QI-Core Implementation Guide
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This page is part of the Quality Improvement Core Framework (v5.0.0: STU5 (v5.0.0)) based on FHIR R4. The current version which supercedes this version is 4.1.1. For a full list of available versions, see the Directory of published versions

Resource Profile: QICore MedicationDispense Declined

Official URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationdispensedeclined Version: 5.0.0
Active as of 2018-08-22 Computable Name: QICoreMedicationDispenseDeclined

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

Usage

See the patterns page for implementation and usage patterns.

The following example illustrates the use of the MedicationDispenseDeclined profile:

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

For a more complete discussion of representation of negation within QICore and quality improvement artifacts, see the Negation in QI Core topic.

Examples

Negation Example with valuesetOpthalmic Antihistamines not indicated; indicates that none of the drugs in the given not done value set were dispensed.
Negation Example with codeAlcaftadine 2.5 MG/ML Opthalmic Solution not indicated; indicates that the specific drug was not dispensed.

Usage:

Formal Views of Profile Content

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

This structure is derived from MedicationDispense

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense C0..*MedicationDispenseDispensing 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 S1..1dateTimeExtension
URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-recorded
... status S1..1codepreparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
Fixed Value: declined
... statusReason[x] S1..1CodeableConceptWhy a dispense was not performed
Binding: QICore Negation Reason Codes (extensible): The reason the event did not occur or was not performed

.... notDoneValueSet S0..1canonical(ValueSet)Url of a value set of activities not requested or performed
URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
... subject S0..1Reference(QICore Patient)Who the dispense is for
... authorizingPrescription 0..*Reference(QICore MedicationRequest)Medication order that authorizes the dispense
... dosageInstruction 0..*DosageHow the medication is to be used by the patient or administered by the caregiver
.... timing S0..1TimingWhen medication should be administered
.... site 0..1CodeableConceptBody site to administer to
.... route S0..1CodeableConceptHow drug should enter body
Binding: SNOMEDCTRouteCodes (preferred)
.... doseAndRate S0..*ElementAmount of medication administered
..... type S1..1CodeableConceptThe kind of dose or rate specified
Binding: QICore SNOMED CT Dosage Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)

..... dose[x] S0..1Range, SimpleQuantityAmount of medication per dose

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
MedicationDispense.statusReason[x]extensibleNegationReasonCodes
MedicationDispense.medication[x]preferredSNOMEDCTMedicationCodes
MedicationDispense.dosageInstruction.routepreferredSNOMEDCTRouteCodes
MedicationDispense.dosageInstruction.doseAndRate.typepreferredQICoreMedicationDoseType

Constraints

IdGradePath(s)DetailsRequirements
mnd-1errorMedicationDispenseTo 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()
NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense C0..*MedicationDispenseDispensing 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 ?!Σ0..1uriA set of rules under which this content was created
... recorded S1..1dateTimeExtension
URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-recorded
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... statusReason[x] S1..1CodeableConceptWhy a dispense was not performed
Binding: QICore Negation Reason Codes (extensible): The reason the event did not occur or was not performed

... medication[x] SΣ1..1CodeableConceptWhat medication was supplied
Binding: SNOMEDCTMedicationCodes (preferred)
.... notDoneValueSet S0..1canonical(ValueSet)Url of a value set of activities not requested or performed
URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
... subject SΣ0..1Reference(QICore Patient)Who the dispense is for
... authorizingPrescription 0..*Reference(QICore MedicationRequest)Medication order that authorizes the dispense
... dosageInstruction 0..*DosageHow the medication is to be used by the patient or administered by the caregiver
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... timing SΣ0..1TimingWhen medication should be administered
.... site Σ0..1CodeableConceptBody site to administer to
Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.

.... route SΣ0..1CodeableConceptHow drug should enter body
Binding: SNOMEDCTRouteCodes (preferred)
.... doseAndRate SΣ0..*ElementAmount of medication administered
..... type SΣ1..1CodeableConceptThe kind of dose or rate specified
Binding: QICore SNOMED CT Dosage Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)

..... dose[x] SΣ0..1Amount of medication per dose
...... doseRangeRange
...... doseQuantityQuantity(SimpleQuantity)

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
MedicationDispense.statusrequiredFixed Value: declined
MedicationDispense.statusReason[x]extensibleNegationReasonCodes
MedicationDispense.medication[x]preferredSNOMEDCTMedicationCodes
MedicationDispense.dosageInstruction.siteexampleSNOMEDCTAnatomicalStructureForAdministrationSiteCodes
MedicationDispense.dosageInstruction.routepreferredSNOMEDCTRouteCodes
MedicationDispense.dosageInstruction.doseAndRate.typepreferredQICoreMedicationDoseType

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorMedicationDispenseIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMedicationDispenseIf 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-4errorMedicationDispenseIf 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-5errorMedicationDispenseIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMedicationDispenseA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
mdd-1errorMedicationDispensewhenHandedOver cannot be before whenPrepared
: whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared
mnd-1errorMedicationDispenseTo 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()
NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense C0..*MedicationDispenseDispensing 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 Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... recorded S1..1dateTimeExtension
URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-recorded
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 0..*IdentifierExternal identifier
... partOf 0..*Reference(Procedure)Event that dispense is part of
... status ?!SΣ1..1codepreparation | 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.


Fixed Value: declined
... statusReason[x] S1..1CodeableConceptWhy a dispense was not performed
Binding: QICore Negation Reason Codes (extensible): The reason the event did not occur or was not performed

... category 0..1CodeableConceptType of medication dispense
Binding: MedicationDispense Category Codes (preferred): A code describing where the dispensed medication is expected to be consumed or administered.

... medication[x] SΣ1..1CodeableConceptWhat medication was supplied
Binding: SNOMEDCTMedicationCodes (preferred)
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... notDoneValueSet S0..1canonical(ValueSet)Url of a value set of activities not requested or performed
URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
.... coding Σ0..*CodingCode defined by a terminology system
.... text Σ0..1stringPlain text representation of the concept
... subject SΣ0..1Reference(QICore Patient)Who the dispense is for
... context 0..1Reference(Encounter | EpisodeOfCare)Encounter / Episode associated with event
... supportingInformation 0..*Reference(Resource)Information that supports the dispensing of the medication
... performer 0..*BackboneElementWho performed event
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... function 0..1CodeableConceptWho 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 1..1Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson)Individual who was performing
... location 0..1Reference(Location)Where the dispense occurred
... authorizingPrescription 0..*Reference(QICore MedicationRequest)Medication order that authorizes the dispense
... type 0..1CodeableConceptTrial fill, partial fill, emergency fill, etc.
Binding: ActPharmacySupplyType (example): Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc.

... quantity 0..1SimpleQuantityAmount dispensed
... daysSupply 0..1SimpleQuantityAmount of medication expressed as a timing amount
... whenPrepared Σ0..1dateTimeWhen product was packaged and reviewed
... whenHandedOver 0..1dateTimeWhen product was given out
... destination 0..1Reference(Location)Where the medication was sent
... receiver 0..*Reference(Patient | Practitioner)Who collected the medication
... note 0..*AnnotationInformation about the dispense
... dosageInstruction 0..*DosageHow the medication is to be used by the patient or administered by the caregiver
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence Σ0..1integerThe order of the dosage instructions
.... text Σ0..1stringFree text dosage instructions e.g. SIG
.... additionalInstruction Σ0..*CodeableConceptSupplemental 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 Σ0..1stringPatient or consumer oriented instructions
.... timing SΣ0..1TimingWhen medication should be administered
.... asNeeded[x] Σ0..1Take "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.

..... asNeededBooleanboolean
..... asNeededCodeableConceptCodeableConcept
.... site Σ0..1CodeableConceptBody site to administer to
Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.

.... route SΣ0..1CodeableConceptHow drug should enter body
Binding: SNOMEDCTRouteCodes (preferred)
.... method Σ0..1CodeableConceptTechnique for administering medication
Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.

.... doseAndRate SΣ0..*ElementAmount of medication administered
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... type SΣ1..1CodeableConceptThe kind of dose or rate specified
Binding: QICore SNOMED CT Dosage Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)

..... dose[x] SΣ0..1Amount of medication per dose
...... doseRangeRange
...... doseQuantityQuantity(SimpleQuantity)
..... rate[x] Σ0..1Amount of medication per unit of time
...... rateRatioRatio
...... rateRangeRange
...... rateQuantityQuantity(SimpleQuantity)
.... maxDosePerPeriod Σ0..1RatioUpper limit on medication per unit of time
.... maxDosePerAdministration Σ0..1SimpleQuantityUpper limit on medication per administration
.... maxDosePerLifetime Σ0..1SimpleQuantityUpper limit on medication per lifetime of the patient
... substitution 0..1BackboneElementWhether a substitution was performed on the dispense
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... wasSubstituted 1..1booleanWhether a substitution was or was not performed on the dispense
.... type 0..1CodeableConceptCode 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..*CodeableConceptWhy 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

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
MedicationDispense.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
MedicationDispense.statusrequiredFixed Value: declined
MedicationDispense.statusReason[x]extensibleNegationReasonCodes
MedicationDispense.categorypreferredMedicationDispense Category Codes
MedicationDispense.medication[x]preferredSNOMEDCTMedicationCodes
MedicationDispense.performer.functionexampleMedicationDispense Performer Function Codes
MedicationDispense.typeexampleActPharmacySupplyType
MedicationDispense.dosageInstruction.additionalInstructionexampleSNOMEDCTAdditionalDosageInstructions
MedicationDispense.dosageInstruction.asNeeded[x]exampleSNOMEDCTMedicationAsNeededReasonCodes
MedicationDispense.dosageInstruction.siteexampleSNOMEDCTAnatomicalStructureForAdministrationSiteCodes
MedicationDispense.dosageInstruction.routepreferredSNOMEDCTRouteCodes
MedicationDispense.dosageInstruction.methodexampleSNOMEDCTAdministrationMethodCodes
MedicationDispense.dosageInstruction.doseAndRate.typepreferredQICoreMedicationDoseType
MedicationDispense.substitution.typeexampleActSubstanceAdminSubstitutionCode
MedicationDispense.substitution.reasonexampleSubstanceAdminSubstitutionReason

Constraints

IdGradePath(s)DetailsRequirements
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from MedicationDispense

Summary

Mandatory: 3 elements (1 nested mandatory element)
Must-Support: 11 elements
Fixed Value: 1 element

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Differential View

This structure is derived from MedicationDispense

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense C0..*MedicationDispenseDispensing 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 S1..1dateTimeExtension
URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-recorded
... status S1..1codepreparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
Fixed Value: declined
... statusReason[x] S1..1CodeableConceptWhy a dispense was not performed
Binding: QICore Negation Reason Codes (extensible): The reason the event did not occur or was not performed

.... notDoneValueSet S0..1canonical(ValueSet)Url of a value set of activities not requested or performed
URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
... subject S0..1Reference(QICore Patient)Who the dispense is for
... authorizingPrescription 0..*Reference(QICore MedicationRequest)Medication order that authorizes the dispense
... dosageInstruction 0..*DosageHow the medication is to be used by the patient or administered by the caregiver
.... timing S0..1TimingWhen medication should be administered
.... site 0..1CodeableConceptBody site to administer to
.... route S0..1CodeableConceptHow drug should enter body
Binding: SNOMEDCTRouteCodes (preferred)
.... doseAndRate S0..*ElementAmount of medication administered
..... type S1..1CodeableConceptThe kind of dose or rate specified
Binding: QICore SNOMED CT Dosage Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)

..... dose[x] S0..1Range, SimpleQuantityAmount of medication per dose

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
MedicationDispense.statusReason[x]extensibleNegationReasonCodes
MedicationDispense.medication[x]preferredSNOMEDCTMedicationCodes
MedicationDispense.dosageInstruction.routepreferredSNOMEDCTRouteCodes
MedicationDispense.dosageInstruction.doseAndRate.typepreferredQICoreMedicationDoseType

Constraints

IdGradePath(s)DetailsRequirements
mnd-1errorMedicationDispenseTo 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

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense C0..*MedicationDispenseDispensing 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 ?!Σ0..1uriA set of rules under which this content was created
... recorded S1..1dateTimeExtension
URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-recorded
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... statusReason[x] S1..1CodeableConceptWhy a dispense was not performed
Binding: QICore Negation Reason Codes (extensible): The reason the event did not occur or was not performed

... medication[x] SΣ1..1CodeableConceptWhat medication was supplied
Binding: SNOMEDCTMedicationCodes (preferred)
.... notDoneValueSet S0..1canonical(ValueSet)Url of a value set of activities not requested or performed
URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
... subject SΣ0..1Reference(QICore Patient)Who the dispense is for
... authorizingPrescription 0..*Reference(QICore MedicationRequest)Medication order that authorizes the dispense
... dosageInstruction 0..*DosageHow the medication is to be used by the patient or administered by the caregiver
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... timing SΣ0..1TimingWhen medication should be administered
.... site Σ0..1CodeableConceptBody site to administer to
Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.

.... route SΣ0..1CodeableConceptHow drug should enter body
Binding: SNOMEDCTRouteCodes (preferred)
.... doseAndRate SΣ0..*ElementAmount of medication administered
..... type SΣ1..1CodeableConceptThe kind of dose or rate specified
Binding: QICore SNOMED CT Dosage Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)

..... dose[x] SΣ0..1Amount of medication per dose
...... doseRangeRange
...... doseQuantityQuantity(SimpleQuantity)

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
MedicationDispense.statusrequiredFixed Value: declined
MedicationDispense.statusReason[x]extensibleNegationReasonCodes
MedicationDispense.medication[x]preferredSNOMEDCTMedicationCodes
MedicationDispense.dosageInstruction.siteexampleSNOMEDCTAnatomicalStructureForAdministrationSiteCodes
MedicationDispense.dosageInstruction.routepreferredSNOMEDCTRouteCodes
MedicationDispense.dosageInstruction.doseAndRate.typepreferredQICoreMedicationDoseType

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorMedicationDispenseIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMedicationDispenseIf 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-4errorMedicationDispenseIf 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-5errorMedicationDispenseIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMedicationDispenseA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
mdd-1errorMedicationDispensewhenHandedOver cannot be before whenPrepared
: whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared
mnd-1errorMedicationDispenseTo 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()

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense C0..*MedicationDispenseDispensing 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 Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... recorded S1..1dateTimeExtension
URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-recorded
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier 0..*IdentifierExternal identifier
... partOf 0..*Reference(Procedure)Event that dispense is part of
... status ?!SΣ1..1codepreparation | 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.


Fixed Value: declined
... statusReason[x] S1..1CodeableConceptWhy a dispense was not performed
Binding: QICore Negation Reason Codes (extensible): The reason the event did not occur or was not performed

... category 0..1CodeableConceptType of medication dispense
Binding: MedicationDispense Category Codes (preferred): A code describing where the dispensed medication is expected to be consumed or administered.

... medication[x] SΣ1..1CodeableConceptWhat medication was supplied
Binding: SNOMEDCTMedicationCodes (preferred)
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... notDoneValueSet S0..1canonical(ValueSet)Url of a value set of activities not requested or performed
URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
.... coding Σ0..*CodingCode defined by a terminology system
.... text Σ0..1stringPlain text representation of the concept
... subject SΣ0..1Reference(QICore Patient)Who the dispense is for
... context 0..1Reference(Encounter | EpisodeOfCare)Encounter / Episode associated with event
... supportingInformation 0..*Reference(Resource)Information that supports the dispensing of the medication
... performer 0..*BackboneElementWho performed event
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... function 0..1CodeableConceptWho 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 1..1Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson)Individual who was performing
... location 0..1Reference(Location)Where the dispense occurred
... authorizingPrescription 0..*Reference(QICore MedicationRequest)Medication order that authorizes the dispense
... type 0..1CodeableConceptTrial fill, partial fill, emergency fill, etc.
Binding: ActPharmacySupplyType (example): Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc.

... quantity 0..1SimpleQuantityAmount dispensed
... daysSupply 0..1SimpleQuantityAmount of medication expressed as a timing amount
... whenPrepared Σ0..1dateTimeWhen product was packaged and reviewed
... whenHandedOver 0..1dateTimeWhen product was given out
... destination 0..1Reference(Location)Where the medication was sent
... receiver 0..*Reference(Patient | Practitioner)Who collected the medication
... note 0..*AnnotationInformation about the dispense
... dosageInstruction 0..*DosageHow the medication is to be used by the patient or administered by the caregiver
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... sequence Σ0..1integerThe order of the dosage instructions
.... text Σ0..1stringFree text dosage instructions e.g. SIG
.... additionalInstruction Σ0..*CodeableConceptSupplemental 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 Σ0..1stringPatient or consumer oriented instructions
.... timing SΣ0..1TimingWhen medication should be administered
.... asNeeded[x] Σ0..1Take "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.

..... asNeededBooleanboolean
..... asNeededCodeableConceptCodeableConcept
.... site Σ0..1CodeableConceptBody site to administer to
Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.

.... route SΣ0..1CodeableConceptHow drug should enter body
Binding: SNOMEDCTRouteCodes (preferred)
.... method Σ0..1CodeableConceptTechnique for administering medication
Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.

.... doseAndRate SΣ0..*ElementAmount of medication administered
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... type SΣ1..1CodeableConceptThe kind of dose or rate specified
Binding: QICore SNOMED CT Dosage Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)

..... dose[x] SΣ0..1Amount of medication per dose
...... doseRangeRange
...... doseQuantityQuantity(SimpleQuantity)
..... rate[x] Σ0..1Amount of medication per unit of time
...... rateRatioRatio
...... rateRangeRange
...... rateQuantityQuantity(SimpleQuantity)
.... maxDosePerPeriod Σ0..1RatioUpper limit on medication per unit of time
.... maxDosePerAdministration Σ0..1SimpleQuantityUpper limit on medication per administration
.... maxDosePerLifetime Σ0..1SimpleQuantityUpper limit on medication per lifetime of the patient
... substitution 0..1BackboneElementWhether a substitution was performed on the dispense
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... wasSubstituted 1..1booleanWhether a substitution was or was not performed on the dispense
.... type 0..1CodeableConceptCode 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..*CodeableConceptWhy 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

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
MedicationDispense.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
MedicationDispense.statusrequiredFixed Value: declined
MedicationDispense.statusReason[x]extensibleNegationReasonCodes
MedicationDispense.categorypreferredMedicationDispense Category Codes
MedicationDispense.medication[x]preferredSNOMEDCTMedicationCodes
MedicationDispense.performer.functionexampleMedicationDispense Performer Function Codes
MedicationDispense.typeexampleActPharmacySupplyType
MedicationDispense.dosageInstruction.additionalInstructionexampleSNOMEDCTAdditionalDosageInstructions
MedicationDispense.dosageInstruction.asNeeded[x]exampleSNOMEDCTMedicationAsNeededReasonCodes
MedicationDispense.dosageInstruction.siteexampleSNOMEDCTAnatomicalStructureForAdministrationSiteCodes
MedicationDispense.dosageInstruction.routepreferredSNOMEDCTRouteCodes
MedicationDispense.dosageInstruction.methodexampleSNOMEDCTAdministrationMethodCodes
MedicationDispense.dosageInstruction.doseAndRate.typepreferredQICoreMedicationDoseType
MedicationDispense.substitution.typeexampleActSubstanceAdminSubstitutionCode
MedicationDispense.substitution.reasonexampleSubstanceAdminSubstitutionReason

Constraints

IdGradePath(s)DetailsRequirements
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from MedicationDispense

Summary

Mandatory: 3 elements (1 nested mandatory element)
Must-Support: 11 elements
Fixed Value: 1 element

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

 

Other representations of profile: CSV, Excel, Schematron