Da Vinci Payer Data Exchange
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This page is part of the Da Vinci Payer Data Exchange (v2.0.0: STU2) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

: ExampleMedicationDispenseClaim - XML Representation

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<MedicationDispense xmlns="http://hl7.org/fhir">
  <id value="1000001"/>
  <meta>
    <versionId value="1"/>
    <lastUpdated value="2020-07-09T15:26:23.217+00:00"/>
    <profile
             value="http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-medicationdispense"/>
  </meta>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: MedicationDispense</b><a name="1000001"> </a></p><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">Resource MedicationDispense &quot;1000001&quot; Version &quot;1&quot; Updated &quot;2020-07-09 15:26:23+0000&quot; </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-pdex-medicationdispense.html">PDex MedicationDispense</a></p></div><p><b>An attribute to express the refill number of a prescription</b>: 1</p><p><b>status</b>: completed</p><p><b>medication</b>: Lisinopril, 30 TABLET in 1 BLISTER PACK (54458-872-10) (package) <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-v3-ndc.html">National drug codes</a>#54458-872-10)</span></p><p><b>subject</b>: <a href="Patient-1.html">Patient/1</a> &quot; APPLESEED&quot;</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/4</a> &quot; SMITH&quot;</td></tr></table><p><b>location</b>: <a href="Location-5.html">Location/5</a> &quot;MyFavorite Pharmacy&quot;</p><p><b>type</b>: Refill <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-v3-ActCode.html">ActCode</a>#RF)</span></p><p><b>quantity</b>: 60</p><p><b>daysSupply</b>: 30</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>
</MedicationDispense>