This page is part of the Quality Improvement Core Framework (v6.0.0-ballot: STU6 (v6.0.0) Ballot 1) based on FHIR R4. The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions

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Resource Profile: QICore MedicationDispense Declined

Negation profile of MedicationDispense for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.

define "Dementia Medication Not Dispensed":
    ["MedicationDispenseNotDone": "Dementia Medications"] MedicationDispense
      where MedicationDispense.statusReason in "Medical Reason"
        or MedicationDispense.statusReason in "Patient Refusal"

Usage:

• Examples for this Resource Profile: MedicationDispense/negation-example and MedicationDispense/negation-with-code-example

Formal Views of Profile Content

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

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

This structure is derived from USCoreMedicationDispenseProfile

Name	Flags	Card.	Type	Description & Constraints
MedicationDispense	C	0..*	USCoreMedicationDispenseProfile	Dispensing a medication to a named patient mnd-1: To indicate what medication was not dispensed, either at least one coding in the medication or a notDoneValueSet extension shall be provided
recorded	S	1..1	dateTime	Extension URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-recorded
status	S	1..1	code	(USCDI) preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown Binding: MedicationDispense Status Codes (required) Fixed Value: declined
statusReason[x]	S	1..1	CodeableConcept	Why a dispense was not performed Binding: QICore Negation Reason Codes (extensible): The reason the event did not occur or was not performed
medication[x]	S	1..1	CodeableConcept, Reference(US Core Medication Profile)	(USCDI) What medication was supplied Binding: Medication Clinical Drug (extensible): The set of RxNorm codes to represent medications
notDoneValueSet	S	0..1	canonical(ValueSet)	Url of a value set of activities not requested or performed URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
subject	S	1..1	Reference(QICore Patient)	(USCDI) Who the dispense is for
authorizingPrescription		0..*	Reference(QICore MedicationRequest)	(USCDI) Medication order that authorizes the dispense
dosageInstruction		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
route		0..1	CodeableConcept	How drug should enter body Binding: SNOMEDCTRouteCodes (preferred)
doseAndRate	S	0..*	Element	(USCDI) Amount of medication administered
type	S	1..1	CodeableConcept	The kind of dose or rate specified Binding: QICore SNOMED CT Dosage Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)
dose[x]	S	0..1	Quantity S, Range	(USCDI) Amount of medication per dose
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet / Code
MedicationDispense.status	required	Fixed Value: declined
MedicationDispense.statusReason[x]	extensible	NegationReasonCodes
MedicationDispense.medication[x]	extensible	Medication Clinical Drug
MedicationDispense.dosageInstruction.route	preferred	SNOMEDCTRouteCodes
MedicationDispense.dosageInstruction.doseAndRate.type	preferred	QICoreMedicationDoseType

Constraints

Id	Grade	Path(s)	Details	Requirements
mnd-1	error	MedicationDispense	To indicate what medication was not dispensed, either at least one coding in the medication or a notDoneValueSet extension shall be provided : medication.extension('http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet').exists() xor medication.coding.exists()

Name	Flags	Card.	Type	Description & Constraints
MedicationDispense	C	0..*	USCoreMedicationDispenseProfile	Dispensing a medication to a named patient mnd-1: To indicate what medication was not dispensed, either at least one coding in the medication or a notDoneValueSet extension shall be provided
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
recorded	S	1..1	dateTime	Extension URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-recorded
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) Fixed Value: declined
statusReason[x]	S	1..1	CodeableConcept	Why a dispense was not performed Binding: QICore Negation Reason Codes (extensible): The reason the event did not occur or was not performed
medication[x]	SΣ	1..1		(USCDI) What medication was supplied Binding: Medication Clinical Drug (extensible): The set of RxNorm codes to represent medications
medication[x]:All Types				Content/Rules for all Types
notDoneValueSet	S	0..1	canonical(ValueSet)	Url of a value set of activities not requested or performed URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(US Core Medication Profile)
subject	SΣ	1..1	Reference(QICore Patient)	(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(QICore MedicationRequest)	(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
route	Σ	0..1	CodeableConcept	How drug should enter body Binding: SNOMEDCTRouteCodes (preferred)
doseAndRate	SΣ	0..*	Element	(USCDI) Amount of medication administered
type	SΣ	1..1	CodeableConcept	The kind of dose or rate specified Binding: QICore SNOMED CT Dosage Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)
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 / Code
MedicationDispense.status	required	Fixed Value: declined
MedicationDispense.statusReason[x]	extensible	NegationReasonCodes
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.route	preferred	SNOMEDCTRouteCodes
MedicationDispense.dosageInstruction.doseAndRate.type	preferred	QICoreMedicationDoseType
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
mnd-1	error	MedicationDispense	To indicate what medication was not dispensed, either at least one coding in the medication or a notDoneValueSet extension shall be provided : medication.extension('http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet').exists() xor medication.coding.exists()
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..*	USCoreMedicationDispenseProfile	Dispensing a medication to a named patient mnd-1: To indicate what medication was not dispensed, either at least one coding in the medication or a notDoneValueSet extension shall be provided
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
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
recorded	S	1..1	dateTime	Extension URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-recorded
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) Fixed Value: declined
statusReason[x]	S	1..1	CodeableConcept	Why a dispense was not performed Binding: QICore Negation Reason Codes (extensible): The reason the event did not occur or was not performed
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): The set of RxNorm codes to represent medications
medication[x]:All Types				Content/Rules for all Types
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
notDoneValueSet	S	0..1	canonical(ValueSet)	Url of a value set of activities not requested or performed URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(US Core Medication Profile)
subject	SΣ	1..1	Reference(QICore Patient)	(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(QICore MedicationRequest)	(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 (preferred)
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	SΣ	1..1	CodeableConcept	The kind of dose or rate specified Binding: QICore SNOMED CT Dosage Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)
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 / Code
MedicationDispense.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
MedicationDispense.status	required	Fixed Value: declined
MedicationDispense.statusReason[x]	extensible	NegationReasonCodes
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	preferred	SNOMEDCTRouteCodes
MedicationDispense.dosageInstruction.method	example	SNOMEDCTAdministrationMethodCodes
MedicationDispense.dosageInstruction.doseAndRate.type	preferred	QICoreMedicationDoseType
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 USCoreMedicationDispenseProfile

Summary

Mandatory: 2 elements (1 nested mandatory element)
Must-Support: 11 elements
Fixed Value: 1 element

Structures

This structure refers to these other structures:

• QICore Patient (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient)
• QICore MedicationRequest (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-recorded
• http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet

Differential View

This structure is derived from USCoreMedicationDispenseProfile

Name	Flags	Card.	Type	Description & Constraints
MedicationDispense	C	0..*	USCoreMedicationDispenseProfile	Dispensing a medication to a named patient mnd-1: To indicate what medication was not dispensed, either at least one coding in the medication or a notDoneValueSet extension shall be provided
recorded	S	1..1	dateTime	Extension URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-recorded
status	S	1..1	code	(USCDI) preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown Binding: MedicationDispense Status Codes (required) Fixed Value: declined
statusReason[x]	S	1..1	CodeableConcept	Why a dispense was not performed Binding: QICore Negation Reason Codes (extensible): The reason the event did not occur or was not performed
medication[x]	S	1..1	CodeableConcept, Reference(US Core Medication Profile)	(USCDI) What medication was supplied Binding: Medication Clinical Drug (extensible): The set of RxNorm codes to represent medications
notDoneValueSet	S	0..1	canonical(ValueSet)	Url of a value set of activities not requested or performed URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
subject	S	1..1	Reference(QICore Patient)	(USCDI) Who the dispense is for
authorizingPrescription		0..*	Reference(QICore MedicationRequest)	(USCDI) Medication order that authorizes the dispense
dosageInstruction		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
route		0..1	CodeableConcept	How drug should enter body Binding: SNOMEDCTRouteCodes (preferred)
doseAndRate	S	0..*	Element	(USCDI) Amount of medication administered
type	S	1..1	CodeableConcept	The kind of dose or rate specified Binding: QICore SNOMED CT Dosage Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)
dose[x]	S	0..1	Quantity S, Range	(USCDI) Amount of medication per dose
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet / Code
MedicationDispense.status	required	Fixed Value: declined
MedicationDispense.statusReason[x]	extensible	NegationReasonCodes
MedicationDispense.medication[x]	extensible	Medication Clinical Drug
MedicationDispense.dosageInstruction.route	preferred	SNOMEDCTRouteCodes
MedicationDispense.dosageInstruction.doseAndRate.type	preferred	QICoreMedicationDoseType

Constraints

Id	Grade	Path(s)	Details	Requirements
mnd-1	error	MedicationDispense	To indicate what medication was not dispensed, either at least one coding in the medication or a notDoneValueSet extension shall be provided : medication.extension('http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet').exists() xor medication.coding.exists()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
MedicationDispense	C	0..*	USCoreMedicationDispenseProfile	Dispensing a medication to a named patient mnd-1: To indicate what medication was not dispensed, either at least one coding in the medication or a notDoneValueSet extension shall be provided
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
recorded	S	1..1	dateTime	Extension URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-recorded
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) Fixed Value: declined
statusReason[x]	S	1..1	CodeableConcept	Why a dispense was not performed Binding: QICore Negation Reason Codes (extensible): The reason the event did not occur or was not performed
medication[x]	SΣ	1..1		(USCDI) What medication was supplied Binding: Medication Clinical Drug (extensible): The set of RxNorm codes to represent medications
medication[x]:All Types				Content/Rules for all Types
notDoneValueSet	S	0..1	canonical(ValueSet)	Url of a value set of activities not requested or performed URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(US Core Medication Profile)
subject	SΣ	1..1	Reference(QICore Patient)	(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(QICore MedicationRequest)	(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
route	Σ	0..1	CodeableConcept	How drug should enter body Binding: SNOMEDCTRouteCodes (preferred)
doseAndRate	SΣ	0..*	Element	(USCDI) Amount of medication administered
type	SΣ	1..1	CodeableConcept	The kind of dose or rate specified Binding: QICore SNOMED CT Dosage Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)
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 / Code
MedicationDispense.status	required	Fixed Value: declined
MedicationDispense.statusReason[x]	extensible	NegationReasonCodes
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.route	preferred	SNOMEDCTRouteCodes
MedicationDispense.dosageInstruction.doseAndRate.type	preferred	QICoreMedicationDoseType
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
mnd-1	error	MedicationDispense	To indicate what medication was not dispensed, either at least one coding in the medication or a notDoneValueSet extension shall be provided : medication.extension('http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet').exists() xor medication.coding.exists()
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..*	USCoreMedicationDispenseProfile	Dispensing a medication to a named patient mnd-1: To indicate what medication was not dispensed, either at least one coding in the medication or a notDoneValueSet extension shall be provided
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
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
recorded	S	1..1	dateTime	Extension URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-recorded
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) Fixed Value: declined
statusReason[x]	S	1..1	CodeableConcept	Why a dispense was not performed Binding: QICore Negation Reason Codes (extensible): The reason the event did not occur or was not performed
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): The set of RxNorm codes to represent medications
medication[x]:All Types				Content/Rules for all Types
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
notDoneValueSet	S	0..1	canonical(ValueSet)	Url of a value set of activities not requested or performed URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(US Core Medication Profile)
subject	SΣ	1..1	Reference(QICore Patient)	(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(QICore MedicationRequest)	(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 (preferred)
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	SΣ	1..1	CodeableConcept	The kind of dose or rate specified Binding: QICore SNOMED CT Dosage Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)
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 / Code
MedicationDispense.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
MedicationDispense.status	required	Fixed Value: declined
MedicationDispense.statusReason[x]	extensible	NegationReasonCodes
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	preferred	SNOMEDCTRouteCodes
MedicationDispense.dosageInstruction.method	example	SNOMEDCTAdministrationMethodCodes
MedicationDispense.dosageInstruction.doseAndRate.type	preferred	QICoreMedicationDoseType
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 USCoreMedicationDispenseProfile

Summary

Mandatory: 2 elements (1 nested mandatory element)
Must-Support: 11 elements
Fixed Value: 1 element

Structures

This structure refers to these other structures:

• QICore Patient (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient)
• QICore MedicationRequest (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-recorded
• http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet

Other representations of profile: CSV, Excel, Schematron