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

* 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. a date for when dispensed to the patient
6. free text dosage instructions (the SIG)
7. the dose and rate

Profile Specific Implementation Guidance:

• The MedicationDispense resource is used to represent the USCDI v3 medication fill status.
• *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.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from MedicationDispense

Name	Flags	Card.	Type	Description & Constraints
MedicationDispense	C	0..*	MedicationDispense	Dispensing a medication to a named patient us-core-20: whenHandedOver SHALL be present if the status is "completed"
status	SC	1..1	code	(USCDI) preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
medication[x]	S	1..1		(USCDI) What medication was supplied Binding: Medication Clinical Drug (extensible)
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(US Core Medication Profile)
subject	S	1..1	Reference(US Core Patient Profile)	(USCDI) Who the dispense is for
performer	S	0..*	BackboneElement	(USCDI) Who performed event
actor	S	1..1	Reference(US Core Practitioner Profile S | US Core Patient Profile | US Core Organization Profile S | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device)	(USCDI) Individual who was performing
authorizingPrescription	S	0..*	Reference(US Core MedicationRequest Profile)	(USCDI) Medication order that authorizes the dispense
type	S	0..1	CodeableConcept	(USCDI) Trial fill, partial fill, emergency fill, etc. Binding: ActPharmacySupplyType (extensible)
quantity	S	0..1	Quantity	(USCDI) Amount dispensed Binding: Common UCUM units (preferred) Additional Bindings Purpose UCUMCodes Max Binding
whenHandedOver	SC	0..1	dateTime	(USCDI) When product was given out or mailed
dosageInstruction	S	0..*	Dosage	(USCDI) How the medication is to be used by the patient or administered by the caregiver
text	S	0..1	string	(USCDI) Free text dosage instructions e.g. SIG
timing	S	0..1	Timing	(USCDI) When medication should be administered
doseAndRate	S	0..*	Element	(USCDI) Amount of medication administered
dose[x]	S	0..1		(USCDI) Amount of medication per dose Binding: Common UCUM units (preferred) Additional Bindings Purpose UCUMCodes Max Binding
doseQuantity			Quantity S
doseRange			Range
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
MedicationDispense.medication[x]	extensible	Medication Clinical Drug
MedicationDispense.type	extensible	ActPharmacySupplyType
MedicationDispense.quantity	preferred	Common UCUM units Additional Bindings Purpose UCUMCodes Max Binding
MedicationDispense.dosageInstruction.doseAndRate.dose[x]	preferred	Common UCUM units Additional Bindings Purpose UCUMCodes Max Binding

Constraints

Id	Grade	Path(s)	Details	Requirements
us-core-20	error	MedicationDispense	whenHandedOver SHALL be present if the status is "completed" : status='completed' implies whenHandedOver.exists()

Name	Flags	Card.	Type	Description & Constraints
MedicationDispense	C	0..*	MedicationDispense	Dispensing a medication to a named patient us-core-20: whenHandedOver SHALL be present if the status is "completed"
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣC	1..1	code	(USCDI) preparation | 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]	SΣ	1..1		(USCDI) What medication was supplied Binding: Medication Clinical Drug (extensible)
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(US Core Medication Profile)
subject	SΣ	1..1	Reference(US Core Patient Profile)	(USCDI) Who the dispense is for
performer	S	0..*	BackboneElement	(USCDI) Who performed event
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
actor	S	1..1	Reference(US Core Practitioner Profile | US Core Organization Profile)	(USCDI) Individual who was performing
authorizingPrescription	S	0..*	Reference(US Core MedicationRequest Profile)	(USCDI) Medication order that authorizes the dispense
type	S	0..1	CodeableConcept	(USCDI) Trial fill, partial fill, emergency fill, etc. Binding: ActPharmacySupplyType (extensible)
quantity	S	0..1	Quantity	(USCDI) Amount dispensed Binding: Common UCUM units (preferred) Additional Bindings Purpose UCUMCodes Max Binding
whenHandedOver	SC	0..1	dateTime	(USCDI) When product was given out or mailed
dosageInstruction	S	0..*	Dosage	(USCDI) How the medication is to be used by the patient or administered by the caregiver
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
text	SΣ	0..1	string	(USCDI) Free text dosage instructions e.g. SIG
timing	SΣ	0..1	Timing	(USCDI) When medication should be administered
doseAndRate	SΣ	0..*	Element	(USCDI) Amount of medication administered
dose[x]	SΣ	0..1		(USCDI) Amount of medication per dose Binding: Common UCUM units (preferred) Additional Bindings Purpose UCUMCodes Max Binding
doseQuantity			Quantity
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
MedicationDispense.status	required	MedicationDispense Status Codes
MedicationDispense.medication[x]	extensible	Medication Clinical Drug
MedicationDispense.type	extensible	ActPharmacySupplyType
MedicationDispense.quantity	preferred	Common UCUM units Additional Bindings Purpose UCUMCodes Max Binding
MedicationDispense.dosageInstruction.doseAndRate.dose[x]	preferred	Common UCUM units Additional Bindings Purpose UCUMCodes Max Binding

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MedicationDispense	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MedicationDispense	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	MedicationDispense	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	MedicationDispense	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MedicationDispense	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
mdd-1	error	MedicationDispense	whenHandedOver cannot be before whenPrepared : whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared
us-core-20	error	MedicationDispense	whenHandedOver SHALL be present if the status is "completed" : status='completed' implies whenHandedOver.exists()

Name	Flags	Card.	Type	Description & Constraints
MedicationDispense	C	0..*	MedicationDispense	Dispensing a medication to a named patient us-core-20: whenHandedOver SHALL be present if the status is "completed"
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		0..*	Identifier	External identifier
partOf		0..*	Reference(Procedure)	Event that dispense is part of
status	?!SΣC	1..1	code	(USCDI) preparation | 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..1		Why a dispense was not performed Binding: MedicationDispense Status Reason Codes (example): A code describing why a dispense was not performed.
statusReasonCodeableConcept			CodeableConcept
statusReasonReference			Reference(DetectedIssue)
category		0..1	CodeableConcept	Type of medication dispense Binding: MedicationDispense Category Codes (preferred): A code describing where the dispensed medication is expected to be consumed or administered.
medication[x]	SΣ	1..1		(USCDI) What medication was supplied Binding: Medication Clinical Drug (extensible)
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(US Core Medication Profile)
subject	SΣ	1..1	Reference(US Core Patient Profile)	(USCDI) Who the dispense is for
context		0..1	Reference(Encounter | EpisodeOfCare)	Encounter / Episode associated with event
supportingInformation		0..*	Reference(Resource)	Information that supports the dispensing of the medication
performer	S	0..*	BackboneElement	(USCDI) Who performed event
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
function		0..1	CodeableConcept	Who 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	S	1..1	Reference(US Core Practitioner Profile S | US Core Patient Profile | US Core Organization Profile S | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device)	(USCDI) Individual who was performing
location		0..1	Reference(Location)	Where the dispense occurred
authorizingPrescription	S	0..*	Reference(US Core MedicationRequest Profile)	(USCDI) Medication order that authorizes the dispense
type	S	0..1	CodeableConcept	(USCDI) Trial fill, partial fill, emergency fill, etc. Binding: ActPharmacySupplyType (extensible)
quantity	S	0..1	Quantity	(USCDI) Amount dispensed Binding: Common UCUM units (preferred) Additional Bindings Purpose UCUMCodes Max Binding
daysSupply		0..1	SimpleQuantity	Amount of medication expressed as a timing amount
whenPrepared	Σ	0..1	dateTime	When product was packaged and reviewed
whenHandedOver	SC	0..1	dateTime	(USCDI) When product was given out or mailed
destination		0..1	Reference(Location)	Where the medication was sent
receiver		0..*	Reference(Patient | Practitioner)	Who collected the medication
note		0..*	Annotation	Information about the dispense
dosageInstruction	S	0..*	Dosage	(USCDI) How the medication is to be used by the patient or administered by the caregiver
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	Σ	0..1	integer	The order of the dosage instructions
text	SΣ	0..1	string	(USCDI) Free text dosage instructions e.g. SIG
additionalInstruction	Σ	0..*	CodeableConcept	Supplemental 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	Σ	0..1	string	Patient or consumer oriented instructions
timing	SΣ	0..1	Timing	(USCDI) When medication should be administered
asNeeded[x]	Σ	0..1		Take "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.
asNeededBoolean			boolean
asNeededCodeableConcept			CodeableConcept
site	Σ	0..1	CodeableConcept	Body site to administer to Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.
route	Σ	0..1	CodeableConcept	How 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	Σ	0..1	CodeableConcept	Technique for administering medication Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.
doseAndRate	SΣ	0..*	Element	(USCDI) Amount of medication administered
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
type	Σ	0..1	CodeableConcept	The kind of dose or rate specified Binding: DoseAndRateType (example): The kind of dose or rate specified.
dose[x]	SΣ	0..1		(USCDI) Amount of medication per dose Binding: Common UCUM units (preferred) Additional Bindings Purpose UCUMCodes Max Binding
doseQuantity			Quantity S
doseRange			Range
rate[x]	Σ	0..1		Amount of medication per unit of time
rateRatio			Ratio
rateRange			Range
rateQuantity			Quantity(SimpleQuantity)
maxDosePerPeriod	Σ	0..1	Ratio	Upper limit on medication per unit of time
maxDosePerAdministration	Σ	0..1	SimpleQuantity	Upper limit on medication per administration
maxDosePerLifetime	Σ	0..1	SimpleQuantity	Upper limit on medication per lifetime of the patient
substitution		0..1	BackboneElement	Whether a substitution was performed on the dispense
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
wasSubstituted		1..1	boolean	Whether a substitution was or was not performed on the dispense
type		0..1	CodeableConcept	Code 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..*	CodeableConcept	Why 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
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
MedicationDispense.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
MedicationDispense.status	required	MedicationDispense Status Codes
MedicationDispense.statusReason[x]	example	MedicationDispense Status Reason Codes
MedicationDispense.category	preferred	MedicationDispense Category Codes
MedicationDispense.medication[x]	extensible	Medication Clinical Drug
MedicationDispense.performer.function	example	MedicationDispense Performer Function Codes
MedicationDispense.type	extensible	ActPharmacySupplyType
MedicationDispense.quantity	preferred	Common UCUM units Additional Bindings Purpose UCUMCodes Max Binding
MedicationDispense.dosageInstruction.additionalInstruction	example	SNOMEDCTAdditionalDosageInstructions
MedicationDispense.dosageInstruction.asNeeded[x]	example	SNOMEDCTMedicationAsNeededReasonCodes
MedicationDispense.dosageInstruction.site	example	SNOMEDCTAnatomicalStructureForAdministrationSiteCodes
MedicationDispense.dosageInstruction.route	example	SNOMEDCTRouteCodes
MedicationDispense.dosageInstruction.method	example	SNOMEDCTAdministrationMethodCodes
MedicationDispense.dosageInstruction.doseAndRate.type	example	DoseAndRateType
MedicationDispense.dosageInstruction.doseAndRate.dose[x]	preferred	Common UCUM units Additional Bindings Purpose UCUMCodes Max Binding
MedicationDispense.substitution.type	example	ActSubstanceAdminSubstitutionCode
MedicationDispense.substitution.reason	example	SubstanceAdminSubstitutionReason

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Differential View

This structure is derived from MedicationDispense

Name	Flags	Card.	Type	Description & Constraints
MedicationDispense	C	0..*	MedicationDispense	Dispensing a medication to a named patient us-core-20: whenHandedOver SHALL be present if the status is "completed"
status	SC	1..1	code	(USCDI) preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
medication[x]	S	1..1		(USCDI) What medication was supplied Binding: Medication Clinical Drug (extensible)
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(US Core Medication Profile)
subject	S	1..1	Reference(US Core Patient Profile)	(USCDI) Who the dispense is for
performer	S	0..*	BackboneElement	(USCDI) Who performed event
actor	S	1..1	Reference(US Core Practitioner Profile S | US Core Patient Profile | US Core Organization Profile S | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device)	(USCDI) Individual who was performing
authorizingPrescription	S	0..*	Reference(US Core MedicationRequest Profile)	(USCDI) Medication order that authorizes the dispense
type	S	0..1	CodeableConcept	(USCDI) Trial fill, partial fill, emergency fill, etc. Binding: ActPharmacySupplyType (extensible)
quantity	S	0..1	Quantity	(USCDI) Amount dispensed Binding: Common UCUM units (preferred) Additional Bindings Purpose UCUMCodes Max Binding
whenHandedOver	SC	0..1	dateTime	(USCDI) When product was given out or mailed
dosageInstruction	S	0..*	Dosage	(USCDI) How the medication is to be used by the patient or administered by the caregiver
text	S	0..1	string	(USCDI) Free text dosage instructions e.g. SIG
timing	S	0..1	Timing	(USCDI) When medication should be administered
doseAndRate	S	0..*	Element	(USCDI) Amount of medication administered
dose[x]	S	0..1		(USCDI) Amount of medication per dose Binding: Common UCUM units (preferred) Additional Bindings Purpose UCUMCodes Max Binding
doseQuantity			Quantity S
doseRange			Range
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
MedicationDispense.medication[x]	extensible	Medication Clinical Drug
MedicationDispense.type	extensible	ActPharmacySupplyType
MedicationDispense.quantity	preferred	Common UCUM units Additional Bindings Purpose UCUMCodes Max Binding
MedicationDispense.dosageInstruction.doseAndRate.dose[x]	preferred	Common UCUM units Additional Bindings Purpose UCUMCodes Max Binding

Constraints

Id	Grade	Path(s)	Details	Requirements
us-core-20	error	MedicationDispense	whenHandedOver SHALL be present if the status is "completed" : status='completed' implies whenHandedOver.exists()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
MedicationDispense	C	0..*	MedicationDispense	Dispensing a medication to a named patient us-core-20: whenHandedOver SHALL be present if the status is "completed"
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣC	1..1	code	(USCDI) preparation | 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]	SΣ	1..1		(USCDI) What medication was supplied Binding: Medication Clinical Drug (extensible)
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(US Core Medication Profile)
subject	SΣ	1..1	Reference(US Core Patient Profile)	(USCDI) Who the dispense is for
performer	S	0..*	BackboneElement	(USCDI) Who performed event
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
actor	S	1..1	Reference(US Core Practitioner Profile | US Core Organization Profile)	(USCDI) Individual who was performing
authorizingPrescription	S	0..*	Reference(US Core MedicationRequest Profile)	(USCDI) Medication order that authorizes the dispense
type	S	0..1	CodeableConcept	(USCDI) Trial fill, partial fill, emergency fill, etc. Binding: ActPharmacySupplyType (extensible)
quantity	S	0..1	Quantity	(USCDI) Amount dispensed Binding: Common UCUM units (preferred) Additional Bindings Purpose UCUMCodes Max Binding
whenHandedOver	SC	0..1	dateTime	(USCDI) When product was given out or mailed
dosageInstruction	S	0..*	Dosage	(USCDI) How the medication is to be used by the patient or administered by the caregiver
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
text	SΣ	0..1	string	(USCDI) Free text dosage instructions e.g. SIG
timing	SΣ	0..1	Timing	(USCDI) When medication should be administered
doseAndRate	SΣ	0..*	Element	(USCDI) Amount of medication administered
dose[x]	SΣ	0..1		(USCDI) Amount of medication per dose Binding: Common UCUM units (preferred) Additional Bindings Purpose UCUMCodes Max Binding
doseQuantity			Quantity
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
MedicationDispense.status	required	MedicationDispense Status Codes
MedicationDispense.medication[x]	extensible	Medication Clinical Drug
MedicationDispense.type	extensible	ActPharmacySupplyType
MedicationDispense.quantity	preferred	Common UCUM units Additional Bindings Purpose UCUMCodes Max Binding
MedicationDispense.dosageInstruction.doseAndRate.dose[x]	preferred	Common UCUM units Additional Bindings Purpose UCUMCodes Max Binding

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MedicationDispense	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MedicationDispense	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	MedicationDispense	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	MedicationDispense	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MedicationDispense	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
mdd-1	error	MedicationDispense	whenHandedOver cannot be before whenPrepared : whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared
us-core-20	error	MedicationDispense	whenHandedOver SHALL be present if the status is "completed" : status='completed' implies whenHandedOver.exists()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
MedicationDispense	C	0..*	MedicationDispense	Dispensing a medication to a named patient us-core-20: whenHandedOver SHALL be present if the status is "completed"
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		0..*	Identifier	External identifier
partOf		0..*	Reference(Procedure)	Event that dispense is part of
status	?!SΣC	1..1	code	(USCDI) preparation | 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..1		Why a dispense was not performed Binding: MedicationDispense Status Reason Codes (example): A code describing why a dispense was not performed.
statusReasonCodeableConcept			CodeableConcept
statusReasonReference			Reference(DetectedIssue)
category		0..1	CodeableConcept	Type of medication dispense Binding: MedicationDispense Category Codes (preferred): A code describing where the dispensed medication is expected to be consumed or administered.
medication[x]	SΣ	1..1		(USCDI) What medication was supplied Binding: Medication Clinical Drug (extensible)
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(US Core Medication Profile)
subject	SΣ	1..1	Reference(US Core Patient Profile)	(USCDI) Who the dispense is for
context		0..1	Reference(Encounter | EpisodeOfCare)	Encounter / Episode associated with event
supportingInformation		0..*	Reference(Resource)	Information that supports the dispensing of the medication
performer	S	0..*	BackboneElement	(USCDI) Who performed event
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
function		0..1	CodeableConcept	Who 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	S	1..1	Reference(US Core Practitioner Profile S | US Core Patient Profile | US Core Organization Profile S | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device)	(USCDI) Individual who was performing
location		0..1	Reference(Location)	Where the dispense occurred
authorizingPrescription	S	0..*	Reference(US Core MedicationRequest Profile)	(USCDI) Medication order that authorizes the dispense
type	S	0..1	CodeableConcept	(USCDI) Trial fill, partial fill, emergency fill, etc. Binding: ActPharmacySupplyType (extensible)
quantity	S	0..1	Quantity	(USCDI) Amount dispensed Binding: Common UCUM units (preferred) Additional Bindings Purpose UCUMCodes Max Binding
daysSupply		0..1	SimpleQuantity	Amount of medication expressed as a timing amount
whenPrepared	Σ	0..1	dateTime	When product was packaged and reviewed
whenHandedOver	SC	0..1	dateTime	(USCDI) When product was given out or mailed
destination		0..1	Reference(Location)	Where the medication was sent
receiver		0..*	Reference(Patient | Practitioner)	Who collected the medication
note		0..*	Annotation	Information about the dispense
dosageInstruction	S	0..*	Dosage	(USCDI) How the medication is to be used by the patient or administered by the caregiver
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	Σ	0..1	integer	The order of the dosage instructions
text	SΣ	0..1	string	(USCDI) Free text dosage instructions e.g. SIG
additionalInstruction	Σ	0..*	CodeableConcept	Supplemental 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	Σ	0..1	string	Patient or consumer oriented instructions
timing	SΣ	0..1	Timing	(USCDI) When medication should be administered
asNeeded[x]	Σ	0..1		Take "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.
asNeededBoolean			boolean
asNeededCodeableConcept			CodeableConcept
site	Σ	0..1	CodeableConcept	Body site to administer to Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.
route	Σ	0..1	CodeableConcept	How 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	Σ	0..1	CodeableConcept	Technique for administering medication Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.
doseAndRate	SΣ	0..*	Element	(USCDI) Amount of medication administered
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
type	Σ	0..1	CodeableConcept	The kind of dose or rate specified Binding: DoseAndRateType (example): The kind of dose or rate specified.
dose[x]	SΣ	0..1		(USCDI) Amount of medication per dose Binding: Common UCUM units (preferred) Additional Bindings Purpose UCUMCodes Max Binding
doseQuantity			Quantity S
doseRange			Range
rate[x]	Σ	0..1		Amount of medication per unit of time
rateRatio			Ratio
rateRange			Range
rateQuantity			Quantity(SimpleQuantity)
maxDosePerPeriod	Σ	0..1	Ratio	Upper limit on medication per unit of time
maxDosePerAdministration	Σ	0..1	SimpleQuantity	Upper limit on medication per administration
maxDosePerLifetime	Σ	0..1	SimpleQuantity	Upper limit on medication per lifetime of the patient
substitution		0..1	BackboneElement	Whether a substitution was performed on the dispense
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
wasSubstituted		1..1	boolean	Whether a substitution was or was not performed on the dispense
type		0..1	CodeableConcept	Code 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..*	CodeableConcept	Why 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
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
MedicationDispense.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
MedicationDispense.status	required	MedicationDispense Status Codes
MedicationDispense.statusReason[x]	example	MedicationDispense Status Reason Codes
MedicationDispense.category	preferred	MedicationDispense Category Codes
MedicationDispense.medication[x]	extensible	Medication Clinical Drug
MedicationDispense.performer.function	example	MedicationDispense Performer Function Codes
MedicationDispense.type	extensible	ActPharmacySupplyType
MedicationDispense.quantity	preferred	Common UCUM units Additional Bindings Purpose UCUMCodes Max Binding
MedicationDispense.dosageInstruction.additionalInstruction	example	SNOMEDCTAdditionalDosageInstructions
MedicationDispense.dosageInstruction.asNeeded[x]	example	SNOMEDCTMedicationAsNeededReasonCodes
MedicationDispense.dosageInstruction.site	example	SNOMEDCTAnatomicalStructureForAdministrationSiteCodes
MedicationDispense.dosageInstruction.route	example	SNOMEDCTRouteCodes
MedicationDispense.dosageInstruction.method	example	SNOMEDCTAdministrationMethodCodes
MedicationDispense.dosageInstruction.doseAndRate.type	example	DoseAndRateType
MedicationDispense.dosageInstruction.doseAndRate.dose[x]	preferred	Common UCUM units Additional Bindings Purpose UCUMCodes Max Binding
MedicationDispense.substitution.type	example	ActSubstanceAdminSubstitutionCode
MedicationDispense.substitution.reason	example	SubstanceAdminSubstitutionReason

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from MedicationDispense

Summary

Mandatory: 1 element
Must-Support: 14 elements

Structures

This structure refers to these other structures:

• US Core Medication Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication)
• US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)
• US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner)
• US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)
• US Core PractitionerRole Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole)
• US Core RelatedPerson Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson)
• US Core MedicationRequest Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest)

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.

• Servers providing access to dispensed medication data can use US Core SMART Scopes for:
  • resource level scopes (for example, patient/MedicationDispense.rs).
• 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.

Mandatory Search Parameters:

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)