QI-Core Implementation Guide
6.0.0 - STU6 United States of America flag

This page is part of the Quality Improvement Core Framework (v6.0.0: STU6 (v6.0.0)) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. 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: 6.0.0
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 QI-Core 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 USCoreMedicationDispenseProfile

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense C0..*USCoreMedicationDispenseProfileDispensing 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 1..1dateTime(QI-Core) Extension
URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-recorded
... status 1..1code(QI-Core)(USCDI) preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
Binding: MedicationDispense Status Codes (required)
Fixed Value: declined
... statusReason[x] 1..1CodeableConcept(QI-Core) Why a dispense was not performed
Binding: QICore Negation Reason Codes (extensible): The reason the event did not occur or was not performed

.... notDoneValueSet 0..1canonical(ValueSet)(QI-Core) Url of a value set of activities not requested or performed
URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
... subject 1..1Reference(QICore Patient)(QI-Core)(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 0..1string(QI-Core)(USCDI) Free text dosage instructions e.g. SIG
.... timing 0..1Timing(QI-Core) When medication should be administered
.... route 0..1CodeableConceptHow drug should enter body
Binding: SNOMEDCTRouteCodes (preferred)
.... doseAndRate 0..*Element(QI-Core)(USCDI) Amount of medication administered
..... type 1..1CodeableConcept(QI-Core)(USCDI) The kind of dose or rate specified
Binding: QICore SNOMED CT Dosage Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)

..... dose[x] 0..1Quantity, Range(QI-Core)(USCDI) Amount of medication per dose

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet / CodeURI
MedicationDispense.statusrequiredFixed Value: declined
http://hl7.org/fhir/ValueSet/medicationdispense-status
from the FHIR Standard
MedicationDispense.statusReason[x]extensibleNegationReasonCodes
http://hl7.org/fhir/us/qicore/ValueSet/qicore-negation-reason
from this IG
MedicationDispense.medication[x]extensibleMedication Clinical Drug .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4
MedicationDispense.dosageInstruction.routepreferredSNOMEDCTRouteCodes
http://hl7.org/fhir/ValueSet/route-codes
from the FHIR Standard
MedicationDispense.dosageInstruction.doseAndRate.typepreferredQICoreMedicationDoseType
http://hl7.org/fhir/us/qicore/ValueSet/qicore-medication-dose-type
from this IG

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..*USCoreMedicationDispenseProfileDispensing a medication to a named patient
mdd-1: whenHandedOver cannot be before whenPrepared
us-core-20: whenHandedOver SHALL be present if the status is "completed"
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
... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
... recorded 1..1dateTime(QI-Core) Extension
URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-recorded
... status ?!SΣC1..1code(QI-Core)(USCDI) preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
Binding: MedicationDispense Status Codes (required)
Fixed Value: declined
... statusReason[x] 1..1CodeableConcept(QI-Core) 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] SΣ1..1(QI-Core)(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 0..1canonical(ValueSet)(QI-Core) Url of a value set of activities not requested or performed
URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(US Core Medication Profile)
... subject SΣ1..1Reference(QICore Patient)(QI-Core)(USCDI) Who the dispense is for
... performer S0..*BackboneElement(USCDI) Who performed event
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... actor S1..1Reference(US Core Practitioner Profile | US Core Organization Profile)(USCDI) Individual who was performing
... authorizingPrescription S0..*Reference(QICore MedicationRequest)(USCDI) Medication order that authorizes the dispense
... type S0..1CodeableConcept(USCDI) Trial fill, partial fill, emergency fill, etc.
Binding: ActPharmacySupplyType (extensible)
... quantity S0..1Quantity(USCDI) Amount dispensed
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
... whenHandedOver SC0..1dateTime(USCDI) When product was given out or mailed
... dosageInstruction S0..*Dosage(USCDI) How the medication is to be used by the patient or administered by the caregiver
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... text SΣ0..1string(QI-Core)(USCDI) Free text dosage instructions e.g. SIG
.... timing SΣ0..1Timing(QI-Core) When medication should be administered
.... route Σ0..1CodeableConceptHow drug should enter body
Binding: SNOMEDCTRouteCodes (preferred)
.... doseAndRate SΣ0..*Element(QI-Core)(USCDI) Amount of medication administered
..... type Σ1..1CodeableConcept(QI-Core)(USCDI) The kind of dose or rate specified
Binding: QICore SNOMED CT Dosage Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)

..... dose[x] SΣ0..1(QI-Core)(USCDI) Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
...... doseQuantityQuantity

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
MedicationDispense.statusrequiredFixed Value: declined
http://hl7.org/fhir/ValueSet/medicationdispense-status
from the FHIR Standard
MedicationDispense.statusReason[x]extensibleNegationReasonCodes
http://hl7.org/fhir/us/qicore/ValueSet/qicore-negation-reason
from this IG
MedicationDispense.medication[x]extensibleMedication Clinical Drug .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4
MedicationDispense.typeextensibleActPharmacySupplyType
http://terminology.hl7.org/ValueSet/v3-ActPharmacySupplyType
MedicationDispense.quantitypreferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
http://hl7.org/fhir/ValueSet/ucum-common
from the FHIR Standard
MedicationDispense.dosageInstruction.routepreferredSNOMEDCTRouteCodes
http://hl7.org/fhir/ValueSet/route-codes
from the FHIR Standard
MedicationDispense.dosageInstruction.doseAndRate.typepreferredQICoreMedicationDoseType
http://hl7.org/fhir/us/qicore/ValueSet/qicore-medication-dose-type
from this IG
MedicationDispense.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
http://hl7.org/fhir/ValueSet/ucum-common
from the FHIR Standard

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()
us-core-20errorMedicationDispensewhenHandedOver SHALL be present if the status is "completed"
: status='completed' implies whenHandedOver.exists()
NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense C0..*USCoreMedicationDispenseProfileDispensing a medication to a named patient
mdd-1: whenHandedOver cannot be before whenPrepared
us-core-20: whenHandedOver SHALL be present if the status is "completed"
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 1..*ExtensionExtension
Slice: Unordered, Open by value:url
... recorded 1..1dateTime(QI-Core) Extension
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 ?!SΣC1..1code(QI-Core)(USCDI) preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
Binding: MedicationDispense Status Codes (required)
Fixed Value: declined
... statusReason[x] 1..1CodeableConcept(QI-Core) 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..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..1(QI-Core)(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..1stringUnique id for inter-element referencing
..... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... notDoneValueSet 0..1canonical(ValueSet)(QI-Core) Url of a value set of activities not requested or performed
URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(US Core Medication Profile)
... subject SΣ1..1Reference(QICore Patient)(QI-Core)(USCDI) 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 S0..*BackboneElement(USCDI) Who 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 S1..1Reference(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..1Reference(Location)Where the dispense occurred
... authorizingPrescription S0..*Reference(QICore MedicationRequest)(USCDI) Medication order that authorizes the dispense
... type S0..1CodeableConcept(USCDI) Trial fill, partial fill, emergency fill, etc.
Binding: ActPharmacySupplyType (extensible)
... quantity S0..1Quantity(USCDI) Amount dispensed
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
... daysSupply 0..1SimpleQuantityAmount of medication expressed as a timing amount
... whenPrepared Σ0..1dateTimeWhen product was packaged and reviewed
... whenHandedOver SC0..1dateTime(USCDI) When product was given out or mailed
... 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 S0..*Dosage(USCDI) How 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 SΣ0..1string(QI-Core)(USCDI) Free 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..1Timing(QI-Core) When 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 Σ0..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..*Element(QI-Core)(USCDI) Amount 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 Σ1..1CodeableConcept(QI-Core)(USCDI) The kind of dose or rate specified
Binding: QICore SNOMED CT Dosage Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)

..... dose[x] SΣ0..1(QI-Core)(USCDI) Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
...... doseQuantityQuantity S
...... doseRangeRange
..... 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 / CodeURI
MedicationDispense.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
MedicationDispense.statusrequiredFixed Value: declined
http://hl7.org/fhir/ValueSet/medicationdispense-status
from the FHIR Standard
MedicationDispense.statusReason[x]extensibleNegationReasonCodes
http://hl7.org/fhir/us/qicore/ValueSet/qicore-negation-reason
from this IG
MedicationDispense.categorypreferredMedicationDispense Category Codes
http://hl7.org/fhir/ValueSet/medicationdispense-category
from the FHIR Standard
MedicationDispense.medication[x]extensibleMedication Clinical Drug .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4
MedicationDispense.performer.functionexampleMedicationDispense Performer Function Codes
http://hl7.org/fhir/ValueSet/medicationdispense-performer-function
from the FHIR Standard
MedicationDispense.typeextensibleActPharmacySupplyType
http://terminology.hl7.org/ValueSet/v3-ActPharmacySupplyType
MedicationDispense.quantitypreferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
http://hl7.org/fhir/ValueSet/ucum-common
from the FHIR Standard
MedicationDispense.dosageInstruction.additionalInstructionexampleSNOMEDCTAdditionalDosageInstructions
http://hl7.org/fhir/ValueSet/additional-instruction-codes
from the FHIR Standard
MedicationDispense.dosageInstruction.asNeeded[x]exampleSNOMEDCTMedicationAsNeededReasonCodes
http://hl7.org/fhir/ValueSet/medication-as-needed-reason
from the FHIR Standard
MedicationDispense.dosageInstruction.siteexampleSNOMEDCTAnatomicalStructureForAdministrationSiteCodes
http://hl7.org/fhir/ValueSet/approach-site-codes
from the FHIR Standard
MedicationDispense.dosageInstruction.routepreferredSNOMEDCTRouteCodes
http://hl7.org/fhir/ValueSet/route-codes
from the FHIR Standard
MedicationDispense.dosageInstruction.methodexampleSNOMEDCTAdministrationMethodCodes
http://hl7.org/fhir/ValueSet/administration-method-codes
from the FHIR Standard
MedicationDispense.dosageInstruction.doseAndRate.typepreferredQICoreMedicationDoseType
http://hl7.org/fhir/us/qicore/ValueSet/qicore-medication-dose-type
from this IG
MedicationDispense.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
http://hl7.org/fhir/ValueSet/ucum-common
from the FHIR Standard
MedicationDispense.substitution.typeexampleActSubstanceAdminSubstitutionCode
http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode
MedicationDispense.substitution.reasonexampleSubstanceAdminSubstitutionReason
http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason

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()
us-core-20errorMedicationDispensewhenHandedOver SHALL be present if the status is "completed"
: status='completed' implies whenHandedOver.exists()

Differential View

This structure is derived from USCoreMedicationDispenseProfile

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense C0..*USCoreMedicationDispenseProfileDispensing 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 1..1dateTime(QI-Core) Extension
URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-recorded
... status 1..1code(QI-Core)(USCDI) preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
Binding: MedicationDispense Status Codes (required)
Fixed Value: declined
... statusReason[x] 1..1CodeableConcept(QI-Core) Why a dispense was not performed
Binding: QICore Negation Reason Codes (extensible): The reason the event did not occur or was not performed

.... notDoneValueSet 0..1canonical(ValueSet)(QI-Core) Url of a value set of activities not requested or performed
URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
... subject 1..1Reference(QICore Patient)(QI-Core)(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 0..1string(QI-Core)(USCDI) Free text dosage instructions e.g. SIG
.... timing 0..1Timing(QI-Core) When medication should be administered
.... route 0..1CodeableConceptHow drug should enter body
Binding: SNOMEDCTRouteCodes (preferred)
.... doseAndRate 0..*Element(QI-Core)(USCDI) Amount of medication administered
..... type 1..1CodeableConcept(QI-Core)(USCDI) The kind of dose or rate specified
Binding: QICore SNOMED CT Dosage Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)

..... dose[x] 0..1Quantity, Range(QI-Core)(USCDI) Amount of medication per dose

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet / CodeURI
MedicationDispense.statusrequiredFixed Value: declined
http://hl7.org/fhir/ValueSet/medicationdispense-status
from the FHIR Standard
MedicationDispense.statusReason[x]extensibleNegationReasonCodes
http://hl7.org/fhir/us/qicore/ValueSet/qicore-negation-reason
from this IG
MedicationDispense.medication[x]extensibleMedication Clinical Drug .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4
MedicationDispense.dosageInstruction.routepreferredSNOMEDCTRouteCodes
http://hl7.org/fhir/ValueSet/route-codes
from the FHIR Standard
MedicationDispense.dosageInstruction.doseAndRate.typepreferredQICoreMedicationDoseType
http://hl7.org/fhir/us/qicore/ValueSet/qicore-medication-dose-type
from this IG

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..*USCoreMedicationDispenseProfileDispensing a medication to a named patient
mdd-1: whenHandedOver cannot be before whenPrepared
us-core-20: whenHandedOver SHALL be present if the status is "completed"
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
... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
... recorded 1..1dateTime(QI-Core) Extension
URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-recorded
... status ?!SΣC1..1code(QI-Core)(USCDI) preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
Binding: MedicationDispense Status Codes (required)
Fixed Value: declined
... statusReason[x] 1..1CodeableConcept(QI-Core) 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] SΣ1..1(QI-Core)(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 0..1canonical(ValueSet)(QI-Core) Url of a value set of activities not requested or performed
URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(US Core Medication Profile)
... subject SΣ1..1Reference(QICore Patient)(QI-Core)(USCDI) Who the dispense is for
... performer S0..*BackboneElement(USCDI) Who performed event
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... actor S1..1Reference(US Core Practitioner Profile | US Core Organization Profile)(USCDI) Individual who was performing
... authorizingPrescription S0..*Reference(QICore MedicationRequest)(USCDI) Medication order that authorizes the dispense
... type S0..1CodeableConcept(USCDI) Trial fill, partial fill, emergency fill, etc.
Binding: ActPharmacySupplyType (extensible)
... quantity S0..1Quantity(USCDI) Amount dispensed
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
... whenHandedOver SC0..1dateTime(USCDI) When product was given out or mailed
... dosageInstruction S0..*Dosage(USCDI) How the medication is to be used by the patient or administered by the caregiver
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... text SΣ0..1string(QI-Core)(USCDI) Free text dosage instructions e.g. SIG
.... timing SΣ0..1Timing(QI-Core) When medication should be administered
.... route Σ0..1CodeableConceptHow drug should enter body
Binding: SNOMEDCTRouteCodes (preferred)
.... doseAndRate SΣ0..*Element(QI-Core)(USCDI) Amount of medication administered
..... type Σ1..1CodeableConcept(QI-Core)(USCDI) The kind of dose or rate specified
Binding: QICore SNOMED CT Dosage Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)

..... dose[x] SΣ0..1(QI-Core)(USCDI) Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
...... doseQuantityQuantity

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
MedicationDispense.statusrequiredFixed Value: declined
http://hl7.org/fhir/ValueSet/medicationdispense-status
from the FHIR Standard
MedicationDispense.statusReason[x]extensibleNegationReasonCodes
http://hl7.org/fhir/us/qicore/ValueSet/qicore-negation-reason
from this IG
MedicationDispense.medication[x]extensibleMedication Clinical Drug .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4
MedicationDispense.typeextensibleActPharmacySupplyType
http://terminology.hl7.org/ValueSet/v3-ActPharmacySupplyType
MedicationDispense.quantitypreferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
http://hl7.org/fhir/ValueSet/ucum-common
from the FHIR Standard
MedicationDispense.dosageInstruction.routepreferredSNOMEDCTRouteCodes
http://hl7.org/fhir/ValueSet/route-codes
from the FHIR Standard
MedicationDispense.dosageInstruction.doseAndRate.typepreferredQICoreMedicationDoseType
http://hl7.org/fhir/us/qicore/ValueSet/qicore-medication-dose-type
from this IG
MedicationDispense.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
http://hl7.org/fhir/ValueSet/ucum-common
from the FHIR Standard

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()
us-core-20errorMedicationDispensewhenHandedOver SHALL be present if the status is "completed"
: status='completed' implies whenHandedOver.exists()

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MedicationDispense C0..*USCoreMedicationDispenseProfileDispensing a medication to a named patient
mdd-1: whenHandedOver cannot be before whenPrepared
us-core-20: whenHandedOver SHALL be present if the status is "completed"
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 1..*ExtensionExtension
Slice: Unordered, Open by value:url
... recorded 1..1dateTime(QI-Core) Extension
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 ?!SΣC1..1code(QI-Core)(USCDI) preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
Binding: MedicationDispense Status Codes (required)
Fixed Value: declined
... statusReason[x] 1..1CodeableConcept(QI-Core) 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..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..1(QI-Core)(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..1stringUnique id for inter-element referencing
..... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... notDoneValueSet 0..1canonical(ValueSet)(QI-Core) Url of a value set of activities not requested or performed
URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneValueSet
.... medicationCodeableConceptCodeableConcept
.... medicationReferenceReference(US Core Medication Profile)
... subject SΣ1..1Reference(QICore Patient)(QI-Core)(USCDI) 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 S0..*BackboneElement(USCDI) Who 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 S1..1Reference(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..1Reference(Location)Where the dispense occurred
... authorizingPrescription S0..*Reference(QICore MedicationRequest)(USCDI) Medication order that authorizes the dispense
... type S0..1CodeableConcept(USCDI) Trial fill, partial fill, emergency fill, etc.
Binding: ActPharmacySupplyType (extensible)
... quantity S0..1Quantity(USCDI) Amount dispensed
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
... daysSupply 0..1SimpleQuantityAmount of medication expressed as a timing amount
... whenPrepared Σ0..1dateTimeWhen product was packaged and reviewed
... whenHandedOver SC0..1dateTime(USCDI) When product was given out or mailed
... 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 S0..*Dosage(USCDI) How 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 SΣ0..1string(QI-Core)(USCDI) Free 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..1Timing(QI-Core) When 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 Σ0..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..*Element(QI-Core)(USCDI) Amount 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 Σ1..1CodeableConcept(QI-Core)(USCDI) The kind of dose or rate specified
Binding: QICore SNOMED CT Dosage Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)

..... dose[x] SΣ0..1(QI-Core)(USCDI) Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodesMax Binding
...... doseQuantityQuantity S
...... doseRangeRange
..... 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 / CodeURI
MedicationDispense.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
MedicationDispense.statusrequiredFixed Value: declined
http://hl7.org/fhir/ValueSet/medicationdispense-status
from the FHIR Standard
MedicationDispense.statusReason[x]extensibleNegationReasonCodes
http://hl7.org/fhir/us/qicore/ValueSet/qicore-negation-reason
from this IG
MedicationDispense.categorypreferredMedicationDispense Category Codes
http://hl7.org/fhir/ValueSet/medicationdispense-category
from the FHIR Standard
MedicationDispense.medication[x]extensibleMedication Clinical Drug .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4
MedicationDispense.performer.functionexampleMedicationDispense Performer Function Codes
http://hl7.org/fhir/ValueSet/medicationdispense-performer-function
from the FHIR Standard
MedicationDispense.typeextensibleActPharmacySupplyType
http://terminology.hl7.org/ValueSet/v3-ActPharmacySupplyType
MedicationDispense.quantitypreferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
http://hl7.org/fhir/ValueSet/ucum-common
from the FHIR Standard
MedicationDispense.dosageInstruction.additionalInstructionexampleSNOMEDCTAdditionalDosageInstructions
http://hl7.org/fhir/ValueSet/additional-instruction-codes
from the FHIR Standard
MedicationDispense.dosageInstruction.asNeeded[x]exampleSNOMEDCTMedicationAsNeededReasonCodes
http://hl7.org/fhir/ValueSet/medication-as-needed-reason
from the FHIR Standard
MedicationDispense.dosageInstruction.siteexampleSNOMEDCTAnatomicalStructureForAdministrationSiteCodes
http://hl7.org/fhir/ValueSet/approach-site-codes
from the FHIR Standard
MedicationDispense.dosageInstruction.routepreferredSNOMEDCTRouteCodes
http://hl7.org/fhir/ValueSet/route-codes
from the FHIR Standard
MedicationDispense.dosageInstruction.methodexampleSNOMEDCTAdministrationMethodCodes
http://hl7.org/fhir/ValueSet/administration-method-codes
from the FHIR Standard
MedicationDispense.dosageInstruction.doseAndRate.typepreferredQICoreMedicationDoseType
http://hl7.org/fhir/us/qicore/ValueSet/qicore-medication-dose-type
from this IG
MedicationDispense.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
Additional Bindings Purpose
UCUMCodes Max Binding
http://hl7.org/fhir/ValueSet/ucum-common
from the FHIR Standard
MedicationDispense.substitution.typeexampleActSubstanceAdminSubstitutionCode
http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode
MedicationDispense.substitution.reasonexampleSubstanceAdminSubstitutionReason
http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason

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()
us-core-20errorMedicationDispensewhenHandedOver SHALL be present if the status is "completed"
: status='completed' implies whenHandedOver.exists()

 

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