{ "resourceType": "StructureDefinition", "id": "MedicationDispense", "meta": { "lastUpdated": "2021-01-01T21:58:31.578+00:00" }, "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-category", "valueString": "Clinical.Medications" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode": "trial-use" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm", "valueInteger": 2 }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-security-category", "valueCode": "patient" }, { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg", "valueCode": "phx" }, { "url": "http://hl7.org/fhir/build/StructureDefinition/entered-in-error-status", "valueCode": ".status = entered-in-error" } ], "url": "http://hl7.org/fhir/StructureDefinition/MedicationDispense", "version": "4.6.0", "name": "MedicationDispense", "status": "draft", "date": "2021-01-01T21:58:31+00:00", "publisher": "Health Level Seven International (Pharmacy)", "contact": [ { "telecom": [ { "system": "url", "value": "http://hl7.org/fhir" } ] }, { "telecom": [ { "system": "url", "value": "http://www.hl7.org/Special/committees/medication/index.cfm" } ] } ], "description": "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.", "fhirVersion": "4.6.0", "mapping": [ { "identity": "workflow", "uri": "http://hl7.org/fhir/workflow", "name": "Workflow Pattern" }, { "identity": "rim", "uri": "http://hl7.org/v3", "name": "RIM Mapping" }, { "identity": "w5", "uri": "http://hl7.org/fhir/fivews", "name": "FiveWs Pattern Mapping" }, { "identity": "rx-dispense-rmim", "uri": "http://www.hl7.org/v3/PORX_RM020070UV", "name": "V3 Pharmacy Dispense RMIM" }, { "identity": "v2", "uri": "http://hl7.org/v2", "name": "HL7 v2 Mapping" } ], "kind": "resource", "abstract": false, "type": "MedicationDispense", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/DomainResource", "derivation": "specialization", "differential": { "element": [ { "id": "MedicationDispense", "extension": [ { "url": "http://hl7.org/fhir/build/StructureDefinition/committee-notes", "valueString": "Need to add confidentiality." } ], "path": "MedicationDispense", "short": "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.", "min": 0, "max": "*", "constraint": [ { "key": "mdd-1", "severity": "error", "human": "whenHandedOver cannot be before whenPrepared", "expression": "whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared", "xpath": "not(exists(f:whenHandedOver/@value)) or not(exists(f:whenPrepared/@value)) or ( f:whenHandedOver/@value >= f:whenPrepared/@value)", "source": "http://hl7.org/fhir/StructureDefinition/MedicationDispense" } ], "mapping": [ { "identity": "workflow", "map": "Event" }, { "identity": "rim", "map": "Supply[moodCode=EVN]" }, { "identity": "w5", "map": "clinical.medication" } ] }, { "id": "MedicationDispense.identifier", "path": "MedicationDispense.identifier", "short": "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.", "comment": "This is a business identifier, not a resource identifier.", "min": 0, "max": "*", "type": [ { "code": "Identifier" } ], "mapping": [ { "identity": "workflow", "map": "Event.identifier" }, { "identity": "w5", "map": "FiveWs.identifier" }, { "identity": "rim", "map": ".id" }, { "identity": "rx-dispense-rmim", "map": "CombinedMedicationDispense.id" } ] }, { "id": "MedicationDispense.basedOn", "path": "MedicationDispense.basedOn", "short": "Plan that is fulfilled by this dispense", "definition": "A plan that is fulfilled in whole or in part by this MedicationDispense.", "min": 0, "max": "*", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/CarePlan" ] } ], "mapping": [ { "identity": "rim", "map": ".outboundRelationship[typeCode=FLFS].target" } ] }, { "id": "MedicationDispense.partOf", "path": "MedicationDispense.partOf", "short": "Event that dispense is part of", "definition": "The procedure or medication administration that triggered the dispense.", "comment": "While both a procedure and a medication administration may have triggered the dispense, but it is not expected that multiple procedures and/or multiple medication administrations would be triggers.", "min": 0, "max": "*", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Procedure", "http://hl7.org/fhir/StructureDefinition/MedicationAdministration" ] } ], "mapping": [ { "identity": "workflow", "map": "Event.partOf" }, { "identity": "rim", "map": ".outboundRelationship[typeCode=COMP]/target[classCode=PROC,moodCode=EVN]" } ] }, { "id": "MedicationDispense.status", "extension": [ { "url": "http://hl7.org/fhir/build/StructureDefinition/committee-notes", "valueString": "Active - processed but not pickup Completed - process and pickup Aborted - process and put back in stock This is not related to partialFill whioch is really a partialFulfillment of the order." } ], "path": "MedicationDispense.status", "short": "preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown", "definition": "A code specifying the state of the set of dispense events.", "comment": "This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.", "min": 1, "max": "1", "type": [ { "code": "code" } ], "isModifier": true, "isModifierReason": "This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid", "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "MedicationDispenseStatus" }, { "url": "http://hl7.org/fhir/build/StructureDefinition/definition", "valueString": "A coded concept specifying the state of the dispense event." }, { "url": "http://hl7.org/fhir/build/StructureDefinition/v3-map", "valueString": "ActStatus" } ], "strength": "required", "description": "Describes the lifecycle of the dispense.", "valueSet": "http://hl7.org/fhir/ValueSet/medicationdispense-status" }, "mapping": [ { "identity": "workflow", "map": "Event.status" }, { "identity": "w5", "map": "FiveWs.status" }, { "identity": "rim", "map": ".statusCode" }, { "identity": "rx-dispense-rmim", "map": "CombinedMedicationDispense.SupplyEvent.statusCode" } ] }, { "id": "MedicationDispense.notPerformedReason", "path": "MedicationDispense.notPerformedReason", "short": "Why a dispense was not performed", "definition": "Indicates the reason why a dispense was not performed.", "min": 0, "max": "1", "type": [ { "code": "CodeableReference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/DetectedIssue" ] } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "MedicationDispenseStatusReason" } ], "strength": "example", "valueSet": "http://hl7.org/fhir/ValueSet/medicationdispense-status-reason" } }, { "id": "MedicationDispense.statusChanged", "path": "MedicationDispense.statusChanged", "short": "When the status changed", "definition": "The date (and maybe time) when the status of the dispense record changed.", "min": 0, "max": "1", "type": [ { "code": "dateTime" } ], "mapping": [ { "identity": "rim", "map": ".subjectOf Observation[code = statusChange].value = date" } ] }, { "id": "MedicationDispense.category", "path": "MedicationDispense.category", "short": "Type of medication dispense", "definition": "Indicates the type of medication dispense (for example, drug classification like ATC, where meds would be administered, legal category of the medication.).", "comment": "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.", "min": 0, "max": "*", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "MedicationDispenseAdminLocation" } ], "strength": "example", "description": "A code describing where the dispensed medication is expected to be consumed or administered.", "valueSet": "http://hl7.org/fhir/ValueSet/medicationdispense-admin-location" }, "mapping": [ { "identity": "rim", "map": ".inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code=\"type of medication dispense\"].value" } ] }, { "id": "MedicationDispense.medication", "path": "MedicationDispense.medication", "short": "What medication was supplied", "definition": "Identifies the medication supplied. 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.", "comment": "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.", "min": 1, "max": "1", "type": [ { "code": "CodeableReference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Medication" ] } ], "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "MedicationCode" } ], "strength": "example", "description": "A coded concept identifying which substance or product can be dispensed.", "valueSet": "http://hl7.org/fhir/ValueSet/medication-codes" }, "mapping": [ { "identity": "workflow", "map": "Event.code" }, { "identity": "w5", "map": "FiveWs.what[x]" }, { "identity": "v2", "map": "RXD-2-Dispense/Give Code" }, { "identity": "rim", "map": ".participation[typeCode=PRD].role" }, { "identity": "rx-dispense-rmim", "map": "CombinedMedicationRequest.component1.AdministrationRequest.consumable" } ] }, { "id": "MedicationDispense.subject", "path": "MedicationDispense.subject", "short": "Who the dispense is for", "definition": "A link to a resource representing the person or the group to whom the medication will be given.", "comment": "SubstanceAdministration->subject->Patient.", "min": 1, "max": "1", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Patient", "http://hl7.org/fhir/StructureDefinition/Group" ] } ], "isSummary": true, "mapping": [ { "identity": "workflow", "map": "Event.subject" }, { "identity": "w5", "map": "FiveWs.subject[x]" }, { "identity": "v2", "map": "PID-3-Patient ID List" }, { "identity": "rim", "map": ".participation[typeCode=SBJ].role[classCode=PAT]" }, { "identity": "w5", "map": "FiveWs.subject" } ] }, { "id": "MedicationDispense.encounter", "path": "MedicationDispense.encounter", "short": "Encounter associated with event", "definition": "The encounter that establishes the context for this event.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Encounter" ] } ], "mapping": [ { "identity": "workflow", "map": "Event.context" }, { "identity": "rim", "map": ".inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code=\"type of encounter or episode\"]" } ] }, { "id": "MedicationDispense.supportingInformation", "path": "MedicationDispense.supportingInformation", "short": "Information that supports the dispensing of the medication", "definition": "Additional information that supports the medication being dispensed. For example, there may be requirements that a specific lab test has been completed prior to dispensing or the patient's weight at the time of dispensing is documented.", "min": 0, "max": "*", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Resource" ] } ], "mapping": [ { "identity": "w5", "map": "FiveWs.context" }, { "identity": "rim", "map": ".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)]" } ] }, { "id": "MedicationDispense.performer", "path": "MedicationDispense.performer", "short": "Who performed event", "definition": "Indicates who or what performed the event.", "min": 0, "max": "*", "type": [ { "code": "BackboneElement" } ], "mapping": [ { "identity": "workflow", "map": "Event.performer" }, { "identity": "rim", "map": ".participation[typeCode=PRF]" } ] }, { "id": "MedicationDispense.performer.function", "path": "MedicationDispense.performer.function", "short": "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.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "MedicationDispensePerformerFunction" } ], "strength": "example", "description": "A code describing the role an individual played in dispensing a medication.", "valueSet": "http://hl7.org/fhir/ValueSet/medicationdispense-performer-function" }, "mapping": [ { "identity": "rim", "map": "participation[typeCode=PRF].functionCode" } ] }, { "id": "MedicationDispense.performer.actor", "path": "MedicationDispense.performer.actor", "short": "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.", "min": 1, "max": "1", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/PractitionerRole", "http://hl7.org/fhir/StructureDefinition/Organization", "http://hl7.org/fhir/StructureDefinition/Patient", "http://hl7.org/fhir/StructureDefinition/Device", "http://hl7.org/fhir/StructureDefinition/RelatedPerson", "http://hl7.org/fhir/StructureDefinition/CareTeam" ] } ], "mapping": [ { "identity": "workflow", "map": "Event.performer.actor" }, { "identity": "rim", "map": ".role" } ] }, { "id": "MedicationDispense.location", "path": "MedicationDispense.location", "short": "Where the dispense occurred", "definition": "The principal physical location where the dispense was performed.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Location" ] } ], "mapping": [ { "identity": "rim", "map": ".participation[typeCode=LOC].role" } ] }, { "id": "MedicationDispense.authorizingPrescription", "path": "MedicationDispense.authorizingPrescription", "short": "Medication order that authorizes the dispense", "definition": "Indicates the medication order that is being dispensed against.", "comment": "Maps to basedOn in Event logical model.", "min": 0, "max": "*", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/MedicationRequest" ] } ], "mapping": [ { "identity": "workflow", "map": "Event.basedOn" }, { "identity": "v2", "map": "ORC-2 Placer Order Number" }, { "identity": "rim", "map": ".outboundRelationship[typeCode=FLFS].target[moodCode=RQO]" }, { "identity": "rx-dispense-rmim", "map": "CombinedMedicationDispense.inFulfillmentOf" } ] }, { "id": "MedicationDispense.type", "path": "MedicationDispense.type", "short": "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.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "MedicationDispenseType" }, { "url": "http://hl7.org/fhir/build/StructureDefinition/definition", "valueString": "Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc." } ], "strength": "example", "description": "ActPharmacySupplyType", "valueSet": "http://terminology.hl7.org/ValueSet/v3-ActPharmacySupplyType" }, "mapping": [ { "identity": "v2", "map": "RXD-33-Dispense Type" }, { "identity": "rim", "map": ".code" }, { "identity": "rx-dispense-rmim", "map": "CombinedMedicationDispense.SupplyEvent.code" } ] }, { "id": "MedicationDispense.quantity", "path": "MedicationDispense.quantity", "short": "Amount dispensed", "definition": "The amount of medication that has been dispensed. Includes unit of measure.", "min": 0, "max": "1", "type": [ { "code": "Quantity", "profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ] } ], "mapping": [ { "identity": "v2", "map": "RXD-4-Actual Dispense Amount / RXD-5.1-Actual Dispense Units.code / RXD-5.3-Actual Dispense Units.name of coding system" }, { "identity": "rim", "map": ".quantity" }, { "identity": "rx-dispense-rmim", "map": "CombinedMedicationDispense.SupplyEvent.quantity" } ] }, { "id": "MedicationDispense.daysSupply", "path": "MedicationDispense.daysSupply", "short": "Amount of medication expressed as a timing amount", "definition": "The amount of medication expressed as a timing amount.", "min": 0, "max": "1", "type": [ { "code": "Quantity", "profile": [ "http://hl7.org/fhir/StructureDefinition/SimpleQuantity" ] } ], "mapping": [ { "identity": "v2", "map": "TQ1.6 Timing/Quantity Segment Service Duration.\rPrior 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”\rFrom v2.5 on, TQ1.6 Timing/Quantity Segment / Service Duration. This is a CQ data type ( ^ ), thus for days supply, assuming the unit of measure is “days”, the numeric value is TQ1.6.1 (…|14^\rFor 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" }, { "identity": "rim", "map": "effectiveUseTime" } ] }, { "id": "MedicationDispense.recorded", "path": "MedicationDispense.recorded", "short": "When the recording of the dispense started", "definition": "The date (and maybe time) when the dispense activity started if whenPrepared or whenHandedOver is not populated.", "min": 0, "max": "1", "type": [ { "code": "dateTime" } ], "mapping": [ { "identity": "rim", "map": ".MedicationDispense.dataEnterer..time" } ] }, { "id": "MedicationDispense.whenPrepared", "extension": [ { "url": "http://hl7.org/fhir/build/StructureDefinition/committee-notes", "valueString": "This is time of dispense (preparation). The time of supply to the patient is a separate attribute." } ], "path": "MedicationDispense.whenPrepared", "short": "When product was packaged and reviewed", "definition": "The time when the dispensed product was packaged and reviewed.", "min": 0, "max": "1", "type": [ { "code": "dateTime" } ], "isSummary": true, "mapping": [ { "identity": "v2", "map": "RXD-3-Date/Time Dispensed" }, { "identity": "rim", "map": ".effectiveTime[xmi:type=IVL_TS].low" }, { "identity": "rx-dispense-rmim", "map": "CombinedMedicationDispense.SupplyEvent.effectiveTime" } ] }, { "id": "MedicationDispense.whenHandedOver", "extension": [ { "url": "http://hl7.org/fhir/build/StructureDefinition/committee-notes", "valueString": "The time of supply to the patient (pickup/handover in community or supply in inpatient)." } ], "path": "MedicationDispense.whenHandedOver", "short": "When product was given out", "definition": "The time the dispensed product was provided to the patient or their representative.", "min": 0, "max": "1", "type": [ { "code": "dateTime" } ], "mapping": [ { "identity": "workflow", "map": "Event.occurrence[x]" }, { "identity": "v2", "map": "RXD-3-Date/Time Dispensed" }, { "identity": "rim", "map": ".effectiveTime[xmi:type=IVL_TS].high" }, { "identity": "rx-dispense-rmim", "map": "CombinedMedicationDispense.SupplyEvent.effectiveTime" } ] }, { "id": "MedicationDispense.destination", "extension": [ { "url": "http://hl7.org/fhir/build/StructureDefinition/committee-notes", "valueString": "for inpatient setting this is core, but this might not be core for community setting. Also core for internet pharmacy. Core for radioactive materials Will service delivery location be defined by another group?" } ], "path": "MedicationDispense.destination", "short": "Where the medication was sent", "definition": "Identification of the facility/location where the medication was shipped to, as part of the dispense event.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Location" ] } ], "mapping": [ { "identity": "v2", "map": "RXD-13 Dispense-to Location; RXD-30 Dispense to Pharmacy; RXD-31 Dispense to Pharmacy Address" }, { "identity": "rim", "map": ".participation[typeCode=DST].role" }, { "identity": "rx-dispense-rmim", "map": "CombinedMedicationDispense.SupplyEvent.destination" } ] }, { "id": "MedicationDispense.receiver", "extension": [ { "url": "http://hl7.org/fhir/build/StructureDefinition/committee-notes", "valueString": "This is in the core because Controlled Drugs must be signed for and the recievers identiy must be recorded." } ], "path": "MedicationDispense.receiver", "short": "Who collected the medication or where the medication was delivered", "definition": "Identifies the person who picked up the medication or the location of where the medication was delivered. This will usually be a patient or their caregiver, but some cases exist where it can be a healthcare professional or a location.", "min": 0, "max": "*", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Patient", "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/RelatedPerson", "http://hl7.org/fhir/StructureDefinition/Location", "http://hl7.org/fhir/StructureDefinition/PractitionerRole" ] } ], "mapping": [ { "identity": "rim", "map": ".participation[typeCode=RCV].role" }, { "identity": "rx-dispense-rmim", "map": "CombinedMedicationDispense.SupplyEvent.receiver" } ] }, { "id": "MedicationDispense.note", "path": "MedicationDispense.note", "short": "Information about the dispense", "definition": "Extra information about the dispense that could not be conveyed in the other attributes.", "min": 0, "max": "*", "type": [ { "code": "Annotation" } ], "mapping": [ { "identity": "workflow", "map": "Event.note" }, { "identity": "v2", "map": "RXD-9 Dispense Notes" }, { "identity": "rim", "map": ".inboundRelationship[typeCode=SUBJ]/source[classCode=ACT,moodCode=EVN]" } ] }, { "id": "MedicationDispense.renderedDosageInstruction", "path": "MedicationDispense.renderedDosageInstruction", "short": "Full representation of the dosage instructions", "definition": "The full representation of the dose of the medication included in all dosage instructions. To be used when multiple dosage instructions are included to represent complex dosing such as increasing or tapering doses.", "comment": "The content of the renderedDosageInstructions must not be different than the dose represented in the dosageInstruction content.", "min": 0, "max": "1", "type": [ { "code": "string" } ], "mapping": [ { "identity": "rim", "map": "SubstanceAdministration.text" } ] }, { "id": "MedicationDispense.dosageInstruction", "extension": [ { "url": "http://hl7.org/fhir/build/StructureDefinition/committee-notes", "valueString": "The RMIM has priority code on the act relationship. How do we handle this?" }, { "url": "http://hl7.org/fhir/build/StructureDefinition/uml-dir", "valueCode": "right" } ], "path": "MedicationDispense.dosageInstruction", "short": "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.", "comment": "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.\rThe pharmacist reviews the medication order prior to dispense and updates the dosageInstruction based on the actual product being dispensed.", "min": 0, "max": "*", "type": [ { "code": "Dosage" } ], "mapping": [ { "identity": "rim", "map": ".outboundRelationship[typeCode=COMP].target[classCode=SBADM, moodCode=INT]" } ] }, { "id": "MedicationDispense.substitution", "extension": [ { "url": "http://hl7.org/fhir/build/StructureDefinition/committee-notes", "valueString": "Significant discssion around this topic. Might not have it right yet. What about the attribution?" }, { "url": "http://hl7.org/fhir/build/StructureDefinition/uml-dir", "valueCode": "right" } ], "path": "MedicationDispense.substitution", "short": "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.", "min": 0, "max": "1", "type": [ { "code": "BackboneElement" } ], "mapping": [ { "identity": "rim", "map": ".outboundRelationship[typeCode=COMP].target[classCode=SUBST, moodCode=EVN]" }, { "identity": "rx-dispense-rmim", "map": "CombinedMedicationDispense.substitutionMade" } ] }, { "id": "MedicationDispense.substitution.wasSubstituted", "path": "MedicationDispense.substitution.wasSubstituted", "short": "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.", "min": 1, "max": "1", "type": [ { "code": "boolean" } ], "mapping": [ { "identity": "rim", "map": ".actionNegationInd" } ] }, { "id": "MedicationDispense.substitution.type", "extension": [ { "url": "http://hl7.org/fhir/build/StructureDefinition/committee-notes", "valueString": "No substitution made or expected Subtitution made but not expected Substitution expected but not made Substitution made and expected." } ], "path": "MedicationDispense.substitution.type", "short": "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.", "min": 0, "max": "1", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "MedicationIntendedSubstitutionType" }, { "url": "http://hl7.org/fhir/build/StructureDefinition/definition", "valueString": "A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription." } ], "strength": "example", "description": "ActSubstanceAdminSubstitutionCode", "valueSet": "http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode" }, "mapping": [ { "identity": "v2", "map": "RXO-9-Allow Substitutions / RXE-9-Substitution Status" }, { "identity": "rim", "map": ".code" }, { "identity": "rx-dispense-rmim", "map": "CombinedMedicationDispense.substitutionMade.code" } ] }, { "id": "MedicationDispense.substitution.reason", "path": "MedicationDispense.substitution.reason", "short": "Why was substitution made", "definition": "Indicates the reason for the substitution (or lack of substitution) from what was prescribed.", "min": 0, "max": "*", "type": [ { "code": "CodeableConcept" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "MedicationIntendedSubstitutionReason" }, { "url": "http://hl7.org/fhir/build/StructureDefinition/definition", "valueString": "A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed." } ], "strength": "example", "description": "SubstanceAdminSubstitutionReason", "valueSet": "http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason" }, "mapping": [ { "identity": "rim", "map": ".reasonCode" }, { "identity": "rx-dispense-rmim", "map": "CombinedMedicationDispense.substitutionMade.reasonCode" } ] }, { "id": "MedicationDispense.substitution.responsibleParty", "path": "MedicationDispense.substitution.responsibleParty", "short": "Who is responsible for the substitution", "definition": "The person or organization that has primary responsibility for the substitution.", "min": 0, "max": "1", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/PractitionerRole", "http://hl7.org/fhir/StructureDefinition/Organization" ] } ], "mapping": [ { "identity": "rim", "map": ".participation[typeCode=PFM].role[classCode=ASSIGN]" }, { "identity": "rx-dispense-rmim", "map": "CombinedMedicationDispense.substitutionMade.ResponsibleParty" } ] }, { "id": "MedicationDispense.eventHistory", "path": "MedicationDispense.eventHistory", "short": "A list of relevant lifecycle events", "definition": "A summary of the events of interest that have occurred, such as when the dispense was verified.", "comment": "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.).", "min": 0, "max": "*", "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Provenance" ] } ], "mapping": [ { "identity": "rim", "map": ".inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]" } ] } ] } }