US Core Implementation Guide
8.0.0-ballot - STU8 Ballot United States of America flag

This page is part of the US Core (v8.0.0-ballot: STU8 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 7.0.0. For a full list of available versions, see the Directory of published versions

Resource Profile: US Core MedicationDispense Profile

Official URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationdispense Version: 8.0.0-ballot
Standards status: Trial-use Maturity Level: 3 Computable Name: USCoreMedicationDispenseProfile
Other Identifiers: OID:2.16.840.1.113883.4.642.40.2.42.38

Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

The US Core MedicationDispense Profile inherits from the FHIR MedicationDispense resource; refer to it for scope and usage definitions. This profile sets minimum expectations for the MedicationDispense resource to record, search, and fetch the state of a patients medication with regards to dispensing or other activity. (e.g., dispensed, partially dispensed, not dispensed) It specifies which core elements, extensions, vocabularies, and value sets SHALL be present and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption.

Example Usage Scenarios:

The following are example usage scenarios for the US Core-MedicationDispense profile:

  • Fetching dispense statuses for medications that have been prescribed to a particular patient
  • Record or update dispense statuses for medications that have been prescribed for a particular patient

Mandatory and Must Support Data Elements

The following data elements must always be present (Mandatory definition) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements.

Each MedicationDispense Must Have:

  1. a status (e.g., dispensed, not dispensed)
  2. a medication*
  3. a patient

* see guidance below

Each MedicationDispense Must Support:

  1. the encounter associated with the dispense
  2. who dispensed the medication
  3. the authorizing prescription
  4. type of dispense (e.g., partially dispensed)
  5. the quantity dispensed
  6. a date for when medication was dispensed to the patient
  7. free text dosage instructions (the SIG)
  8. when medication should be administered
  9. the route of administration
  10. the dose and rate

Profile Specific Implementation Guidance:

  • The MedicationDispense resource is used to represent the USCDI medication fill status.
  • *This Profile can represent a medication using a code or reference a Medication resource.
    • When using a code, RXNorm concepts are used. They are defined as an extensible binding to .medicationCodeableConcept. USCDI recommends the National Drug Codes (NDC) as an optional terminology. They can be supplied as an additional coding element.
      • Systems that primarily rely on NDC codes instead of RxNorm to represent medications can use the National Library of Medicine's (NLM) NDC to RxNorm mappings to aid in translations.
    • When referencing a Medication resource in .medicationReference, the resource may be contained or an external resource.
    • The Server systems are not required to support both a code and a reference, but SHALL support at least one of these methods.
    • If an external reference to a Medication resource is used, the Server SHALL support the _include parameter for searching this element.
    • The Client application SHALL support all methods.

Usage:

Changes since version 7.0.0:

  • The data elements list has changed

    • Formal Views of Profile Content

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

    This structure is derived from MedicationDispense

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. MedicationDispense C 0..* MedicationDispense Dispensing a medication to a named patient
    us-core-20: whenHandedOver SHALL be present if the status is "completed"
    ... status SC 1..1 code preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
    ... medication[x] S 1..1 What medication was supplied
    Binding: Medication Clinical Drug . (extensible)
    .... medicationCodeableConcept CodeableConcept
    .... medicationReference Reference(US Core Medication Profile)
    ... subject S 1..1 Reference(US Core Patient Profile S | Group) Who the dispense is for
    ... context S 0..1 Reference(US Core Encounter Profile S | EpisodeOfCare) Encounter associated with MedicationDispense
    ... performer S 0..* BackboneElement Who performed event
    .... actor S 1..1 Reference(US Core Practitioner Profile S | US Core Patient Profile | US Core Organization Profile S | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) Individual who was performing
    ... authorizingPrescription S 0..* Reference(US Core MedicationRequest Profile) Medication order that authorizes the dispense
    ... type S 0..1 CodeableConcept Trial fill, partial fill, emergency fill, etc.
    Binding: ActPharmacySupplyType (extensible)
    ... quantity S 0..1 SimpleQuantity Amount dispensed
    Binding: Common UCUM units (preferred)
    Additional BindingsPurpose
    UCUMCodes Max Binding
    ... whenHandedOver SC 0..1 dateTime When product was given out or mailed
    ... dosageInstruction S 0..* Dosage How the medication is to be used by the patient or administered by the caregiver
    .... text S 0..1 string Free text dosage instructions e.g. SIG
    .... timing S 0..1 Timing When medication should be administered
    .... route S 0..1 CodeableConcept How drug should enter body
    Binding: Route of Administration of Therapeutic Agents . (extensible): SNOMED CT and NCI Thesaurus SPL route of administration codes

    .... doseAndRate S 0..* Element Amount of medication administered
    ..... dose[x] S 0..1 Amount of medication per dose
    Binding: Common UCUM units (preferred)
    Additional BindingsPurpose
    UCUMCodes Max Binding
    ...... doseQuantity Quantity S(SimpleQuantity)
    ...... doseRange Range

    doco Documentation for this format

    Terminology Bindings (Differential)

    PathConformanceValueSetURI
    MedicationDispense.medication[x]extensibleMedicationClinicalDrug .
    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
    http://hl7.org/fhir/ValueSet/ucum-common
    from the FHIR Standard
    Additional Bindings Purpose
    UCUMCodes Max Binding
    MedicationDispense.dosageInstruction.routeextensibleRouteOfAdministrationOfTherapeuticAgents .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.22
    MedicationDispense.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
    http://hl7.org/fhir/ValueSet/ucum-common
    from the FHIR Standard
    Additional Bindings Purpose
    UCUMCodes Max Binding

    Constraints

    IdGradePath(s)DetailsRequirements
    us-core-20errorMedicationDispensewhenHandedOver SHALL be present if the status is "completed"
    : status='completed' implies whenHandedOver.exists()
    NameFlagsCard.TypeDescription & Constraintsdoco
    .. MedicationDispense C 0..* MedicationDispense Dispensing a medication to a named patient
    dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
    dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    dom-6: A resource should have narrative for robust management
    mdd-1: whenHandedOver cannot be before whenPrepared
    us-core-20: whenHandedOver SHALL be present if the status is "completed"
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ele-1: All FHIR elements must have a @value or children
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ... status ?!SΣC 1..1 code preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
    Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event.


    ele-1: All FHIR elements must have a @value or children
    ... medication[x] SΣ 1..1 What medication was supplied
    Binding: Medication Clinical Drug . (extensible)
    ele-1: All FHIR elements must have a @value or children
    .... medicationCodeableConcept CodeableConcept
    .... medicationReference Reference(US Core Medication Profile)
    ... subject SΣ 1..1 Reference(US Core Patient Profile) Who the dispense is for
    ele-1: All FHIR elements must have a @value or children
    ... context S 0..1 Reference(US Core Encounter Profile) Encounter associated with MedicationDispense
    ele-1: All FHIR elements must have a @value or children
    ... performer S 0..* BackboneElement Who performed event
    ele-1: All FHIR elements must have a @value or children
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    .... actor S 1..1 Reference(US Core Practitioner Profile | US Core Organization Profile) Individual who was performing
    ele-1: All FHIR elements must have a @value or children
    ... authorizingPrescription S 0..* Reference(US Core MedicationRequest Profile) Medication order that authorizes the dispense
    ele-1: All FHIR elements must have a @value or children
    ... type S 0..1 CodeableConcept Trial fill, partial fill, emergency fill, etc.
    Binding: ActPharmacySupplyType (extensible)
    ele-1: All FHIR elements must have a @value or children
    ... quantity S 0..1 SimpleQuantity Amount dispensed
    Binding: Common UCUM units (preferred)
    Additional BindingsPurpose
    UCUMCodes Max Binding

    ele-1: All FHIR elements must have a @value or children
    ... whenHandedOver SC 0..1 dateTime When product was given out or mailed
    ele-1: All FHIR elements must have a @value or children
    ... dosageInstruction S 0..* Dosage How the medication is to be used by the patient or administered by the caregiver
    ele-1: All FHIR elements must have a @value or children
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    .... text SΣ 0..1 string Free text dosage instructions e.g. SIG
    ele-1: All FHIR elements must have a @value or children
    .... timing SΣ 0..1 Timing When medication should be administered
    ele-1: All FHIR elements must have a @value or children
    .... route SΣ 0..1 CodeableConcept How drug should enter body
    Binding: Route of Administration of Therapeutic Agents . (extensible): SNOMED CT and NCI Thesaurus SPL route of administration codes


    ele-1: All FHIR elements must have a @value or children
    .... doseAndRate SΣ 0..* Element Amount of medication administered
    ele-1: All FHIR elements must have a @value or children
    ..... dose[x] SΣ 0..1 Amount of medication per dose
    Binding: Common UCUM units (preferred)
    Additional BindingsPurpose
    UCUMCodes Max Binding

    ele-1: All FHIR elements must have a @value or children
    ...... doseQuantity Quantity(SimpleQuantity)

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSetURI
    MedicationDispense.statusrequiredMedicationDispense Status Codes
    http://hl7.org/fhir/ValueSet/medicationdispense-status|4.0.1
    from the FHIR Standard
    MedicationDispense.medication[x]extensibleMedicationClinicalDrug .
    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
    http://hl7.org/fhir/ValueSet/ucum-common
    from the FHIR Standard
    Additional Bindings Purpose
    UCUMCodes Max Binding
    MedicationDispense.dosageInstruction.routeextensibleRouteOfAdministrationOfTherapeuticAgents .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.22
    MedicationDispense.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
    http://hl7.org/fhir/ValueSet/ucum-common
    from the FHIR Standard
    Additional Bindings Purpose
    UCUMCodes Max Binding

    Constraints

    IdGradePath(s)DetailsRequirements
    us-core-20errorMedicationDispensewhenHandedOver SHALL be present if the status is "completed"
    : status='completed' implies whenHandedOver.exists()
    NameFlagsCard.TypeDescription & Constraintsdoco
    .. MedicationDispense C 0..* MedicationDispense Dispensing 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"
    ... id Σ 0..1 id Logical id of this artifact
    ... meta Σ 0..1 Meta Metadata about the resource
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... language 0..1 code Language of the resource content
    Binding: CommonLanguages (preferred): A human language.

    Additional BindingsPurpose
    AllLanguages Max Binding
    ... text 0..1 Narrative Text summary of the resource, for human interpretation
    ... contained 0..* Resource Contained, inline Resources
    ... extension 0..* Extension Additional content defined by implementations
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... identifier 0..* Identifier External identifier
    ... partOf 0..* Reference(Procedure) Event that dispense is part of
    ... status ?!SΣC 1..1 code preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
    Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event.

    ... statusReason[x] 0..1 Why a dispense was not performed
    Binding: MedicationDispense Status Reason Codes (example): A code describing why a dispense was not performed.

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

    ... medication[x] SΣ 1..1 What medication was supplied
    Binding: Medication Clinical Drug . (extensible)
    .... medicationCodeableConcept CodeableConcept
    .... medicationReference Reference(US Core Medication Profile)
    ... subject SΣ 1..1 Reference(US Core Patient Profile S | Group) Who the dispense is for
    ... context S 0..1 Reference(US Core Encounter Profile S | EpisodeOfCare) Encounter associated with MedicationDispense
    ... supportingInformation 0..* Reference(Resource) Information that supports the dispensing of the medication
    ... performer S 0..* BackboneElement Who performed event
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... function 0..1 CodeableConcept Who performed the dispense and what they did
    Binding: MedicationDispense Performer Function Codes (example): A code describing the role an individual played in dispensing a medication.

    .... actor S 1..1 Reference(US Core Practitioner Profile S | US Core Patient Profile | US Core Organization Profile S | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) Individual who was performing
    ... location 0..1 Reference(Location) Where the dispense occurred
    ... authorizingPrescription S 0..* Reference(US Core MedicationRequest Profile) Medication order that authorizes the dispense
    ... type S 0..1 CodeableConcept Trial fill, partial fill, emergency fill, etc.
    Binding: ActPharmacySupplyType (extensible)
    ... quantity S 0..1 SimpleQuantity Amount dispensed
    Binding: Common UCUM units (preferred)
    Additional BindingsPurpose
    UCUMCodes Max Binding
    ... daysSupply 0..1 SimpleQuantity Amount of medication expressed as a timing amount
    ... whenPrepared Σ 0..1 dateTime When product was packaged and reviewed
    ... whenHandedOver SC 0..1 dateTime When product was given out or mailed
    ... destination 0..1 Reference(Location) Where the medication was sent
    ... receiver 0..* Reference(Patient | Practitioner) Who collected the medication
    ... note 0..* Annotation Information about the dispense
    ... dosageInstruction S 0..* Dosage How the medication is to be used by the patient or administered by the caregiver
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... sequence Σ 0..1 integer The order of the dosage instructions
    .... text SΣ 0..1 string Free text dosage instructions e.g. SIG
    .... additionalInstruction Σ 0..* CodeableConcept Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
    Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".


    .... patientInstruction Σ 0..1 string Patient or consumer oriented instructions
    .... timing SΣ 0..1 Timing When medication should be administered
    .... asNeeded[x] Σ 0..1 Take "as needed" (for x)
    Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.

    ..... asNeededBoolean boolean
    ..... asNeededCodeableConcept CodeableConcept
    .... site Σ 0..1 CodeableConcept Body site to administer to
    Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.

    .... route SΣ 0..1 CodeableConcept How drug should enter body
    Binding: Route of Administration of Therapeutic Agents . (extensible): SNOMED CT and NCI Thesaurus SPL route of administration codes

    .... method Σ 0..1 CodeableConcept Technique for administering medication
    Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.

    .... doseAndRate SΣ 0..* Element Amount of medication administered
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... type Σ 0..1 CodeableConcept The kind of dose or rate specified
    Binding: DoseAndRateType (example): The kind of dose or rate specified.

    ..... dose[x] SΣ 0..1 Amount of medication per dose
    Binding: Common UCUM units (preferred)
    Additional BindingsPurpose
    UCUMCodes Max Binding
    ...... doseQuantity Quantity S(SimpleQuantity)
    ...... doseRange Range
    ..... rate[x] Σ 0..1 Amount of medication per unit of time
    ...... rateRatio Ratio
    ...... rateRange Range
    ...... rateQuantity Quantity(SimpleQuantity)
    .... maxDosePerPeriod Σ 0..1 Ratio Upper limit on medication per unit of time
    .... maxDosePerAdministration Σ 0..1 SimpleQuantity Upper limit on medication per administration
    .... maxDosePerLifetime Σ 0..1 SimpleQuantity Upper limit on medication per lifetime of the patient
    ... substitution 0..1 BackboneElement Whether a substitution was performed on the dispense
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... wasSubstituted 1..1 boolean Whether a substitution was or was not performed on the dispense
    .... type 0..1 CodeableConcept Code signifying whether a different drug was dispensed from what was prescribed
    Binding: ActSubstanceAdminSubstitutionCode (example): A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription.

    .... reason 0..* CodeableConcept Why was substitution made
    Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.


    .... responsibleParty 0..* Reference(Practitioner | PractitionerRole) Who is responsible for the substitution
    ... detectedIssue 0..* Reference(DetectedIssue) Clinical issue with action
    ... eventHistory 0..* Reference(Provenance) A list of relevant lifecycle events

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSetURI
    MedicationDispense.languagepreferredCommonLanguages
    http://hl7.org/fhir/ValueSet/languages
    from the FHIR Standard
    Additional Bindings Purpose
    AllLanguages Max Binding
    MedicationDispense.statusrequiredMedicationDispense Status Codes
    http://hl7.org/fhir/ValueSet/medicationdispense-status|4.0.1
    from the FHIR Standard
    MedicationDispense.statusReason[x]exampleMedicationDispense Status Reason Codes
    http://hl7.org/fhir/ValueSet/medicationdispense-status-reason
    from the FHIR Standard
    MedicationDispense.categorypreferredMedicationDispense Category Codes
    http://hl7.org/fhir/ValueSet/medicationdispense-category
    from the FHIR Standard
    MedicationDispense.medication[x]extensibleMedicationClinicalDrug .
    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
    http://hl7.org/fhir/ValueSet/ucum-common
    from the FHIR Standard
    Additional Bindings Purpose
    UCUMCodes Max Binding
    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.routeextensibleRouteOfAdministrationOfTherapeuticAgents .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.22
    MedicationDispense.dosageInstruction.methodexampleSNOMEDCTAdministrationMethodCodes
    http://hl7.org/fhir/ValueSet/administration-method-codes
    from the FHIR Standard
    MedicationDispense.dosageInstruction.doseAndRate.typeexampleDoseAndRateType
    http://hl7.org/fhir/ValueSet/dose-rate-type
    from the FHIR Standard
    MedicationDispense.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
    http://hl7.org/fhir/ValueSet/ucum-common
    from the FHIR Standard
    Additional Bindings Purpose
    UCUMCodes Max Binding
    MedicationDispense.substitution.typeexampleActSubstanceAdminSubstitutionCode
    http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode
    MedicationDispense.substitution.reasonexampleSubstanceAdminSubstitutionReason
    http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason

    Constraints

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

    Differential View

    This structure is derived from MedicationDispense

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. MedicationDispense C 0..* MedicationDispense Dispensing a medication to a named patient
    us-core-20: whenHandedOver SHALL be present if the status is "completed"
    ... status SC 1..1 code preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
    ... medication[x] S 1..1 What medication was supplied
    Binding: Medication Clinical Drug . (extensible)
    .... medicationCodeableConcept CodeableConcept
    .... medicationReference Reference(US Core Medication Profile)
    ... subject S 1..1 Reference(US Core Patient Profile S | Group) Who the dispense is for
    ... context S 0..1 Reference(US Core Encounter Profile S | EpisodeOfCare) Encounter associated with MedicationDispense
    ... performer S 0..* BackboneElement Who performed event
    .... actor S 1..1 Reference(US Core Practitioner Profile S | US Core Patient Profile | US Core Organization Profile S | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) Individual who was performing
    ... authorizingPrescription S 0..* Reference(US Core MedicationRequest Profile) Medication order that authorizes the dispense
    ... type S 0..1 CodeableConcept Trial fill, partial fill, emergency fill, etc.
    Binding: ActPharmacySupplyType (extensible)
    ... quantity S 0..1 SimpleQuantity Amount dispensed
    Binding: Common UCUM units (preferred)
    Additional BindingsPurpose
    UCUMCodes Max Binding
    ... whenHandedOver SC 0..1 dateTime When product was given out or mailed
    ... dosageInstruction S 0..* Dosage How the medication is to be used by the patient or administered by the caregiver
    .... text S 0..1 string Free text dosage instructions e.g. SIG
    .... timing S 0..1 Timing When medication should be administered
    .... route S 0..1 CodeableConcept How drug should enter body
    Binding: Route of Administration of Therapeutic Agents . (extensible): SNOMED CT and NCI Thesaurus SPL route of administration codes

    .... doseAndRate S 0..* Element Amount of medication administered
    ..... dose[x] S 0..1 Amount of medication per dose
    Binding: Common UCUM units (preferred)
    Additional BindingsPurpose
    UCUMCodes Max Binding
    ...... doseQuantity Quantity S(SimpleQuantity)
    ...... doseRange Range

    doco Documentation for this format

    Terminology Bindings (Differential)

    PathConformanceValueSetURI
    MedicationDispense.medication[x]extensibleMedicationClinicalDrug .
    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
    http://hl7.org/fhir/ValueSet/ucum-common
    from the FHIR Standard
    Additional Bindings Purpose
    UCUMCodes Max Binding
    MedicationDispense.dosageInstruction.routeextensibleRouteOfAdministrationOfTherapeuticAgents .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.22
    MedicationDispense.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
    http://hl7.org/fhir/ValueSet/ucum-common
    from the FHIR Standard
    Additional Bindings Purpose
    UCUMCodes Max Binding

    Constraints

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

    Key Elements View

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. MedicationDispense C 0..* MedicationDispense Dispensing a medication to a named patient
    dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
    dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    dom-6: A resource should have narrative for robust management
    mdd-1: whenHandedOver cannot be before whenPrepared
    us-core-20: whenHandedOver SHALL be present if the status is "completed"
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ele-1: All FHIR elements must have a @value or children
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    ... status ?!SΣC 1..1 code preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
    Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event.


    ele-1: All FHIR elements must have a @value or children
    ... medication[x] SΣ 1..1 What medication was supplied
    Binding: Medication Clinical Drug . (extensible)
    ele-1: All FHIR elements must have a @value or children
    .... medicationCodeableConcept CodeableConcept
    .... medicationReference Reference(US Core Medication Profile)
    ... subject SΣ 1..1 Reference(US Core Patient Profile) Who the dispense is for
    ele-1: All FHIR elements must have a @value or children
    ... context S 0..1 Reference(US Core Encounter Profile) Encounter associated with MedicationDispense
    ele-1: All FHIR elements must have a @value or children
    ... performer S 0..* BackboneElement Who performed event
    ele-1: All FHIR elements must have a @value or children
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    .... actor S 1..1 Reference(US Core Practitioner Profile | US Core Organization Profile) Individual who was performing
    ele-1: All FHIR elements must have a @value or children
    ... authorizingPrescription S 0..* Reference(US Core MedicationRequest Profile) Medication order that authorizes the dispense
    ele-1: All FHIR elements must have a @value or children
    ... type S 0..1 CodeableConcept Trial fill, partial fill, emergency fill, etc.
    Binding: ActPharmacySupplyType (extensible)
    ele-1: All FHIR elements must have a @value or children
    ... quantity S 0..1 SimpleQuantity Amount dispensed
    Binding: Common UCUM units (preferred)
    Additional BindingsPurpose
    UCUMCodes Max Binding

    ele-1: All FHIR elements must have a @value or children
    ... whenHandedOver SC 0..1 dateTime When product was given out or mailed
    ele-1: All FHIR elements must have a @value or children
    ... dosageInstruction S 0..* Dosage How the medication is to be used by the patient or administered by the caregiver
    ele-1: All FHIR elements must have a @value or children
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    ele-1: All FHIR elements must have a @value or children
    ext-1: Must have either extensions or value[x], not both
    .... text SΣ 0..1 string Free text dosage instructions e.g. SIG
    ele-1: All FHIR elements must have a @value or children
    .... timing SΣ 0..1 Timing When medication should be administered
    ele-1: All FHIR elements must have a @value or children
    .... route SΣ 0..1 CodeableConcept How drug should enter body
    Binding: Route of Administration of Therapeutic Agents . (extensible): SNOMED CT and NCI Thesaurus SPL route of administration codes


    ele-1: All FHIR elements must have a @value or children
    .... doseAndRate SΣ 0..* Element Amount of medication administered
    ele-1: All FHIR elements must have a @value or children
    ..... dose[x] SΣ 0..1 Amount of medication per dose
    Binding: Common UCUM units (preferred)
    Additional BindingsPurpose
    UCUMCodes Max Binding

    ele-1: All FHIR elements must have a @value or children
    ...... doseQuantity Quantity(SimpleQuantity)

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSetURI
    MedicationDispense.statusrequiredMedicationDispense Status Codes
    http://hl7.org/fhir/ValueSet/medicationdispense-status|4.0.1
    from the FHIR Standard
    MedicationDispense.medication[x]extensibleMedicationClinicalDrug .
    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
    http://hl7.org/fhir/ValueSet/ucum-common
    from the FHIR Standard
    Additional Bindings Purpose
    UCUMCodes Max Binding
    MedicationDispense.dosageInstruction.routeextensibleRouteOfAdministrationOfTherapeuticAgents .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.22
    MedicationDispense.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
    http://hl7.org/fhir/ValueSet/ucum-common
    from the FHIR Standard
    Additional Bindings Purpose
    UCUMCodes Max Binding

    Constraints

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

    Snapshot View

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. MedicationDispense C 0..* MedicationDispense Dispensing 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"
    ... id Σ 0..1 id Logical id of this artifact
    ... meta Σ 0..1 Meta Metadata about the resource
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... language 0..1 code Language of the resource content
    Binding: CommonLanguages (preferred): A human language.

    Additional BindingsPurpose
    AllLanguages Max Binding
    ... text 0..1 Narrative Text summary of the resource, for human interpretation
    ... contained 0..* Resource Contained, inline Resources
    ... extension 0..* Extension Additional content defined by implementations
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... identifier 0..* Identifier External identifier
    ... partOf 0..* Reference(Procedure) Event that dispense is part of
    ... status ?!SΣC 1..1 code preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
    Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event.

    ... statusReason[x] 0..1 Why a dispense was not performed
    Binding: MedicationDispense Status Reason Codes (example): A code describing why a dispense was not performed.

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

    ... medication[x] SΣ 1..1 What medication was supplied
    Binding: Medication Clinical Drug . (extensible)
    .... medicationCodeableConcept CodeableConcept
    .... medicationReference Reference(US Core Medication Profile)
    ... subject SΣ 1..1 Reference(US Core Patient Profile S | Group) Who the dispense is for
    ... context S 0..1 Reference(US Core Encounter Profile S | EpisodeOfCare) Encounter associated with MedicationDispense
    ... supportingInformation 0..* Reference(Resource) Information that supports the dispensing of the medication
    ... performer S 0..* BackboneElement Who performed event
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... function 0..1 CodeableConcept Who performed the dispense and what they did
    Binding: MedicationDispense Performer Function Codes (example): A code describing the role an individual played in dispensing a medication.

    .... actor S 1..1 Reference(US Core Practitioner Profile S | US Core Patient Profile | US Core Organization Profile S | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) Individual who was performing
    ... location 0..1 Reference(Location) Where the dispense occurred
    ... authorizingPrescription S 0..* Reference(US Core MedicationRequest Profile) Medication order that authorizes the dispense
    ... type S 0..1 CodeableConcept Trial fill, partial fill, emergency fill, etc.
    Binding: ActPharmacySupplyType (extensible)
    ... quantity S 0..1 SimpleQuantity Amount dispensed
    Binding: Common UCUM units (preferred)
    Additional BindingsPurpose
    UCUMCodes Max Binding
    ... daysSupply 0..1 SimpleQuantity Amount of medication expressed as a timing amount
    ... whenPrepared Σ 0..1 dateTime When product was packaged and reviewed
    ... whenHandedOver SC 0..1 dateTime When product was given out or mailed
    ... destination 0..1 Reference(Location) Where the medication was sent
    ... receiver 0..* Reference(Patient | Practitioner) Who collected the medication
    ... note 0..* Annotation Information about the dispense
    ... dosageInstruction S 0..* Dosage How the medication is to be used by the patient or administered by the caregiver
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... sequence Σ 0..1 integer The order of the dosage instructions
    .... text SΣ 0..1 string Free text dosage instructions e.g. SIG
    .... additionalInstruction Σ 0..* CodeableConcept Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
    Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".


    .... patientInstruction Σ 0..1 string Patient or consumer oriented instructions
    .... timing SΣ 0..1 Timing When medication should be administered
    .... asNeeded[x] Σ 0..1 Take "as needed" (for x)
    Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.

    ..... asNeededBoolean boolean
    ..... asNeededCodeableConcept CodeableConcept
    .... site Σ 0..1 CodeableConcept Body site to administer to
    Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.

    .... route SΣ 0..1 CodeableConcept How drug should enter body
    Binding: Route of Administration of Therapeutic Agents . (extensible): SNOMED CT and NCI Thesaurus SPL route of administration codes

    .... method Σ 0..1 CodeableConcept Technique for administering medication
    Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.

    .... doseAndRate SΣ 0..* Element Amount of medication administered
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... type Σ 0..1 CodeableConcept The kind of dose or rate specified
    Binding: DoseAndRateType (example): The kind of dose or rate specified.

    ..... dose[x] SΣ 0..1 Amount of medication per dose
    Binding: Common UCUM units (preferred)
    Additional BindingsPurpose
    UCUMCodes Max Binding
    ...... doseQuantity Quantity S(SimpleQuantity)
    ...... doseRange Range
    ..... rate[x] Σ 0..1 Amount of medication per unit of time
    ...... rateRatio Ratio
    ...... rateRange Range
    ...... rateQuantity Quantity(SimpleQuantity)
    .... maxDosePerPeriod Σ 0..1 Ratio Upper limit on medication per unit of time
    .... maxDosePerAdministration Σ 0..1 SimpleQuantity Upper limit on medication per administration
    .... maxDosePerLifetime Σ 0..1 SimpleQuantity Upper limit on medication per lifetime of the patient
    ... substitution 0..1 BackboneElement Whether a substitution was performed on the dispense
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    .... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
    .... wasSubstituted 1..1 boolean Whether a substitution was or was not performed on the dispense
    .... type 0..1 CodeableConcept Code signifying whether a different drug was dispensed from what was prescribed
    Binding: ActSubstanceAdminSubstitutionCode (example): A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription.

    .... reason 0..* CodeableConcept Why was substitution made
    Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.


    .... responsibleParty 0..* Reference(Practitioner | PractitionerRole) Who is responsible for the substitution
    ... detectedIssue 0..* Reference(DetectedIssue) Clinical issue with action
    ... eventHistory 0..* Reference(Provenance) A list of relevant lifecycle events

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSetURI
    MedicationDispense.languagepreferredCommonLanguages
    http://hl7.org/fhir/ValueSet/languages
    from the FHIR Standard
    Additional Bindings Purpose
    AllLanguages Max Binding
    MedicationDispense.statusrequiredMedicationDispense Status Codes
    http://hl7.org/fhir/ValueSet/medicationdispense-status|4.0.1
    from the FHIR Standard
    MedicationDispense.statusReason[x]exampleMedicationDispense Status Reason Codes
    http://hl7.org/fhir/ValueSet/medicationdispense-status-reason
    from the FHIR Standard
    MedicationDispense.categorypreferredMedicationDispense Category Codes
    http://hl7.org/fhir/ValueSet/medicationdispense-category
    from the FHIR Standard
    MedicationDispense.medication[x]extensibleMedicationClinicalDrug .
    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
    http://hl7.org/fhir/ValueSet/ucum-common
    from the FHIR Standard
    Additional Bindings Purpose
    UCUMCodes Max Binding
    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.routeextensibleRouteOfAdministrationOfTherapeuticAgents .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.22
    MedicationDispense.dosageInstruction.methodexampleSNOMEDCTAdministrationMethodCodes
    http://hl7.org/fhir/ValueSet/administration-method-codes
    from the FHIR Standard
    MedicationDispense.dosageInstruction.doseAndRate.typeexampleDoseAndRateType
    http://hl7.org/fhir/ValueSet/dose-rate-type
    from the FHIR Standard
    MedicationDispense.dosageInstruction.doseAndRate.dose[x]preferredCommon UCUM units
    http://hl7.org/fhir/ValueSet/ucum-common
    from the FHIR Standard
    Additional Bindings Purpose
    UCUMCodes Max Binding
    MedicationDispense.substitution.typeexampleActSubstanceAdminSubstitutionCode
    http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode
    MedicationDispense.substitution.reasonexampleSubstanceAdminSubstitutionReason
    http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason

    Constraints

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

     

    Other representations of profile: CSV, Excel, Schematron

    Notes:

    Quick Start

    Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile's information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

    • See the Scopes Format section for a description of the SMART scopes syntax.
    • See the Search Syntax section for a description of the US Core search syntax.
    • See the General Requirements section for additional rules and expectations when a Server requires status parameters.
    • See the General Guidance section for additional guidance on searching for multiple patients.

    US Core Scopes

    Servers providing access to dispensed medication data SHALL support these US Core SMART Scopes:

    Mandatory Search Parameters:

    1. SHALL support searching using the patient search parameter:

      • including optional support for these _include parameters: MedicationDispense:medication

      GET [base]/MedicationDispense?patient={Type/}[id]

      Example:

      1. GET [base]/MedicationDispense?patient=14676
      2. GET [base]/MedicationStatement?patient=14676&_include=MedicationDispense:medication

      Implementation Notes: Fetches a bundle of all MedicationDispense resources for the specified patient. (how to search by reference)

    Optional Search Parameters:

    The following search parameter combinations SHOULD be supported:

    1. SHOULD support searching using the combination of the patient and status search parameters:
      • including optional support for these _include parameters: MedicationDispense:medication
      • including support for OR search on status (e.g.status={system|}[code],{system|}[code],...)

      GET [base]/MedicationDispense?patient={Type/}[id]&status={system|}[code]{,{system|}[code],...}

      Example:

      1. GET [base]/MedicationDispense?patient=1137192&status=completed
      2. GET [base]/MedicationDispense?patient=1137192&status=completed&_include=MedicationDispense:medication

      Implementation Notes: Fetches a bundle of all MedicationDispense resources for the specified patient that have a given dispense status (e.g., dispensed, not dispensed)). (how to search by reference and how to search by token)

    2. SHOULD support searching using the combination of the patient and status and type search parameters:
      • including optional support for these _include parameters: MedicationDispense:medication
      • including support for OR search on status (e.g.status={system|}[code],{system|}[code],...)
      • including support for OR search on type (e.g.type={system|}[code],{system|}[code],...)

      GET [base]/MedicationDispense?patient={Type/}[id]&status={system|}[code]{,{system|}[code],...}&type={system|}[code]{,{system|}[code],...}

      Example:

      1. GET [base]/MedicationDispense?patient=1137192&status=&type=
      2. GET [base]/MedicationDispense?patient=1137192&status=&type=FFP&_include=MedicationDispense:medication

      Implementation Notes: Fetches a bundle of all MedicationDispense resources for the specified patient that have a given dispense status (e.g., dispensed, not dispensed) and type of dispense (e.g., partially dispensed). (how to search by reference and how to search by token)