STU 3 Candidate

This page is part of the FHIR Specification (v1.4.0: STU 3 Ballot 3). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

4.26.7 Resource MedicationDispense - Detailed Descriptions

Detailed Descriptions for the elements in the MedicationDispense resource.

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.

Control1..1
Summarytrue
InvariantsDefined on this element
mdd-1: 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))
MedicationDispense.identifier
Definition

Identifier assigned by the dispensing facility - this is an identifier assigned outside FHIR.

NoteThis is a business identifer, not a resource identifier (see discussion)
Control0..1
TypeIdentifier
Summarytrue
MedicationDispense.status
Definition

A code specifying the state of the set of dispense events.

Control0..1
BindingMedicationDispenseStatus: A code specifying the state of the dispense event. (Required)
Typecode
Is Modifiertrue
Summarytrue
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.

Control1..1
TypeCodeableConcept|Reference(Medication)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
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. Note: do not use Medication.name to describe the dispensed medication. When the only available information is a text description of the medication, Medication.code.text should be used.

MedicationDispense.patient
Definition

A link to a resource representing the person to whom the medication will be given.

Control0..1
TypeReference(Patient)
Summarytrue
Comments

SubstanceAdministration->subject->Patient.

MedicationDispense.dispenser
Definition

The individual responsible for dispensing the medication.

Control0..1
TypeReference(Practitioner)
Summarytrue
MedicationDispense.authorizingPrescription
Definition

Indicates the medication order that is being dispensed against.

Control0..*
TypeReference(MedicationOrder)
Summarytrue
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.

Control0..1
BindingActPharmacySupplyType: Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc. (Example)
TypeCodeableConcept
Summarytrue
MedicationDispense.quantity
Definition

The amount of medication that has been dispensed. Includes unit of measure.

Control0..1
TypeSimpleQuantity
Summarytrue
MedicationDispense.daysSupply
Definition

The amount of medication expressed as a timing amount.

Control0..1
TypeSimpleQuantity
Summarytrue
MedicationDispense.whenPrepared
Definition

The time when the dispensed product was packaged and reviewed.

Control0..1
TypedateTime
Summarytrue
MedicationDispense.whenHandedOver
Definition

The time the dispensed product was provided to the patient or their representative.

Control0..1
TypedateTime
Summarytrue
MedicationDispense.destination
Definition

Identification of the facility/location where the medication was shipped to, as part of the dispense event.

Control0..1
TypeReference(Location)
Summarytrue
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.

Control0..*
TypeReference(Patient | Practitioner)
Summarytrue
MedicationDispense.note
Definition

Extra information about the dispense that could not be conveyed in the other attributes.

Control0..*
TypeAnnotation
Summarytrue
MedicationDispense.dosageInstruction
Definition

Indicates how the medication is to be used by the patient. The pharmacist reviews the medication order prior to dispense and updates the dosageInstruction based on the actual product being dispensed.

Control0..*
Summarytrue
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.

MedicationDispense.dosageInstruction.text
Definition

Free text dosage instructions can be used for cases where the instructions are too complex to code. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication.

Control0..1
Typestring
Summarytrue
MedicationDispense.dosageInstruction.additionalInstructions
Definition

Additional instructions such as "Swallow with plenty of water" which may or may not be coded.

Control0..1
BindingAdditionalInstructions: Codes identifying additional instructions such as "take with water" or "avoid operating heavy machinery"
TypeCodeableConcept
Summarytrue
MedicationDispense.dosageInstruction.timing
Definition

The timing schedule for giving the medication to the patient. The Schedule data type allows many different expressions. For example, "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013".

Control0..1
TypeTiming
Summarytrue
MedicationDispense.dosageInstruction.asNeeded[x]
Definition

Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept).

Specifically if 'boolean' datatype is selected, then the following logic applies: If set to True, this indicates that the medication is only taken when needed, within the specified schedule.

Control0..1
BindingMedicationAsNeededReason: A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.
Typeboolean|CodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
MedicationDispense.dosageInstruction.site[x]
Definition

A coded specification of the anatomic site where the medication first enters the body.

Control0..1
BindingSNOMED CT Anatomical Structure for Administration Site Codes: A coded concept describing the site location the medicine enters into or onto the body (Example)
TypeCodeableConcept|Reference(BodySite)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
MedicationDispense.dosageInstruction.route
Definition

A code specifying the route or physiological path of administration of a therapeutic agent into or onto a subject.

Control0..1
BindingSNOMED CT Route Codes: A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject (Example)
TypeCodeableConcept
Summarytrue
MedicationDispense.dosageInstruction.method
Definition

A coded value indicating the method by which the medication is intended to be or was introduced into or on the body.

Control0..1
BindingMedicationAdministrationMethod: A coded concept describing the technique by which the medicine is administered
TypeCodeableConcept
Summarytrue
Comments

This attribute will most often NOT be populated. It is most commonly used for injections. For example, Slow Push, Deep IV. One of the reasons this attribute is not used often, is that the method is often pre-coordinated with the route and/or form of administration. This means the codes used in route or form may pre-coordinate the method in the route code or the form code. The implementation decision about what coding system to use for route or form code will determine how frequently the method code will be populated e.g. if route or form code pre-coordinate method code, then this attribute will not be populated often; if there is no pre-coordination then method code may be used frequently.

MedicationDispense.dosageInstruction.dose[x]
Definition

The amount of therapeutic or other substance given at one administration event.

Control0..1
TypeRange|SimpleQuantity
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
Comments

Note that this specifies the quantity of the specified medication, not the quantity of active ingredient(s). The prescribed strength can be calculated by multiplying the doseQuantity by the strength of each active ingredient in the prescribed Medication. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule.

MedicationDispense.dosageInstruction.rate[x]
Definition

Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Currently we do not specify a default of '1' in the denominator, but this is being discussed. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours.

Control0..1
TypeRatio|Range
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
MedicationDispense.dosageInstruction.maxDosePerPeriod
Definition

The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time, e.g. 1000mg in 24 hours.

Control0..1
TypeRatio
Summarytrue
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.

Control0..1
Summarytrue
MedicationDispense.substitution.type
Definition

A code signifying whether a different drug was dispensed from what was prescribed.

Control1..1
BindingActSubstanceAdminSubstitutionCode: A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription (Example)
TypeCodeableConcept
Summarytrue
MedicationDispense.substitution.reason
Definition

Indicates the reason for the substitution of (or lack of substitution) from what was prescribed.

Control0..*
BindingSubstanceAdminSubstitutionReason: A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed (Example)
TypeCodeableConcept
Summarytrue
MedicationDispense.substitution.responsibleParty
Definition

The person or organization that has primary responsibility for the substitution.

Control0..*
TypeReference(Practitioner)
Summarytrue