Indicates that a medication product is to be or has been dispensed for a named person/patient. This includes a description of the medication product (supply) provided and the instructions for administering the medication. The medication dispense is the result of a pharmacy system responding to a medication order.

The WG will be updating the MedicationDispense resource to adjust each affected resource to align with the workflow pattern (see workflow.html).

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

An Extension

R4B: MedicationDispense.location (new:Reference(Location))

Element MedicationDispense.location has a context of MedicationDispense based on following the parent source element upwards and mapping to MedicationDispense. Element MedicationDispense.location has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). An externally-defined extension that has been mapped as the representation of FHIR R4B element MedicationDispense.location: http://hl7.org/fhir/StructureDefinition/event-location.

May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

A code specifying the state of the set of dispense events.

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

A coded concept specifying the state of the dispense event.

An Extension

R4B: MedicationDispense.status additional codes

Element MedicationDispense.status is mapped to FHIR STU3 element MedicationDispense.status as RelatedTo. The mappings for MedicationDispense.status do not allow expression of the necessary codes, per the bindings on the source and target. The target context MedicationDispense.status is a modifier element, so this extension does not need to be defined as a modifier. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.

If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended.  For example if you require form or lot number, then you must reference the Medication resource. .

A coded concept identifying which substance or product can be dispensed

R4B: MedicationDispense.medication[x] additional types from child elements (display, identifier, reference, type)

Element MedicationDispense.medication[x] is mapped to FHIR STU3 element MedicationDispense.medication[x] as SourceIsBroaderThanTarget. The mappings for MedicationDispense.medication[x] do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element MedicationDispense.medication[x] with unmapped reference targets: Medication. Source element MedicationDispense.medication[x] has unmapped reference types. While the target element MedicationDispense.medication[x] is a choice type and does not allow extensions, the alternate-reference extension can be applied to Reference values within it. If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended. For example, if you require form or lot number, then you must reference the Medication resource.

R4B: MedicationDispense.meta additional types (Meta) additional types from child elements (lastUpdated, profile, security, source, tag, versionId)

Element MedicationDispense.meta is mapped to FHIR STU3 element MedicationDispense.meta as SourceIsBroaderThanTarget. The mappings for MedicationDispense.meta do not cover the following types: Meta. The mappings for MedicationDispense.meta do not cover the following types based on type expansion: lastUpdated, profile, security, source, tag, versionId.

R4B: MedicationDispense.text additional types (Narrative) additional types from child elements (div, status)

Element MedicationDispense.text is mapped to FHIR STU3 element MedicationDispense.text as SourceIsBroaderThanTarget. The mappings for MedicationDispense.text do not cover the following types: Narrative. The mappings for MedicationDispense.text do not cover the following types based on type expansion: div, status. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

R4B: MedicationDispense.location (new:Reference(Location))

Element MedicationDispense.location has a context of MedicationDispense based on following the parent source element upwards and mapping to MedicationDispense. Element MedicationDispense.location has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). An externally-defined extension that has been mapped as the representation of FHIR R4B element MedicationDispense.location: http://hl7.org/fhir/StructureDefinition/event-location.

R4B: MedicationDispense.identifier additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)

Element MedicationDispense.identifier is mapped to FHIR STU3 element MedicationDispense.identifier as SourceIsBroaderThanTarget. The mappings for MedicationDispense.identifier do not cover the following types: Identifier. The mappings for MedicationDispense.identifier do not cover the following types based on type expansion: assigner, period, system, type, use, value. This is a business identifier, not a resource identifier.

R4B: MedicationDispense.partOf additional types from child elements (display, identifier, reference, type)

Element MedicationDispense.partOf is mapped to FHIR STU3 element MedicationDispense.partOf as SourceIsBroaderThanTarget. The mappings for MedicationDispense.partOf do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element MedicationDispense.partOf with unmapped reference targets: Procedure.

R4B: MedicationDispense.status additional codes

Element MedicationDispense.status is mapped to FHIR STU3 element MedicationDispense.status as RelatedTo. The mappings for MedicationDispense.status do not allow expression of the necessary codes, per the bindings on the source and target. The target context MedicationDispense.status is a modifier element, so this extension does not need to be defined as a modifier. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

R4B: MedicationDispense.medication[x] additional types from child elements (display, identifier, reference, type)

Element MedicationDispense.medication[x] is mapped to FHIR STU3 element MedicationDispense.medication[x] as SourceIsBroaderThanTarget. The mappings for MedicationDispense.medication[x] do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element MedicationDispense.medication[x] with unmapped reference targets: Medication. Source element MedicationDispense.medication[x] has unmapped reference types. While the target element MedicationDispense.medication[x] is a choice type and does not allow extensions, the alternate-reference extension can be applied to Reference values within it. If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended. For example, if you require form or lot number, then you must reference the Medication resource.

R4B: MedicationDispense.subject additional types from child elements (display, identifier, reference, type)

Element MedicationDispense.subject is mapped to FHIR STU3 element MedicationDispense.subject as SourceIsBroaderThanTarget. The mappings for MedicationDispense.subject do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element MedicationDispense.subject with unmapped reference targets: Group, Patient. SubstanceAdministration->subject->Patient.

R4B: MedicationDispense.context additional types from child elements (display, identifier, reference, type)

Element MedicationDispense.context is mapped to FHIR STU3 element MedicationDispense.context as SourceIsBroaderThanTarget. The mappings for MedicationDispense.context do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element MedicationDispense.context with unmapped reference targets: Encounter, EpisodeOfCare.

R4B: MedicationDispense.supportingInformation additional types from child elements (display, identifier, reference, type)

Element MedicationDispense.supportingInformation is mapped to FHIR STU3 element MedicationDispense.supportingInformation as SourceIsBroaderThanTarget. The mappings for MedicationDispense.supportingInformation do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element MedicationDispense.supportingInformation with unmapped reference targets: Resource.

R4B: MedicationDispense.performer.function (new:CodeableConcept)

Element MedicationDispense.performer.function has a context of MedicationDispense.performer based on following the parent source element upwards and mapping to MedicationDispense. Element MedicationDispense.performer.function has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4B: MedicationDispense.performer.actor

Element MedicationDispense.performer.actor is mapped to FHIR STU3 element MedicationDispense.performer.actor as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element MedicationDispense.performer.actor with unmapped reference targets: Device, Organization, Patient, Practitioner, PractitionerRole, RelatedPerson.

R4B: MedicationDispense.authorizingPrescription additional types from child elements (display, identifier, reference, type)

Element MedicationDispense.authorizingPrescription is mapped to FHIR STU3 element MedicationDispense.authorizingPrescription as SourceIsBroaderThanTarget. The mappings for MedicationDispense.authorizingPrescription do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element MedicationDispense.authorizingPrescription with unmapped reference targets: MedicationRequest. Maps to basedOn in Event logical model.

R4B: MedicationDispense.destination additional types from child elements (display, identifier, reference, type)

Element MedicationDispense.destination is mapped to FHIR STU3 element MedicationDispense.destination as SourceIsBroaderThanTarget. The mappings for MedicationDispense.destination do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element MedicationDispense.destination with unmapped reference targets: Location.

R4B: MedicationDispense.receiver additional types from child elements (display, identifier, reference, type)

Element MedicationDispense.receiver is mapped to FHIR STU3 element MedicationDispense.receiver as SourceIsBroaderThanTarget. The mappings for MedicationDispense.receiver do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element MedicationDispense.receiver with unmapped reference targets: Patient, Practitioner.

R4B: MedicationDispense.note additional types (Annotation) additional types from child elements (author[x], text, time)

Element MedicationDispense.note is mapped to FHIR STU3 element MedicationDispense.note as SourceIsBroaderThanTarget. The mappings for MedicationDispense.note do not cover the following types: Annotation. The mappings for MedicationDispense.note do not cover the following types based on type expansion: author[x], text, time.

R4B: MedicationDispense.dosageInstruction additional types (Dosage) additional types from child elements (additionalInstruction, asNeeded[x], doseAndRate, dose[x], rate[x], type, maxDosePerAdministration, maxDosePerLifetime, maxDosePerPeriod, method, patientInstruction, route, sequence, site, text, timing)

Element MedicationDispense.dosageInstruction is mapped to FHIR STU3 element MedicationDispense.dosageInstruction as SourceIsBroaderThanTarget. The mappings for MedicationDispense.dosageInstruction do not cover the following types: Dosage. The mappings for MedicationDispense.dosageInstruction do not cover the following types based on type expansion: additionalInstruction, asNeeded[x], dose[x], doseAndRate, maxDosePerAdministration, maxDosePerLifetime, maxDosePerPeriod, method, patientInstruction, rate[x], route, sequence, site, text, timing, type. When the dose or rate is intended to change over the entire administration period (e.g. Tapering dose prescriptions), multiple instances of dosage instructions will need to be supplied to convey the different doses/rates. The pharmacist reviews the medication order prior to dispense and updates the dosageInstruction based on the actual product being dispensed.

R4B: MedicationDispense.substitution.responsibleParty additional types from child elements (display, identifier, reference, type)

Element MedicationDispense.substitution.responsibleParty is mapped to FHIR STU3 element MedicationDispense.substitution.responsibleParty as SourceIsBroaderThanTarget. The mappings for MedicationDispense.substitution.responsibleParty do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element MedicationDispense.substitution.responsibleParty with unmapped reference targets: Practitioner, PractitionerRole.

R4B: MedicationDispense.detectedIssue additional types from child elements (display, identifier, reference, type)

Element MedicationDispense.detectedIssue is mapped to FHIR STU3 element MedicationDispense.detectedIssue as SourceIsBroaderThanTarget. The mappings for MedicationDispense.detectedIssue do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element MedicationDispense.detectedIssue with unmapped reference targets: DetectedIssue. This element can include a detected issue that has been identified either by a decision support system or by a clinician and may include information on the steps that were taken to address the issue.

R4B: MedicationDispense.statusReason[x] additional types from child elements (display, identifier, reference, type)

Element MedicationDispense.statusReason[x] is mapped to FHIR STU3 element MedicationDispense.notDoneReason[x] as SourceIsBroaderThanTarget. The mappings for MedicationDispense.statusReason[x] do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element MedicationDispense.statusReason[x] with unmapped reference targets: DetectedIssue. Source element MedicationDispense.statusReason[x] has unmapped reference types. While the target element MedicationDispense.notDoneReason[x] is a choice type and does not allow extensions, the alternate-reference extension can be applied to Reference values within it.

R4B: MedicationDispense.eventHistory additional types from child elements (display, identifier, reference, type)

Element MedicationDispense.eventHistory is mapped to FHIR STU3 element MedicationDispense.eventHistory as SourceIsBroaderThanTarget. The mappings for MedicationDispense.eventHistory do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element MedicationDispense.eventHistory with unmapped reference targets: Provenance. This might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.).

Indicates that a medication product is to be or has been dispensed for a named person/patient. This includes a description of the medication product (supply) provided and the instructions for administering the medication. The medication dispense is the result of a pharmacy system responding to a medication order.

The WG will be updating the MedicationDispense resource to adjust each affected resource to align with the workflow pattern (see workflow.html).

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4B: MedicationDispense.meta additional types (Meta) additional types from child elements (lastUpdated, profile, security, source, tag, versionId)

Element MedicationDispense.meta is mapped to FHIR STU3 element MedicationDispense.meta as SourceIsBroaderThanTarget. The mappings for MedicationDispense.meta do not cover the following types: Meta. The mappings for MedicationDispense.meta do not cover the following types based on type expansion: lastUpdated, profile, security, source, tag, versionId.

The version specific identifier, as it appears in the version portion of the URL. This values changes when the resource is created, updated, or deleted.

The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

When the resource last changed - e.g. when the version changed.

This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant.

A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

The security labels can be updated without changing the stated version of the resource The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

Security Labels from the Healthcare Privacy and Security Classification System.

Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

The base language in which the resource is written.

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

A human language.

A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4B: MedicationDispense.text additional types (Narrative) additional types from child elements (div, status)

Element MedicationDispense.text is mapped to FHIR STU3 element MedicationDispense.text as SourceIsBroaderThanTarget. The mappings for MedicationDispense.text do not cover the following types: Narrative. The mappings for MedicationDispense.text do not cover the following types based on type expansion: div, status. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

The status of the narrative - whether it's entirely generated (from just the defined data or the extensions too), or whether a human authored it and it may contain additional data.

The status of a resource narrative

The actual narrative content, a stripped down version of XHTML.

The contents of the html element are an XHTML fragment containing only the basic html formatting elements described in chapters 7-11 and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained stylesheets. The XHTML content may not contain a head, a body, external stylesheet references, scripts, forms, base/link/xlink, frames, iframes and objects.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.

An Extension

R4B: MedicationDispense.location (new:Reference(Location))

Element MedicationDispense.location has a context of MedicationDispense based on following the parent source element upwards and mapping to MedicationDispense. Element MedicationDispense.location has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). An externally-defined extension that has been mapped as the representation of FHIR R4B element MedicationDispense.location: http://hl7.org/fhir/StructureDefinition/event-location.

May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Identifier assigned by the dispensing facility - this is an identifier assigned outside FHIR.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4B: MedicationDispense.identifier additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)

Element MedicationDispense.identifier is mapped to FHIR STU3 element MedicationDispense.identifier as SourceIsBroaderThanTarget. The mappings for MedicationDispense.identifier do not cover the following types: Identifier. The mappings for MedicationDispense.identifier do not cover the following types based on type expansion: assigner, period, system, type, use, value. This is a business identifier, not a resource identifier.

The purpose of this identifier.

This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Identifies the purpose for this identifier, if known .

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage.

Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Allows users to make use of identifiers when the identifier system is not known.

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension.

Time period during which identifier is/was valid for use.

Organization that issued/manages the identifier.

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

The procedure that the dispense is done because of.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4B: MedicationDispense.partOf additional types from child elements (display, identifier, reference, type)

Element MedicationDispense.partOf is mapped to FHIR STU3 element MedicationDispense.partOf as SourceIsBroaderThanTarget. The mappings for MedicationDispense.partOf do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element MedicationDispense.partOf with unmapped reference targets: Procedure.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

A code specifying the state of the set of dispense events.

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

A coded concept specifying the state of the dispense event.

unique id for the element within a resource (for internal references)

An Extension

R4B: MedicationDispense.status additional codes

Element MedicationDispense.status is mapped to FHIR STU3 element MedicationDispense.status as RelatedTo. The mappings for MedicationDispense.status do not allow expression of the necessary codes, per the bindings on the source and target. The target context MedicationDispense.status is a modifier element, so this extension does not need to be defined as a modifier. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Primitive value for code

Indicates type of medication dispense and where the medication is expected to be consumed or administered.

A code describing where the dispensed medication is expected to be consumed or administered

Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.

If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended.  For example if you require form or lot number, then you must reference the Medication resource. .

A coded concept identifying which substance or product can be dispensed

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4B: MedicationDispense.medication[x] additional types from child elements (display, identifier, reference, type)

Element MedicationDispense.medication[x] is mapped to FHIR STU3 element MedicationDispense.medication[x] as SourceIsBroaderThanTarget. The mappings for MedicationDispense.medication[x] do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element MedicationDispense.medication[x] with unmapped reference targets: Medication. Source element MedicationDispense.medication[x] has unmapped reference types. While the target element MedicationDispense.medication[x] is a choice type and does not allow extensions, the alternate-reference extension can be applied to Reference values within it. If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended. For example, if you require form or lot number, then you must reference the Medication resource.

A link to a resource representing the person or the group to whom the medication will be given.

SubstanceAdministration->subject->Patient.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4B: MedicationDispense.subject additional types from child elements (display, identifier, reference, type)

Element MedicationDispense.subject is mapped to FHIR STU3 element MedicationDispense.subject as SourceIsBroaderThanTarget. The mappings for MedicationDispense.subject do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element MedicationDispense.subject with unmapped reference targets: Group, Patient. SubstanceAdministration->subject->Patient.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

The encounter or episode of care that establishes the context for this event.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4B: MedicationDispense.context additional types from child elements (display, identifier, reference, type)

Element MedicationDispense.context is mapped to FHIR STU3 element MedicationDispense.context as SourceIsBroaderThanTarget. The mappings for MedicationDispense.context do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element MedicationDispense.context with unmapped reference targets: Encounter, EpisodeOfCare.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Additional information that supports the medication being dispensed.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4B: MedicationDispense.supportingInformation additional types from child elements (display, identifier, reference, type)

Element MedicationDispense.supportingInformation is mapped to FHIR STU3 element MedicationDispense.supportingInformation as SourceIsBroaderThanTarget. The mappings for MedicationDispense.supportingInformation do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element MedicationDispense.supportingInformation with unmapped reference targets: Resource.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Indicates who or what performed the event. It should be assumed that the performer is the dispenser of the medication.

The performer will be reviewed as part of STU4.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4B: MedicationDispense.performer.function (new:CodeableConcept)

Element MedicationDispense.performer.function has a context of MedicationDispense.performer based on following the parent source element upwards and mapping to MedicationDispense. Element MedicationDispense.performer.function has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

The device, practitioner, etc. who performed the action. It should be assumed that the actor is the dispenser of the medication.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4B: MedicationDispense.performer.actor

Element MedicationDispense.performer.actor is mapped to FHIR STU3 element MedicationDispense.performer.actor as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element MedicationDispense.performer.actor with unmapped reference targets: Device, Organization, Patient, Practitioner, PractitionerRole, RelatedPerson.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

The organization the device or practitioner was acting on behalf of.

Indicates the medication order that is being dispensed against.

Maps to basedOn in Event logical model.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4B: MedicationDispense.authorizingPrescription additional types from child elements (display, identifier, reference, type)

Element MedicationDispense.authorizingPrescription is mapped to FHIR STU3 element MedicationDispense.authorizingPrescription as SourceIsBroaderThanTarget. The mappings for MedicationDispense.authorizingPrescription do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element MedicationDispense.authorizingPrescription with unmapped reference targets: MedicationRequest. Maps to basedOn in Event logical model.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc.

Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc.

The amount of medication that has been dispensed. Includes unit of measure.

The amount of medication expressed as a timing amount.

The time when the dispensed product was packaged and reviewed.

The time the dispensed product was provided to the patient or their representative.

Identification of the facility/location where the medication was shipped to, as part of the dispense event.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4B: MedicationDispense.destination additional types from child elements (display, identifier, reference, type)

Element MedicationDispense.destination is mapped to FHIR STU3 element MedicationDispense.destination as SourceIsBroaderThanTarget. The mappings for MedicationDispense.destination do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element MedicationDispense.destination with unmapped reference targets: Location.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Identifies the person who picked up the medication. This will usually be a patient or their caregiver, but some cases exist where it can be a healthcare professional.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4B: MedicationDispense.receiver additional types from child elements (display, identifier, reference, type)

Element MedicationDispense.receiver is mapped to FHIR STU3 element MedicationDispense.receiver as SourceIsBroaderThanTarget. The mappings for MedicationDispense.receiver do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element MedicationDispense.receiver with unmapped reference targets: Patient, Practitioner.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Extra information about the dispense that could not be conveyed in the other attributes.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4B: MedicationDispense.note additional types (Annotation) additional types from child elements (author[x], text, time)

Element MedicationDispense.note is mapped to FHIR STU3 element MedicationDispense.note as SourceIsBroaderThanTarget. The mappings for MedicationDispense.note do not cover the following types: Annotation. The mappings for MedicationDispense.note do not cover the following types based on type expansion: author[x], text, time.

The individual responsible for making the annotation.

Indicates when this particular annotation was made.

The text of the annotation.

Indicates how the medication is to be used by the patient.

When the dose or rate is intended to change over the entire administration period (e.g. Tapering dose prescriptions), multiple instances of dosage instructions will need to be supplied to convey the different doses/rates. The pharmacist reviews the medication order prior to dispense and updates the dosageInstruction based on the actual product being dispensed.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4B: MedicationDispense.dosageInstruction additional types (Dosage) additional types from child elements (additionalInstruction, asNeeded[x], doseAndRate, dose[x], rate[x], type, maxDosePerAdministration, maxDosePerLifetime, maxDosePerPeriod, method, patientInstruction, route, sequence, site, text, timing)

Element MedicationDispense.dosageInstruction is mapped to FHIR STU3 element MedicationDispense.dosageInstruction as SourceIsBroaderThanTarget. The mappings for MedicationDispense.dosageInstruction do not cover the following types: Dosage. The mappings for MedicationDispense.dosageInstruction do not cover the following types based on type expansion: additionalInstruction, asNeeded[x], dose[x], doseAndRate, maxDosePerAdministration, maxDosePerLifetime, maxDosePerPeriod, method, patientInstruction, rate[x], route, sequence, site, text, timing, type. When the dose or rate is intended to change over the entire administration period (e.g. Tapering dose prescriptions), multiple instances of dosage instructions will need to be supplied to convey the different doses/rates. The pharmacist reviews the medication order prior to dispense and updates the dosageInstruction based on the actual product being dispensed.

Indicates the order in which the dosage instructions should be applied or interpreted.

If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. If the sequence number is different, then the Dosages are intended to be sequential.

Free text dosage instructions e.g. SIG.

Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing.

Supplemental instruction - e.g. "with meals".

A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".

Additional instruction such as "Swallow with plenty of water" which may or may not be coded.

Instructions in terms that are understood by the patient or consumer.

When medication should be administered.

This attribute may not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.

The timing schedule for giving the medication to the patient. The Schedule data type allows many different expressions. For example: "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept).

Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not "prn" or "as needed".

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.

Body site to administer to.

If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension body-site-instance. May be a summary code, or a reference to a very precise definition of the location, or both.

A coded concept describing the site location the medicine enters into or onto the body.

A coded specification of the anatomic site where the medication first enters the body.

How drug should enter body.

A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.

Technique for administering medication.

Terminologies used often pre-coordinate this term with the route and or form of administration.

A coded concept describing the technique by which the medicine is administered.

A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV.

Amount of medication per dose.

Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.

The amount of therapeutic or other substance given at one administration event.

Upper limit on medication per unit of time.

This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".

The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours.

Upper limit on medication per administration.

This is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg.

The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.

Upper limit on medication per lifetime of the patient.

The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.

Amount of medication per unit of time.

It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate.

Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

Indicates whether or not substitution was made as part of the dispense. In some cases substitution will be expected but does not happen, in other cases substitution is not expected but does happen. This block explains what substitution did or did not happen and why. If nothing is specified, substitution was not done.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

True if the dispenser dispensed a different drug or product from what was prescribed.

A code signifying whether a different drug was dispensed from what was prescribed.

A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription

Indicates the reason for the substitution of (or lack of substitution) from what was prescribed.

A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed

The person or organization that has primary responsibility for the substitution.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4B: MedicationDispense.substitution.responsibleParty additional types from child elements (display, identifier, reference, type)

Element MedicationDispense.substitution.responsibleParty is mapped to FHIR STU3 element MedicationDispense.substitution.responsibleParty as SourceIsBroaderThanTarget. The mappings for MedicationDispense.substitution.responsibleParty do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element MedicationDispense.substitution.responsibleParty with unmapped reference targets: Practitioner, PractitionerRole.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. Drug-drug interaction, duplicate therapy, dosage alert etc.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4B: MedicationDispense.detectedIssue additional types from child elements (display, identifier, reference, type)

Element MedicationDispense.detectedIssue is mapped to FHIR STU3 element MedicationDispense.detectedIssue as SourceIsBroaderThanTarget. The mappings for MedicationDispense.detectedIssue do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4B element MedicationDispense.detectedIssue with unmapped reference targets: DetectedIssue. This element can include a detected issue that has been identified either by a decision support system or by a clinician and may include information on the steps that were taken to address the issue.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

True if the dispense was not performed for some reason.

Indicates the reason why a dispense was not performed.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension