.uk/StructureDefinition/NHSDigital-Encounter"
            ]
          }
        ]
      },
      {
        "id": "MedicationDispense.performer",
        "path": "MedicationDispense.performer",
        "definition": "The pharmacist and pharmacy MUST be present and MUST use `identifier references`. This means FHIR Practitioner, Organization and PractitionerRole resource are not included in the FHIR Message. Professional codes and ODS codes should be used instead. `sds-user-role-id` is permitted to identify a Practitioner(& Role) but professional codes are preferred to support wider NHS interoperability.\r\n\r\n```json\r\n \"performer\": [\r\n    {\r\n        \"actor\": {\r\n            \"reference\" : \"#performer\"\r\n        }\r\n    }\r\n],\r\n```\r\n\r\nThe contained PractitionerRole:\r\n\r\n```json\r\n{\r\n    \"resourceType\": \"MedicationDispense\",\r\n    \"id\": \"06167339-9337-d030-0366-514a6a46da17\",\r\n    \"contained\": [\r\n        {\r\n                        \"resourceType\": \"PractitionerRole\",\r\n                        \"id\": \"performer\",\r\n                        \"identifier\": [\r\n                            {\r\n                                \"system\": \"https://fhir.nhs.uk/Id/sds-role-profile-id\",\r\n                                \"value\": \"741555508105\"\r\n                            }\r\n                        ],\r\n                        \"code\": [\r\n                            {\r\n                                \"coding\": [\r\n                                    {\r\n                                        \"system\": \"https://fhir.nhs.uk/CodeSystem/NHSDigital-SDS-JobRoleCode\",\r\n                                        \"code\": \"S0030:G0100:R0620\"\r\n                                    }\r\n                                ]\r\n                            }\r\n                        ],\r\n                        \"practitioner\": {\r\n                            \"identifier\": {\r\n                                \"system\": \"https://fhir.nhs.uk/Id/sds-user-id\",\r\n                                \"value\": \"7654321\"\r\n                            },\r\n                            \"display\": \"Mr Peter Potion\"\r\n                        },\r\n                        \"organization\": {\r\n                            \"reference\": \"urn:uuid:2bf9f37c-d88b-4f86-ad5f-373c1416e04b\"\r\n                        },\r\n                        \"telecom\": [\r\n                            {\r\n                                \"system\": \"phone\",\r\n                                \"use\": \"work\",\r\n                                \"value\": \"0532567890\"\r\n                            }\r\n                        ]\r\n                   }\r\n    ],\r\n```",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationDispense.performer.actor",
        "path": "MedicationDispense.performer.actor",
        "type": [
          {
            "code": "Reference",
            "profile": [
              "https://fhir.nhs.uk/StructureDefinition/NHSDigital-Reference"
            ],
            "targetProfile": [
              "https://fhir.nhs.uk/StructureDefinition/NHSDigital-PractitionerRole-SDS"
            ],
            "aggregation": [
              "contained"
            ]
          }
        ],
        "constraint": [
          {
            "key": "performer",
            "severity": "error",
            "human": "An identifier reference or resource reference must be provided",
            "expression": "(reference.exists() or identifier.exists())",
            "source": "https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationDispense"
          }
        ]
      },
      {
        "id": "MedicationDispense.performer.actor.reference",
        "path": "MedicationDispense.performer.actor.reference",
        "min": 1
      },
      {
        "id": "MedicationDispense.performer.actor.identifier.system",
        "path": "MedicationDispense.performer.actor.identifier.system",
        "min": 1
      },
      {
        "id": "MedicationDispense.performer.actor.identifier.value",
        "path": "MedicationDispense.performer.actor.identifier.value",
        "min": 1
      },
      {
        "id": "MedicationDispense.location",
        "path": "MedicationDispense.location",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.nhs.uk/StructureDefinition/NHSDigital-Location"
            ]
          }
        ]
      },
      {
        "id": "MedicationDispense.location.identifier.system",
        "path": "MedicationDispense.location.identifier.system",
        "min": 1
      },
      {
        "id": "MedicationDispense.location.identifier.value",
        "path": "MedicationDispense.location.identifier.value",
        "min": 1
      },
      {
        "id": "MedicationDispense.location.display",
        "path": "MedicationDispense.location.display",
        "min": 1
      },
      {
        "id": "MedicationDispense.authorizingPrescription",
        "path": "MedicationDispense.authorizingPrescription",
        "definition": "A reference to the `MedicationRequest`. \r\n\r\n```json\r\n\"authorizingPrescription\": [\r\n    {\r\n        \"reference\": \"#m1\"\r\n    }\r\n]\r\n```\r\n\r\nWhen a MedicationDispesne is sent in a FHIR Message bundle, which is the case with EPS NextGen `dispense-notifications`, a contained MedicationRequest is required. \r\n\r\nThis MedicationRequest **MUST** follow the rules in [NHSDigital-MedicationRequest](https://simplifier.net/resolve?target=simplifier&scope=uk.nhsdigital.r4&canonical=https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationRequest) and it is strongly recommended to reuse the `MedicationRequest` received when the prescription was downloaded. \r\n\r\nFor example:\r\n\r\n```json \r\n{\r\n                \"resourceType\": \"MedicationDispense\",\r\n                \"contained\":  [\r\n                    {\r\n                        \"resourceType\": \"MedicationRequest\",\r\n                        \"id\": \"m1\",\r\n                        \"identifier\":  [\r\n                            {\r\n                                \"system\": \"https://fhir.nhs.uk/Id/prescription-order-item-number\",\r\n                                \"value\": \"299c610b-f4f1-4eac-a7d7-4fb6b0556e11\"\r\n                            }\r\n                        ],\r\n                        \"status\": \"active\",\r\n                        \"intent\": \"order\",\r\n                        \"medicationCodeableConcept\": {\r\n                            \"coding\":  [\r\n                                {\r\n                                    \"system\": \"http://snomed.info/sct\",\r\n                                    \"code\": \"39720311000001101\",\r\n                                    \"display\": \"Paracetamol 500mg soluble tablets\"\r\n                                }\r\n                            ]\r\n                        },\r\n                        \"subject\": {\r\n                            \"identifier\": {\r\n                                \"system\": \"https://fhir.nhs.uk/Id/nhs-number\",\r\n                                \"value\": \"9876543210\"\r\n                            }\r\n                        },\r\n                        \"groupIdentifier\": {\r\n                            \"extension\":  [\r\n                                {\r\n                                    \"url\": \"https://fhir.nhs.uk/StructureDefinition/Extension-DM-PrescriptionId\",\r\n                                    \"valueIdentifier\": {\r\n                                        \"system\": \"https://fhir.nhs.uk/Id/prescription\",\r\n                                        \"value\": \"b2fc79f0-2793-4736-9b2d-0976c21e73a5\"\r\n                                    }\r\n                                }\r\n                            ],\r\n                            \"system\": \"https://fhir.nhs.uk/Id/prescription-order-number\",\r\n                            \"value\": \"82D996-C81010-11DB12\"\r\n                        },\r\n                        \"dispenseRequest\": {\r\n                            \"quantity\": {\r\n                                \"value\": 100,\r\n                                \"unit\": \"tablet\",\r\n                                \"system\": \"http://snomed.info/sct\",\r\n                                \"code\": \"732936001\"\r\n                            }\r\n                        },\r\n                        \"substitution\": {\r\n                            \"allowedBoolean\": false\r\n                        }\r\n                    }\r\n                ],\r\n                \"authorizingPrescription\":  [\r\n                    {\r\n                        \"reference\": \"#m1\"\r\n                    }\r\n                ],\r\n```\r\n\r\nThis is based on a `MedicationRequest` in this implementation guide.\r\nThe uuid resource references are not permitted and must be replaced with identifier references. E.g. in this section from the `$release` \r\n\r\n```json\r\n        \"subject\": {\r\n            \"reference\": \"urn:uuid:78d3c2eb-009e-4ec8-a358-b042954aa9b2\"\r\n        },\r\n        \"authoredOn\": \"2020-12-21T18:15:29+00:00\",\r\n        \"requester\": {\r\n            \"reference\": \"urn:uuid:56166769-c1c4-4d07-afa8-132b5dfca666\"\r\n        },\r\n```\r\n\r\nThe requester reference can be removed and the subject reference changed to use the Patient's NHSNumber e.g. \r\n\r\n```json\r\n        \"subject\": {\r\n            \"identifier\": {\r\n            \"system\": \"https://fhir.nhs.uk/Id/nhs-number\",\r\n            \"value\": \"9876543210\"\r\n        }\r\n    },\r\n```",
        "min": 1,
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationRequest-Minimal"
            ],
            "aggregation": [
              "contained",
              "referenced"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "MedicationDispense.authorizingPrescription.reference",
        "path": "MedicationDispense.authorizingPrescription.reference",
        "min": 1
      },
      {
        "id": "MedicationDispense.type",
        "path": "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.\r\n\r\n```json\r\n\"type\": {\r\n    \"coding\": [\r\n        {\r\n            \"system\": \"https://fhir.nhs.uk/CodeSystem/medicationdispense-type\",\r\n            \"code\": \"0001\",\r\n            \"display\": \"Item fully dispensed\"\r\n        }\r\n    ]\r\n}\r\n```",
        "mustSupport": true,
        "binding": {
          "strength": "required",
          "description": "A ValueSet to identify the type of medication item status.",
          "valueSet": "https://fhir.nhs.uk/ValueSet/DM-medicationdispense-type"
        }
      },
      {
        "id": "MedicationDispense.type.coding.system",
        "path": "MedicationDispense.type.coding.system",
        "min": 1
      },
      {
        "id": "MedicationDispense.type.coding.code",
        "path": "MedicationDispense.type.coding.code",
        "min": 1
      },
      {
        "id": "MedicationDispense.quantity",
        "path": "MedicationDispense.quantity",
        "definition": "The amount of medication that has been dispensed. Includes unit of measure.\r\n\r\n```json\r\n\"quantity\": {\r\n    \"value\": 28,\r\n    \"unit\": \"capsule\",\r\n    \"system\": \"http://snomed.info/sct\",\r\n    \"code\": \"3316911000001105\"\r\n}\r\n```\r\n\r\nIf no actual quantity has been dispensed then use a value of zero.",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "MedicationDispense.quantity.extension",
        "path": "MedicationDispense.quantity.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "open"
        },
        "min": 0
      },
      {
        "id": "MedicationDispense.quantity.extension:runningTotal",
        "path": "MedicationDispense.quantity.extension",
        "sliceName": "runningTotal",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.nhs.uk/StructureDefinition/Extension-DM-RunningTotal"
            ]
          }
        ]
      },
      {
        "id": "MedicationDispense.quantity.value",
        "path": "MedicationDispense.quantity.value",
        "min": 1
      },
      {
        "id": "MedicationDispense.quantity.unit",
        "path": "MedicationDispense.quantity.unit",
        "min": 1
      },
      {
        "id": "MedicationDispense.quantity.system",
        "path": "MedicationDispense.quantity.system",
        "min": 1
      },
      {
        "id": "MedicationDispense.quantity.code",
        "path": "MedicationDispense.quantity.code",
        "min": 1
      },
      {
        "id": "MedicationDispense.daysSupply",
        "path": "MedicationDispense.daysSupply",
        "definition": "The amount of medication expressed as a timing amount.\r\n\r\n```json\r\n\"daysSupply\": {\r\n    \"value\": 7,\r\n    \"unit\": \"Day\",\r\n    \"system\": \"http://unitsofmeasure.org\",\r\n    \"code\": \"d\"\r\n}\r\n```",
        "mustSupport": true
      },
      {
        "id": "MedicationDispense.whenPrepared",
        "path": "MedicationDispense.whenPrepared",
        "definition": "The time when the dispensed product was packaged and reviewed.\r\n\r\n```json\r\n\"whenPrepared\": \"2004-09-16T16:30:00+00:00\"\r\n```",
        "mustSupport": true
      },
      {
        "id": "MedicationDispense.whenHandedOver",
        "path": "MedicationDispense.whenHandedOver",
        "definition": "The time the dispensed product was provided to the patient or their representative.\r\nIn HL7 v3 this is: *The date and local time that the medication is issued by the dispenser*.\r\n\r\n```json\r\n\"whenHandedOver\": \"2004-09-16T16:30:00+00:00\"\r\n```",
        "mustSupport": true
      },
      {
        "id": "MedicationDispense.receiver",
        "path": "MedicationDispense.receiver",
        "max": "1"
      },
      {
        "id": "MedicationDispense.dosageInstruction",
        "path": "MedicationDispense.dosageInstruction",
        "definition": "At present only the `text` element **MUST** be provided. It is recommended the guidance in [FHIR Dose Syntax Implementation Guidance](https://developer.nhs.uk/apis/dose-syntax-implementation-1-3-2-alpha/dosage-overview.html) is followed. \r\n\r\nNote the structure of this section is similar as the [NHSDigital-MedicationRequest](https://simplifier.net/resolve?target=simplifier&scope=uk.nhsdigital.r4&canonical=https://fhir.nhs.uk/StructureDefinition/NHSDigital-MedicationRequest) from the `prescription-order`.\r\n\r\n```json\r\n\"dosageInstruction\": [\r\n    {\r\n        \"text\": \"4 times a day for 7 days\",\r\n        \"timing\": {\r\n            \"repeat\": {\r\n                \"boundsDuration\": {\r\n                    \"value\": 7,\r\n                    \"unit\": \"d\"\r\n                },\r\n                \"frequency\": 4,\r\n                \"period\": 1,\r\n                \"periodUnit\": \"d\"\r\n            }\r\n        },\r\n        \"doseAndRate\": [\r\n            {\r\n                \"doseQuantity\": {\r\n                    \"value\": 1,\r\n                    \"unit\": \"capsule\",\r\n                    \"system\": \"http://snomed.info/sct\",\r\n                    \"code\": \"3316911000001105\"\r\n                }\r\n            }\r\n        ]\r\n    }\r\n]\r\n```",
        "type": [
          {
            "code": "Dosage",
            "profile": [
              "https://fhir.nhs.uk/StructureDefinition/NHSDigital-Dosage"
            ]
          }
        ],
        "mustSupport": true
      }
    ]
  }
}