US Core Implementation Guide
6.0.0-ballot - STU6 Ballot US

This page is part of the US Core (v6.0.0-ballot: STU6 Ballot 1) based on FHIR R4. The current version which supercedes this version is 5.0.1. For a full list of available versions, see the Directory of published versions

Resource Profile: US Core MedicationDispense Profile

Official URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationdispense Version: 6.0.0-ballot
Active as of 2022-09-28 Computable Name: USCoreMedicationDispenseProfile

Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

This profile sets minimum expectations for the MedicationDispense resource to record, search, and fetch the “state of a medication with regards to dispensing or other activity. (e.g., dispensed, partially dispensed, not dispensed)” associated with a patient to promote interoperability and adoption through common implementation. It identifies which core elements, extensions, vocabularies, and value sets SHALL be present in the resource when using this profile. It provides the floor for standards development for specific use cases.

This page is new content for US Core Version 6.0.0

Example Usage Scenarios:

The following are example usage scenarios for the US Core-MedicationDispense profile:

  • Fetching dispense statuses for medications that have been prescribed to a particular patient
  • Record or update dispense statuses for medications that have been prescribed for a particular patient

Mandatory and Must Support Data Elements

The following data elements must always be present (Mandatory definition) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements.

Each MedicationDispense must have:

  1. a status (e.g., dispensed, not dispensed)
  2. a medication*
  3. a patient
  4. a date for when dispensed to the patient

* see guidance below

Each MedicationDispense must support:

  1. who dispensed the medication
  2. the authorizing prescription
  3. type of dispense (e.g., partially dispensed)
  4. the quantity dispensed
  5. free text dosage instructions (the SIG)
  6. the dose and rate

Profile specific implementation guidance:

  • The Fill status is often captured at the pharmacy and not communicated back to EHR/HIT. However, to meet ONC’s USCDI requirements, the HIT/EHR system must support this profile.
  • *This Profile can represent a medication using a code or reference a Medication resource.
    • When using a code, RXNorm concepts are used. They are defined as an extensible binding to .medicationCodeableConcept. USCDI V3+ recommends the National Drug Codes (NDC) as an optional terminology. They can be supplied as an additional coding element.
    • When referencing a Medication resource in .medicationReference, the resource may be contained or an external resource.
    • The server systems are not required to support both a code and a reference, but SHALL support at least one of these methods.
    • If an external reference to a Medication resource is used, the server SHALL support the _include parameter for searching this element.
    • The client application SHALL support all methods.

Usage:

  • This Resource Profile is not used by any profiles in this Implementation Guide

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from MedicationDispense

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense 0..*MedicationDispenseDispensing a medication to a named patient
... status S1..1codepreparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
... medication[x] S1..1What medication was supplied
Binding: Medication Clinical Drug (extensible)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(US Core Medication Profile)
... subject S1..1Reference(US Core Patient Profile)Who the dispense is for
... performer S0..*BackboneElementWho performed event
.... actor S1..1Reference(US Core Practitioner Profile S | US Core Patient Profile | US Core Organization Profile S | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device)Individual who was performing
... authorizingPrescription S0..*Reference(US Core MedicationRequest Profile)Medication order that authorizes the dispense
... type S0..1CodeableConceptTrial fill, partial fill, emergency fill, etc.
Binding: ActPharmacySupplyType (extensible)
... quantity S0..1QuantityAmount dispensed
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
... whenHandedOver S1..1dateTimeWhen product was given out
... dosageInstruction S0..*DosageHow the medication is to be used by the patient or administered by the caregiver
.... text S0..1stringFree text dosage instructions e.g. SIG
.... timing S0..1TimingWhen medication should be administered
.... doseAndRate S0..*ElementAmount of medication administered
..... dose[x] S0..1Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
...... doseQuantityQuantity S
...... doseRangeRange

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
MedicationDispense.medication[x]extensibleMedication Clinical Drug
MedicationDispense.typeextensibleActPharmacySupplyType
MedicationDispense.quantitypreferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
MedicationDispense.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense C0..*MedicationDispenseDispensing a medication to a named patient
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... status ?!SΣ1..1codepreparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event.

... medication[x] SΣ1..1What medication was supplied
Binding: Medication Clinical Drug (extensible)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(US Core Medication Profile)
... subject SΣ1..1Reference(US Core Patient Profile)Who the dispense is for
... performer S0..*BackboneElementWho performed event
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... actor S1..1Reference(US Core Practitioner Profile | US Core Organization Profile)Individual who was performing
... authorizingPrescription S0..*Reference(US Core MedicationRequest Profile)Medication order that authorizes the dispense
... type S0..1CodeableConceptTrial fill, partial fill, emergency fill, etc.
Binding: ActPharmacySupplyType (extensible)
... quantity S0..1QuantityAmount dispensed
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
... whenHandedOver S1..1dateTimeWhen product was given out
... dosageInstruction S0..*DosageHow the medication is to be used by the patient or administered by the caregiver
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... text SΣ0..1stringFree text dosage instructions e.g. SIG
.... timing SΣ0..1TimingWhen medication should be administered
.... doseAndRate SΣ0..*ElementAmount of medication administered
..... dose[x] SΣ0..1Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
...... doseQuantityQuantity

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
MedicationDispense.statusrequiredMedicationDispense Status Codes
MedicationDispense.medication[x]extensibleMedication Clinical Drug
MedicationDispense.typeextensibleActPharmacySupplyType
MedicationDispense.quantitypreferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
MedicationDispense.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense C0..*MedicationDispenseDispensing a medication to a named patient
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 0..*IdentifierExternal identifier
... partOf 0..*Reference(Procedure)Event that dispense is part of
... status ?!SΣ1..1codepreparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event.

... statusReason[x] 0..1Why a dispense was not performed
Binding: MedicationDispense Status Reason Codes (example): A code describing why a dispense was not performed.

.... statusReasonCodeableConceptCodeableConcept
.... statusReasonReferenceReference(DetectedIssue)
... category 0..1CodeableConceptType of medication dispense
Binding: MedicationDispense Category Codes (preferred): A code describing where the dispensed medication is expected to be consumed or administered.

... medication[x] SΣ1..1What medication was supplied
Binding: Medication Clinical Drug (extensible)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(US Core Medication Profile)
... subject SΣ1..1Reference(US Core Patient Profile)Who the dispense is for
... context 0..1Reference(Encounter | EpisodeOfCare)Encounter / Episode associated with event
... supportingInformation 0..*Reference(Resource)Information that supports the dispensing of the medication
... performer S0..*BackboneElementWho performed event
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... function 0..1CodeableConceptWho performed the dispense and what they did
Binding: MedicationDispense Performer Function Codes (example): A code describing the role an individual played in dispensing a medication.

.... actor S1..1Reference(US Core Practitioner Profile S | US Core Patient Profile | US Core Organization Profile S | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device)Individual who was performing
... location 0..1Reference(Location)Where the dispense occurred
... authorizingPrescription S0..*Reference(US Core MedicationRequest Profile)Medication order that authorizes the dispense
... type S0..1CodeableConceptTrial fill, partial fill, emergency fill, etc.
Binding: ActPharmacySupplyType (extensible)
... quantity S0..1QuantityAmount dispensed
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
... daysSupply 0..1SimpleQuantityAmount of medication expressed as a timing amount
... whenPrepared Σ0..1dateTimeWhen product was packaged and reviewed
... whenHandedOver S1..1dateTimeWhen product was given out
... destination 0..1Reference(Location)Where the medication was sent
... receiver 0..*Reference(Patient | Practitioner)Who collected the medication
... note 0..*AnnotationInformation about the dispense
... dosageInstruction S0..*DosageHow the medication is to be used by the patient or administered by the caregiver
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence Σ0..1integerThe order of the dosage instructions
.... text SΣ0..1stringFree text dosage instructions e.g. SIG
.... additionalInstruction Σ0..*CodeableConceptSupplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".


.... patientInstruction Σ0..1stringPatient or consumer oriented instructions
.... timing SΣ0..1TimingWhen medication should be administered
.... asNeeded[x] Σ0..1Take "as needed" (for x)
Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): 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.

..... asNeededBooleanboolean
..... asNeededCodeableConceptCodeableConcept
.... site Σ0..1CodeableConceptBody site to administer to
Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.

.... route Σ0..1CodeableConceptHow drug should enter body
Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

.... method Σ0..1CodeableConceptTechnique for administering medication
Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.

.... doseAndRate SΣ0..*ElementAmount of medication administered
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... type Σ0..1CodeableConceptThe kind of dose or rate specified
Binding: DoseAndRateType (example): The kind of dose or rate specified.

..... dose[x] SΣ0..1Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
...... doseQuantityQuantity S
...... doseRangeRange
..... rate[x] Σ0..1Amount of medication per unit of time
...... rateRatioRatio
...... rateRangeRange
...... rateQuantityQuantity(SimpleQuantity)
.... maxDosePerPeriod Σ0..1RatioUpper limit on medication per unit of time
.... maxDosePerAdministration Σ0..1SimpleQuantityUpper limit on medication per administration
.... maxDosePerLifetime Σ0..1SimpleQuantityUpper limit on medication per lifetime of the patient
... substitution 0..1BackboneElementWhether a substitution was performed on the dispense
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... wasSubstituted 1..1booleanWhether a substitution was or was not performed on the dispense
.... type 0..1CodeableConceptCode signifying whether a different drug was dispensed from what was prescribed
Binding: ActSubstanceAdminSubstitutionCode (example): A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription.

.... reason 0..*CodeableConceptWhy was substitution made
Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.


.... responsibleParty 0..*Reference(Practitioner | PractitionerRole)Who is responsible for the substitution
... detectedIssue 0..*Reference(DetectedIssue)Clinical issue with action
... eventHistory 0..*Reference(Provenance)A list of relevant lifecycle events

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
MedicationDispense.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
MedicationDispense.statusrequiredMedicationDispense Status Codes
MedicationDispense.statusReason[x]exampleMedicationDispense Status Reason Codes
MedicationDispense.categorypreferredMedicationDispense Category Codes
MedicationDispense.medication[x]extensibleMedication Clinical Drug
MedicationDispense.performer.functionexampleMedicationDispense Performer Function Codes
MedicationDispense.typeextensibleActPharmacySupplyType
MedicationDispense.quantitypreferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
MedicationDispense.dosageInstruction.additionalInstructionexampleSNOMEDCTAdditionalDosageInstructions
MedicationDispense.dosageInstruction.asNeeded[x]exampleSNOMEDCTMedicationAsNeededReasonCodes
MedicationDispense.dosageInstruction.siteexampleSNOMEDCTAnatomicalStructureForAdministrationSiteCodes
MedicationDispense.dosageInstruction.routeexampleSNOMEDCTRouteCodes
MedicationDispense.dosageInstruction.methodexampleSNOMEDCTAdministrationMethodCodes
MedicationDispense.dosageInstruction.doseAndRate.typeexampleDoseAndRateType
MedicationDispense.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
MedicationDispense.substitution.typeexampleActSubstanceAdminSubstitutionCode
MedicationDispense.substitution.reasonexampleSubstanceAdminSubstitutionReason

Differential View

This structure is derived from MedicationDispense

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense 0..*MedicationDispenseDispensing a medication to a named patient
... status S1..1codepreparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
... medication[x] S1..1What medication was supplied
Binding: Medication Clinical Drug (extensible)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(US Core Medication Profile)
... subject S1..1Reference(US Core Patient Profile)Who the dispense is for
... performer S0..*BackboneElementWho performed event
.... actor S1..1Reference(US Core Practitioner Profile S | US Core Patient Profile | US Core Organization Profile S | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device)Individual who was performing
... authorizingPrescription S0..*Reference(US Core MedicationRequest Profile)Medication order that authorizes the dispense
... type S0..1CodeableConceptTrial fill, partial fill, emergency fill, etc.
Binding: ActPharmacySupplyType (extensible)
... quantity S0..1QuantityAmount dispensed
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
... whenHandedOver S1..1dateTimeWhen product was given out
... dosageInstruction S0..*DosageHow the medication is to be used by the patient or administered by the caregiver
.... text S0..1stringFree text dosage instructions e.g. SIG
.... timing S0..1TimingWhen medication should be administered
.... doseAndRate S0..*ElementAmount of medication administered
..... dose[x] S0..1Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
...... doseQuantityQuantity S
...... doseRangeRange

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
MedicationDispense.medication[x]extensibleMedication Clinical Drug
MedicationDispense.typeextensibleActPharmacySupplyType
MedicationDispense.quantitypreferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
MedicationDispense.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense C0..*MedicationDispenseDispensing a medication to a named patient
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... status ?!SΣ1..1codepreparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event.

... medication[x] SΣ1..1What medication was supplied
Binding: Medication Clinical Drug (extensible)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(US Core Medication Profile)
... subject SΣ1..1Reference(US Core Patient Profile)Who the dispense is for
... performer S0..*BackboneElementWho performed event
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... actor S1..1Reference(US Core Practitioner Profile | US Core Organization Profile)Individual who was performing
... authorizingPrescription S0..*Reference(US Core MedicationRequest Profile)Medication order that authorizes the dispense
... type S0..1CodeableConceptTrial fill, partial fill, emergency fill, etc.
Binding: ActPharmacySupplyType (extensible)
... quantity S0..1QuantityAmount dispensed
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
... whenHandedOver S1..1dateTimeWhen product was given out
... dosageInstruction S0..*DosageHow the medication is to be used by the patient or administered by the caregiver
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... text SΣ0..1stringFree text dosage instructions e.g. SIG
.... timing SΣ0..1TimingWhen medication should be administered
.... doseAndRate SΣ0..*ElementAmount of medication administered
..... dose[x] SΣ0..1Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
...... doseQuantityQuantity

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
MedicationDispense.statusrequiredMedicationDispense Status Codes
MedicationDispense.medication[x]extensibleMedication Clinical Drug
MedicationDispense.typeextensibleActPharmacySupplyType
MedicationDispense.quantitypreferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
MedicationDispense.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense C0..*MedicationDispenseDispensing a medication to a named patient
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 0..*IdentifierExternal identifier
... partOf 0..*Reference(Procedure)Event that dispense is part of
... status ?!SΣ1..1codepreparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event.

... statusReason[x] 0..1Why a dispense was not performed
Binding: MedicationDispense Status Reason Codes (example): A code describing why a dispense was not performed.

.... statusReasonCodeableConceptCodeableConcept
.... statusReasonReferenceReference(DetectedIssue)
... category 0..1CodeableConceptType of medication dispense
Binding: MedicationDispense Category Codes (preferred): A code describing where the dispensed medication is expected to be consumed or administered.

... medication[x] SΣ1..1What medication was supplied
Binding: Medication Clinical Drug (extensible)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(US Core Medication Profile)
... subject SΣ1..1Reference(US Core Patient Profile)Who the dispense is for
... context 0..1Reference(Encounter | EpisodeOfCare)Encounter / Episode associated with event
... supportingInformation 0..*Reference(Resource)Information that supports the dispensing of the medication
... performer S0..*BackboneElementWho performed event
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... function 0..1CodeableConceptWho performed the dispense and what they did
Binding: MedicationDispense Performer Function Codes (example): A code describing the role an individual played in dispensing a medication.

.... actor S1..1Reference(US Core Practitioner Profile S | US Core Patient Profile | US Core Organization Profile S | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device)Individual who was performing
... location 0..1Reference(Location)Where the dispense occurred
... authorizingPrescription S0..*Reference(US Core MedicationRequest Profile)Medication order that authorizes the dispense
... type S0..1CodeableConceptTrial fill, partial fill, emergency fill, etc.
Binding: ActPharmacySupplyType (extensible)
... quantity S0..1QuantityAmount dispensed
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
... daysSupply 0..1SimpleQuantityAmount of medication expressed as a timing amount
... whenPrepared Σ0..1dateTimeWhen product was packaged and reviewed
... whenHandedOver S1..1dateTimeWhen product was given out
... destination 0..1Reference(Location)Where the medication was sent
... receiver 0..*Reference(Patient | Practitioner)Who collected the medication
... note 0..*AnnotationInformation about the dispense
... dosageInstruction S0..*DosageHow the medication is to be used by the patient or administered by the caregiver
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence Σ0..1integerThe order of the dosage instructions
.... text SΣ0..1stringFree text dosage instructions e.g. SIG
.... additionalInstruction Σ0..*CodeableConceptSupplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".


.... patientInstruction Σ0..1stringPatient or consumer oriented instructions
.... timing SΣ0..1TimingWhen medication should be administered
.... asNeeded[x] Σ0..1Take "as needed" (for x)
Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): 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.

..... asNeededBooleanboolean
..... asNeededCodeableConceptCodeableConcept
.... site Σ0..1CodeableConceptBody site to administer to
Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.

.... route Σ0..1CodeableConceptHow drug should enter body
Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

.... method Σ0..1CodeableConceptTechnique for administering medication
Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.

.... doseAndRate SΣ0..*ElementAmount of medication administered
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... type Σ0..1CodeableConceptThe kind of dose or rate specified
Binding: DoseAndRateType (example): The kind of dose or rate specified.

..... dose[x] SΣ0..1Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
...... doseQuantityQuantity S
...... doseRangeRange
..... rate[x] Σ0..1Amount of medication per unit of time
...... rateRatioRatio
...... rateRangeRange
...... rateQuantityQuantity(SimpleQuantity)
.... maxDosePerPeriod Σ0..1RatioUpper limit on medication per unit of time
.... maxDosePerAdministration Σ0..1SimpleQuantityUpper limit on medication per administration
.... maxDosePerLifetime Σ0..1SimpleQuantityUpper limit on medication per lifetime of the patient
... substitution 0..1BackboneElementWhether a substitution was performed on the dispense
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... wasSubstituted 1..1booleanWhether a substitution was or was not performed on the dispense
.... type 0..1CodeableConceptCode signifying whether a different drug was dispensed from what was prescribed
Binding: ActSubstanceAdminSubstitutionCode (example): A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription.

.... reason 0..*CodeableConceptWhy was substitution made
Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.


.... responsibleParty 0..*Reference(Practitioner | PractitionerRole)Who is responsible for the substitution
... detectedIssue 0..*Reference(DetectedIssue)Clinical issue with action
... eventHistory 0..*Reference(Provenance)A list of relevant lifecycle events

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
MedicationDispense.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
MedicationDispense.statusrequiredMedicationDispense Status Codes
MedicationDispense.statusReason[x]exampleMedicationDispense Status Reason Codes
MedicationDispense.categorypreferredMedicationDispense Category Codes
MedicationDispense.medication[x]extensibleMedication Clinical Drug
MedicationDispense.performer.functionexampleMedicationDispense Performer Function Codes
MedicationDispense.typeextensibleActPharmacySupplyType
MedicationDispense.quantitypreferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
MedicationDispense.dosageInstruction.additionalInstructionexampleSNOMEDCTAdditionalDosageInstructions
MedicationDispense.dosageInstruction.asNeeded[x]exampleSNOMEDCTMedicationAsNeededReasonCodes
MedicationDispense.dosageInstruction.siteexampleSNOMEDCTAnatomicalStructureForAdministrationSiteCodes
MedicationDispense.dosageInstruction.routeexampleSNOMEDCTRouteCodes
MedicationDispense.dosageInstruction.methodexampleSNOMEDCTAdministrationMethodCodes
MedicationDispense.dosageInstruction.doseAndRate.typeexampleDoseAndRateType
MedicationDispense.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
MedicationDispense.substitution.typeexampleActSubstanceAdminSubstitutionCode
MedicationDispense.substitution.reasonexampleSubstanceAdminSubstitutionReason

 

Other representations of profile: CSV, Excel, Schematron

Notes:

Quick Start

Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile’s information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

  • The syntax used to describe the interactions is described here.
  • See the General Requirements section for additional rules and expectations when a server requires status parameters.
  • See the General Guidance section for additional guidance on searching for multiple patients.

  1. SHALL support searching using the patient search parameter:

    • including optional support for these _include parameters: MedicationDispense:medication

    GET [base]/MedicationDispense?patient={Type/}[id]

    Example:

    1. GET [base]/MedicationDispense?patient=14676
    2. GET [base]/MedicationStatement?patient=14676&_include=MedicationDispense:medication

    Implementation Notes: Fetches a bundle of all MedicationDispense resources for the specified patient. (how to search by reference)

Optional Search Parameters:

The following search parameter combinations SHOULD be supported:

  1. SHOULD support searching using the combination of the patient and status search parameters:
    • including optional support for these _include parameters: MedicationDispense:medication
    • including support for OR search on status (e.g.status={system|}[code],{system|}[code],...)

    GET [base]/MedicationDispense?patient={Type/}[id]&status={system|}[code]{,{system|}[code],...}

    Example:

    1. GET [base]/MedicationDispense?patient=1137192&status=completed
    2. GET [base]/MedicationDispense?patient=1137192&status=completed&_include=MedicationDispense:medication

    Implementation Notes: Fetches a bundle of all MedicationDispense resources for the specified patient that have a given dispense status (e.g., dispensed, not dispensed)). (how to search by reference and how to search by token)

  2. SHOULD support searching using the combination of the patient and status and type search parameters:
    • including optional support for these _include parameters: MedicationDispense:medication
    • including support for OR search on status (e.g.status={system|}[code],{system|}[code],...)
    • including support for OR search on type (e.g.type={system|}[code],{system|}[code],...)

    GET [base]/MedicationDispense?patient={Type/}[id]&status={system|}[code]{,{system|}[code],...}&type={system|}[code]{,{system|}[code],...}

    Example:

    1. GET [base]/MedicationDispense?patient=1137192&status=&type=
    2. GET [base]/MedicationDispense?patient=1137192&status=&type=FFP&_include=MedicationDispense:medication

    Implementation Notes: Fetches a bundle of all MedicationDispense resources for the specified patient that have a given dispense status (e.g., dispensed, not dispensed) and type of dispense (e.g., partially dispensed). (how to search by reference and how to search by token)