This page is part of the Da Vinci Payer Data Exchange (v2.1.0-ballot: STU2.1 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions

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: ExampleMedicationDispenseClaim - XML Representation

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<MedicationDispense xmlns="http://hl7.org/fhir">
  <id value="1000001"/>
  <meta>
    <versionId value="1"/>
    <lastUpdated value="2024-04-17T15:26:23.217+00:00"/>
    <profile
             value="http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-medicationdispense"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: MedicationDispense 1000001</b></p><a name="1000001"> </a><a name="hc1000001"> </a><a name="1000001-en-US"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">version: 1; Last updated: 2024-04-17 15:26:23+0000</p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-pdex-medicationdispense.html">PDex MedicationDispense</a></p></div><p><b>status</b>: Completed</p><p><b>medication</b>: <span title="Codes:{http://hl7.org/fhir/sid/ndc 54458-872-10}">Lisinopril, 30 TABLET in 1 BLISTER PACK (54458-872-10) (package)</span></p><p><b>subject</b>: <a href="Patient-1.html">Johnny Appleseed  Male, DoB: 1986-01-01 ( Member Number)</a></p><h3>Performers</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Actor</b></td></tr><tr><td style="display: none">*</td><td><a href="Practitioner-4.html">Practitioner Susan Smith </a></td></tr></table><p><b>location</b>: <a href="Location-5.html">Location MyFavorite Pharmacy</a></p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode RF}">Refill</span></p><p><b>quantity</b>: 60</p><p><b>daysSupply</b>: 30</p><p><b>whenHandedOver</b>: 2024-04-15 09:00:23+0000</p></div>
  </text>
  <extension
             url="http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/DispenseRefill">
    <valueQuantity>
      <value value="1"/>
    </valueQuantity>
  </extension>
  <status value="completed"/>
  <medicationCodeableConcept>
    <coding>
      <system value="http://hl7.org/fhir/sid/ndc"/>
      <code value="54458-872-10"/>
    </coding>
  </medicationCodeableConcept>
  <subject>🔗 
    <reference value="Patient/1"/>
  </subject>
  <performer>
    <actor>🔗 
      <reference value="Practitioner/4"/>
    </actor>
  </performer>
  <location>🔗 
    <reference value="Location/5"/>
  </location>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <code value="RF"/>
    </coding>
  </type>
  <quantity>
    <value value="60"/>
  </quantity>
  <daysSupply>
    <value value="30"/>
  </daysSupply>
  <whenHandedOver value="2024-04-15T09:00:23.217+00:00"/>
</MedicationDispense>