QI-Core Implementation Guide: STU 4 (v4.0.0 for FHIR 4.0.1)

QI-Core Implementation Guide - This is the current published version.. See the Directory of published versions

D.4.1 StructureDefinition-qicore-medicationdispense

Introduction:

To create an expression specifically requesting information that a MedicationDispense intentionally did not occur for a medical, patient or system reason, use the profile QICore-medicationnotdispensed.


// connectathon/fhir4/cql/AdvancedIllnessandFrailtyExclusion_FHIR4-4.0.000.cql
define "Dementia Medications Dispensed":
  ["MedicationDispense": "Dementia Medications"] MedicationDispense
    where MedicationDispense.status in { 'active', 'completed', 'on-hold' }

See the patterns page for implementation and usage patterns.

Examples:

Penicillin MedicationDispense Example

D.4.1.1 Formal Views of Profile Content

The official URL for this profile is: 

http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationdispense

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

This profile builds on MedicationDispense.

This profile was published on Wed Aug 22 00:00:00 UTC 2018 as a draft by Health Level Seven, Inc. - CQI WG.

Description of Profiles, Differentials, and Snapshots.

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense I0..*MedicationDispenseDispensing a medication to a named patient
... id Σ0..1stringLogical id of this artifact
... meta ΣI0..1MetaMetadata about the resource
... implicitRules ?!ΣI0..1uriA set of rules under which this content was created
... language I0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension I0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!I0..*ExtensionExtensions that cannot be ignored
... identifier I0..*IdentifierExternal identifier
... partOf I0..*Reference(Procedure)Event that dispense is part of
... status ?!SΣI1..1codepreparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
Binding: MedicationDispense Status Codes (required)
... statusReason[x] SI0..1Why a dispense was not performed
Binding: MedicationDispense Status Reason Codes (example)
.... statusReasonCodeableConceptCodeableConcept
.... statusReasonReferenceReference(DetectedIssue)
... category I0..1CodeableConceptType of medication dispense
Binding: MedicationDispense Category Codes (preferred)
... medication[x] SΣI1..1What medication was supplied
Binding: US Core Medication Codes (RxNorm) (preferred)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(Medication)
... subject SΣI0..1Reference(QICorePatient)Who the dispense is for
... context I0..1Reference(Encounter | EpisodeOfCare)Encounter / Episode associated with event
... supportingInformation I0..*Reference(Resource)Information that supports the dispensing of the medication
... performer I0..*BackboneElementWho performed event
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... function I0..1CodeableConceptWho performed the dispense and what they did
Binding: MedicationDispense Performer Function Codes (example)
.... actor I1..1Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson)Individual who was performing
... location I0..1Reference(Location)Where the dispense occurred
... authorizingPrescription I0..*Reference(QICoreMedicationRequest)Medication order that authorizes the dispense
... type I0..1CodeableConceptTrial fill, partial fill, emergency fill, etc.
Binding: V3 Value SetActPharmacySupplyType (example)
... quantity SI0..1SimpleQuantityAmount dispensed
... daysSupply SI0..1SimpleQuantityAmount of medication expressed as a timing amount
... whenPrepared ΣI0..1dateTimeWhen product was packaged and reviewed
... whenHandedOver SI0..1dateTimeWhen product was given out
... destination I0..1Reference(QICoreLocation)Where the medication was sent
... receiver I0..*Reference(QICorePatient | QICorePractitioner)Who collected the medication
... note I0..*AnnotationInformation about the dispense
... dosageInstruction I0..*DosageHow the medication is to be used by the patient or administered by the caregiver
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence ΣI0..1integerThe order of the dosage instructions
.... text ΣI0..1stringFree text dosage instructions e.g. SIG
.... additionalInstruction ΣI0..*CodeableConceptSupplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
Binding: SNOMEDCTAdditionalDosageInstructions (example)
.... patientInstruction ΣI0..1stringPatient or consumer oriented instructions
.... timing SΣI0..1TimingWhen medication should be administered
.... asNeeded[x] ΣI0..1Take "as needed" (for x)
Binding: SNOMEDCTMedicationAsNeededReasonCodes (example)
..... asNeededBooleanboolean
..... asNeededCodeableConceptCodeableConcept
.... site ΣI0..1CodeableConceptBody site to administer to
Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example)
.... route SΣI0..1CodeableConceptHow drug should enter body
Binding: SNOMEDCTRouteCodes (example)
.... method ΣI0..1CodeableConceptTechnique for administering medication
Binding: SNOMEDCTAdministrationMethodCodes (example)
.... doseAndRate SΣI0..*ElementAmount of medication administered
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... type SΣI1..1CodeableConceptThe kind of dose or rate specified
Binding: SNOMED CT Dosages Codes (preferred)
..... dose[x] SΣI0..1Amount of medication per dose
...... doseRangeRange
...... doseQuantityQuantity(SimpleQuantity)
..... rate[x] ΣI0..1Amount of medication per unit of time
...... rateRatioRatio
...... rateRangeRange
...... rateQuantityQuantity(SimpleQuantity)
.... maxDosePerPeriod ΣI0..1RatioUpper limit on medication per unit of time
.... maxDosePerAdministration ΣI0..1SimpleQuantityUpper limit on medication per administration
.... maxDosePerLifetime ΣI0..1SimpleQuantityUpper limit on medication per lifetime of the patient
... substitution I0..1BackboneElementWhether a substitution was performed on the dispense
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... wasSubstituted I1..1booleanWhether a substitution was or was not performed on the dispense
.... type I0..1CodeableConceptCode signifying whether a different drug was dispensed from what was prescribed
Binding: V3 Value SetActSubstanceAdminSubstitutionCode (example)
.... reason I0..*CodeableConceptWhy was substitution made
Binding: V3 Value SetSubstanceAdminSubstitutionReason (example)
.... responsibleParty I0..*Reference(QICorePractitioner)Who is responsible for the substitution
... detectedIssue I0..*Reference(DetectedIssue)Clinical issue with action
... eventHistory I0..*Reference(Provenance)A list of relevant lifecycle events

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense I0..*MedicationDispenseDispensing a medication to a named patient
... id Σ0..1stringLogical id of this artifact
... meta ΣI0..1MetaMetadata about the resource
... implicitRules ?!ΣI0..1uriA set of rules under which this content was created
... language I0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension I0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!I0..*ExtensionExtensions that cannot be ignored
... identifier I0..*IdentifierExternal identifier
... partOf I0..*Reference(Procedure)Event that dispense is part of
... status ?!SΣI1..1codepreparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
Binding: MedicationDispense Status Codes (required)
... statusReason[x] SI0..1Why a dispense was not performed
Binding: MedicationDispense Status Reason Codes (example)
.... statusReasonCodeableConceptCodeableConcept
.... statusReasonReferenceReference(DetectedIssue)
... category I0..1CodeableConceptType of medication dispense
Binding: MedicationDispense Category Codes (preferred)
... medication[x] SΣI1..1What medication was supplied
Binding: US Core Medication Codes (RxNorm) (preferred)
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(Medication)
... subject SΣI0..1Reference(QICorePatient)Who the dispense is for
... context I0..1Reference(Encounter | EpisodeOfCare)Encounter / Episode associated with event
... supportingInformation I0..*Reference(Resource)Information that supports the dispensing of the medication
... performer I0..*BackboneElementWho performed event
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... function I0..1CodeableConceptWho performed the dispense and what they did
Binding: MedicationDispense Performer Function Codes (example)
.... actor I1..1Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson)Individual who was performing
... location I0..1Reference(Location)Where the dispense occurred
... authorizingPrescription I0..*Reference(QICoreMedicationRequest)Medication order that authorizes the dispense
... type I0..1CodeableConceptTrial fill, partial fill, emergency fill, etc.
Binding: V3 Value SetActPharmacySupplyType (example)
... quantity SI0..1SimpleQuantityAmount dispensed
... daysSupply SI0..1SimpleQuantityAmount of medication expressed as a timing amount
... whenPrepared ΣI0..1dateTimeWhen product was packaged and reviewed
... whenHandedOver SI0..1dateTimeWhen product was given out
... destination I0..1Reference(QICoreLocation)Where the medication was sent
... receiver I0..*Reference(QICorePatient | QICorePractitioner)Who collected the medication
... note I0..*AnnotationInformation about the dispense
... dosageInstruction I0..*DosageHow the medication is to be used by the patient or administered by the caregiver
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence ΣI0..1integerThe order of the dosage instructions
.... text ΣI0..1stringFree text dosage instructions e.g. SIG
.... additionalInstruction ΣI0..*CodeableConceptSupplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
Binding: SNOMEDCTAdditionalDosageInstructions (example)
.... patientInstruction ΣI0..1stringPatient or consumer oriented instructions
.... timing SΣI0..1TimingWhen medication should be administered
.... asNeeded[x] ΣI0..1Take "as needed" (for x)
Binding: SNOMEDCTMedicationAsNeededReasonCodes (example)
..... asNeededBooleanboolean
..... asNeededCodeableConceptCodeableConcept
.... site ΣI0..1CodeableConceptBody site to administer to
Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example)
.... route SΣI0..1CodeableConceptHow drug should enter body
Binding: SNOMEDCTRouteCodes (example)
.... method ΣI0..1CodeableConceptTechnique for administering medication
Binding: SNOMEDCTAdministrationMethodCodes (example)
.... doseAndRate SΣI0..*ElementAmount of medication administered
..... id 0..1stringUnique id for inter-element referencing
..... extension I0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... type SΣI1..1CodeableConceptThe kind of dose or rate specified
Binding: SNOMED CT Dosages Codes (preferred)
..... dose[x] SΣI0..1Amount of medication per dose
...... doseRangeRange
...... doseQuantityQuantity(SimpleQuantity)
..... rate[x] ΣI0..1Amount of medication per unit of time
...... rateRatioRatio
...... rateRangeRange
...... rateQuantityQuantity(SimpleQuantity)
.... maxDosePerPeriod ΣI0..1RatioUpper limit on medication per unit of time
.... maxDosePerAdministration ΣI0..1SimpleQuantityUpper limit on medication per administration
.... maxDosePerLifetime ΣI0..1SimpleQuantityUpper limit on medication per lifetime of the patient
... substitution I0..1BackboneElementWhether a substitution was performed on the dispense
.... id 0..1stringUnique id for inter-element referencing
.... extension I0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!ΣI0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... wasSubstituted I1..1booleanWhether a substitution was or was not performed on the dispense
.... type I0..1CodeableConceptCode signifying whether a different drug was dispensed from what was prescribed
Binding: V3 Value SetActSubstanceAdminSubstitutionCode (example)
.... reason I0..*CodeableConceptWhy was substitution made
Binding: V3 Value SetSubstanceAdminSubstitutionReason (example)
.... responsibleParty I0..*Reference(QICorePractitioner)Who is responsible for the substitution
... detectedIssue I0..*Reference(DetectedIssue)Clinical issue with action
... eventHistory I0..*Reference(Provenance)A list of relevant lifecycle events

doco Documentation for this format

 

D.4.1.2 Terminology Bindings

Terminology Bindings

PathConformanceValueSet
MedicationDispense.languagepreferredCommonLanguages
Max Binding: AllLanguages
MedicationDispense.statusrequiredMedicationDispense Status Codes
MedicationDispense.statusReason[x]exampleMedicationDispense Status Reason Codes
MedicationDispense.categorypreferredMedicationDispense Category Codes
MedicationDispense.medication[x]preferredUSCoreMedicationCodes
MedicationDispense.performer.functionexampleMedicationDispense Performer Function Codes
MedicationDispense.typeexamplev3.ActPharmacySupplyType
MedicationDispense.dosageInstruction.additionalInstructionexampleSNOMEDCTAdditionalDosageInstructions
MedicationDispense.dosageInstruction.asNeeded[x]exampleSNOMEDCTMedicationAsNeededReasonCodes
MedicationDispense.dosageInstruction.siteexampleSNOMEDCTAnatomicalStructureForAdministrationSiteCodes
MedicationDispense.dosageInstruction.routeexampleSNOMEDCTRouteCodes
MedicationDispense.dosageInstruction.methodexampleSNOMEDCTAdministrationMethodCodes
MedicationDispense.dosageInstruction.doseAndRate.typepreferredQICoreMedicationDoseType
MedicationDispense.substitution.typeexamplev3.ActSubstanceAdminSubstitutionCode
MedicationDispense.substitution.reasonexamplev3.SubstanceAdminSubstitutionReason

D.4.1.3 Constraints

Constraints

IdPathDetailsRequirements
dom-2MedicationDispenseIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3MedicationDispenseIf 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-4MedicationDispenseIf 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-5MedicationDispenseIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6MedicationDispenseA resource should have narrative for robust management
: text.`div`.exists()
mdd-1MedicationDispensewhenHandedOver cannot be before whenPrepared
: whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared
ele-1MedicationDispense.metaAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.implicitRulesAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.languageAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.textAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1MedicationDispense.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1MedicationDispense.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1MedicationDispense.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1MedicationDispense.identifierAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.partOfAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.statusAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.statusReason[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.categoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.medication[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.subjectAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.contextAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.supportingInformationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.performerAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.performer.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1MedicationDispense.performer.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1MedicationDispense.performer.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1MedicationDispense.performer.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1MedicationDispense.performer.functionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.performer.actorAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.locationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.authorizingPrescriptionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.quantityAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.daysSupplyAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.whenPreparedAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.whenHandedOverAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.destinationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.receiverAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.noteAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.dosageInstructionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.dosageInstruction.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1MedicationDispense.dosageInstruction.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1MedicationDispense.dosageInstruction.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1MedicationDispense.dosageInstruction.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1MedicationDispense.dosageInstruction.sequenceAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.dosageInstruction.textAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.dosageInstruction.additionalInstructionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.dosageInstruction.patientInstructionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.dosageInstruction.timingAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.dosageInstruction.asNeeded[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.dosageInstruction.siteAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.dosageInstruction.routeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.dosageInstruction.methodAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.dosageInstruction.doseAndRateAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.dosageInstruction.doseAndRate.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1MedicationDispense.dosageInstruction.doseAndRate.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1MedicationDispense.dosageInstruction.doseAndRate.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.dosageInstruction.doseAndRate.dose[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.dosageInstruction.doseAndRate.rate[x]All FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.dosageInstruction.maxDosePerPeriodAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.dosageInstruction.maxDosePerAdministrationAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.dosageInstruction.maxDosePerLifetimeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.substitutionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.substitution.extensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1MedicationDispense.substitution.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1MedicationDispense.substitution.modifierExtensionAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1MedicationDispense.substitution.modifierExtensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1MedicationDispense.substitution.wasSubstitutedAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.substitution.typeAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.substitution.reasonAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.substitution.responsiblePartyAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.detectedIssueAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ele-1MedicationDispense.eventHistoryAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())