R4 Ballot #1 #2 (Mixed Normative/Trial use)

This page is part of the FHIR Specification (v3.3.0: (v3.5.0: R4 Ballot 2). #2). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

11.3 Resource MedicationDispense - Content

Pharmacy Work Group Maturity Level : 2   Trial Use Compartments : Patient , Practitioner

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.

11.3.1 Scope and Usage

This resource covers the supply of medications to a patient. Examples include dispensing and pick-up from an outpatient or community pharmacy, dispensing patient-specific medications from inpatient pharmacy to ward, as well as issuing a single dose from ward stock to a patient for consumption. The medication dispense is the result of a pharmacy system responding to a medication order.

MedicationDispense is an event resource from a FHIR workflow perspective - see Workflow Event

11.3.2 Boundaries and Relationships

The Medication domain includes a number of related resources

MedicationRequest An order for both supply of the medication and the instructions for administration of the medicine to a patient.
MedicationDispense Provision of a supply of a medication with the intention that it is subsequently consumed by a patient (usually in response to a prescription).
MedicationAdministration When a patient actually consumes a medicine, or the medication is otherwise administered to them
MedicationStatement This is a record of a medication being taken by a patient or that a medication has been given to a patient, where the record is the result of a report from the patient or another clinician. A medication statement is not a part of the prescribe->dispense->administer sequence, but is a report that such a sequence (or at least a part of it) did take place, resulting in a belief that the patient has received a particular medication.

This resource does not deal with the supply or transfer of non-medication related items to a patient.

11.3.3 Background and Context

The supply and the associated administration instructions might not exactly follow the original order (prescription), either because some details were left for completion at this point in the process or because the dispenser exercised their clinical judgment to make some appropriate modification.

This resource is referenced by ChargeItem , MedicationStatement and Observation

11.3.4 Resource Content

Structure

Name Flags Card. Type Description & Constraints doco
. . MedicationDispense I TU DomainResource Dispensing a medication to a named patient
+ Rule: whenHandedOver cannot be before whenPrepared
Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier 0..* Identifier External identifier
. . . partOf 0..* Reference ( Procedure ) Event that dispense is part of
. . . status ?! Σ 1..1 code preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | unknown
MedicationDispenseStatus ( Required )
. . . category 0..1 CodeableConcept Type of medication dispense
MedicationDispenseCategory ( Preferred )
. . . medication[x] Σ 1..1 What medication was supplied
SNOMED CT Medication Codes ( Example )
. . . . medicationCodeableConcept CodeableConcept
. . . . medicationReference Reference ( Medication )
. . . subject Σ 0..1 Reference ( Patient | Group ) Who the dispense is for
. . . context 0..1 Reference ( Encounter | EpisodeOfCare ) Encounter / Episode associated with event
. . . supportingInformation 0..* Reference ( Any ) Information that supports the dispensing of the medication
. . . performer 0..* BackboneElement Who performed event
. . . . function 0..1 CodeableConcept Who performed the dispense and what they did
MedicationDispensePerformerFunction ( Example )
. . . . actor 1..1 Reference ( Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson ) Individual who was performing
. . . location 0..1 Reference ( Location ) Where the dispense occurred
. . . authorizingPrescription 0..* Reference ( MedicationRequest ) Medication order that authorizes the dispense
. . . type 0..1 CodeableConcept Trial fill, partial fill, emergency fill, etc.
ActPharmacySupplyType V3 Value SetActPharmacySupplyType ( Example )
. . . quantity 0..1 SimpleQuantity Amount dispensed
. . . daysSupply 0..1 SimpleQuantity Amount of medication expressed as a timing amount
. . . whenPrepared Σ 0..1 dateTime When product was packaged and reviewed
. . . whenHandedOver 0..1 dateTime When product was given out
. . . 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 0..* Dosage How the medication is to be used by the patient or administered by the caregiver
. . . substitution 0..1 BackboneElement Whether a substitution was performed on the dispense
. . . . 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
ActSubstanceAdminSubstitutionCode V3 Value SetActSubstanceAdminSubstitutionCode ( Example )
. . . . reason 0..* CodeableConcept Why was substitution made
SubstanceAdminSubstitutionReason V3 Value SetSubstanceAdminSubstitutionReason ( Example )
. . . . responsibleParty 0..* Reference ( Practitioner ) Who is responsible for the substitution
. . . detectedIssue 0..* Reference ( DetectedIssue ) Clinical issue with action
. . . statusReason[x] 0..1 Why a dispense was not performed
MedicationDispenseStatusReason ( Example )
. . . . statusReasonCodeableConcept CodeableConcept
. . . . statusReasonReference Reference ( DetectedIssue )
. . . eventHistory 0..* Reference ( Provenance ) A list of relevant lifecycle events

doco Documentation for this format

UML Diagram ( Legend )

MedicationDispense ( DomainResource ) Identifier assigned by the dispensing facility - this is an identifier assigned outside FHIR identifier : Identifier [0..*] The procedure that trigger the dispense partOf : Reference [0..*] « Procedure » A code specifying the state of the set of dispense events (this element modifies the meaning of other elements) status : code [1..1] « A coded concept specifying the state of the dispense event. (Strength=Required) MedicationDispenseStatus ! » Indicates the type of medication dispense and (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)) category : CodeableConcept [0..1] « A code describing where the dispensed medication is expected to be consumed or administered administered. (Strength=Preferred) MedicationDispenseCategory ? » 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 medication[x] : Type [1..1] « CodeableConcept | Reference ( Medication ); A coded concept identifying which substance or product can be dispensed dispensed. (Strength=Example) SNOMED CT Medication SNOMEDCTMedicationCodes ?? » A link to a resource representing the person or the group to whom the medication will be given subject : Reference [0..1] « Patient | Group » The encounter or episode of care that establishes the context for this event context : Reference [0..1] « Encounter | EpisodeOfCare » Additional information that supports the medication being dispensed supportingInformation : Reference [0..*] « Any » The principal physical location where the dispense was performed location : Reference [0..1] « Location » Indicates the medication order that is being dispensed against authorizingPrescription : Reference [0..*] « MedicationRequest » Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc type : CodeableConcept [0..1] « Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc. (Strength=Example) ActPharmacySupplyType v3.ActPharmacySupplyType ?? » The amount of medication that has been dispensed. Includes unit of measure quantity : Quantity ( SimpleQuantity ) [0..1] The amount of medication expressed as a timing amount daysSupply : Quantity ( SimpleQuantity ) [0..1] The time when the dispensed product was packaged and reviewed whenPrepared : dateTime [0..1] The time the dispensed product was provided to the patient or their representative whenHandedOver : dateTime [0..1] Identification of the facility/location where the medication was shipped to, as part of the dispense event destination : Reference [0..1] « Location » 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 receiver : Reference [0..*] « Patient | Practitioner » Extra information about the dispense that could not be conveyed in the other attributes note : Annotation [0..*] Indicates how the medication is to be used by the patient dosageInstruction : Dosage [0..*] 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 detectedIssue : Reference [0..*] « DetectedIssue » Indicates the reason why a dispense was not performed statusReason[x] : Type [0..1] « CodeableConcept | Reference ( DetectedIssue ); A code describing why a dispense was not performed performed. (Strength=Example) MedicationDispenseStatusReason ?? » A summary of the events of interest that have occurred, such as when the dispense was verified eventHistory : Reference [0..*] « Provenance » Performer Distinguishes the type of performer in the dispense. For example, date enterer, packager, final checker function : CodeableConcept [0..1] « A code describing the role an individual played in dispensing a medication medication. (Strength=Example) MedicationDispensePerformerFu... ?? » The device, practitioner, etc. who performed the action. It should be assumed that the actor is the dispenser of the medication actor : Reference [1..1] « Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson » Substitution True if the dispenser dispensed a different drug or product from what was prescribed wasSubstituted : boolean [1..1] A code signifying whether a different drug was dispensed from what was prescribed type : CodeableConcept [0..1] « A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription prescription. (Strength=Example) ActSubstanceAdminSubstitution... v3.ActSubstanceAdminSubstitut... ?? » Indicates the reason for the substitution (or lack of substitution) from what was prescribed reason : CodeableConcept [0..*] « A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed prescribed. (Strength=Example) SubstanceAdminSubstitutionRea... v3.SubstanceAdminSubstitution... ?? » The person or organization that has primary responsibility for the substitution responsibleParty : Reference [0..*] « Practitioner » Indicates who or what performed the event performer [0..*] 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 substitution [0..1]

XML Template 

<MedicationDispense xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier External identifier --></identifier>
 <partOf><!-- 0..* Reference(Procedure) Event that dispense is part of --></partOf>
 <status value="[code]"/><!-- 1..1 preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | unknown -->
 <</category>

 <category><!-- 0..1 CodeableConcept Type of medication dispense --></category>

 <medication[x]><!-- 1..1 CodeableConcept|Reference(Medication) What medication was supplied --></medication[x]>
 <subject><!-- 0..1 Reference(Patient|Group) Who the dispense is for --></subject>
 <context><!-- 0..1 Reference(Encounter|EpisodeOfCare) Encounter / Episode associated with event --></context>
 <supportingInformation><!-- 0..* Reference(Any) Information that supports the dispensing of the medication --></supportingInformation>
 <performer>  <!-- 0..* Who performed event -->
  <function><!-- 0..1 CodeableConcept Who performed the dispense and what they did --></function>
  <actor><!-- 1..1 Reference(Practitioner|PractitionerRole|Organization|Patient|
    Device|RelatedPerson) Individual who was performing --></actor>
 </performer>
 <location><!-- 0..1 Reference(Location) Where the dispense occurred --></location>
 <authorizingPrescription><!-- 0..* Reference(MedicationRequest) Medication order that authorizes the dispense --></authorizingPrescription>
 <type><!-- 0..1 CodeableConcept Trial fill, partial fill, emergency fill, etc. --></type>
 <quantity><!-- 0..1 Quantity(SimpleQuantity) Amount dispensed --></quantity>
 <daysSupply><!-- 0..1 Quantity(SimpleQuantity) Amount of medication expressed as a timing amount --></daysSupply>
 <whenPrepared value="[dateTime]"/><!-- 0..1 When product was packaged and reviewed -->
 <whenHandedOver value="[dateTime]"/><!-- 0..1 When product was given out -->
 <destination><!-- 0..1 Reference(Location) Where the medication was sent --></destination>
 <receiver><!-- 0..* Reference(Patient|Practitioner) Who collected the medication --></receiver>
 <note><!-- 0..* Annotation Information about the dispense --></note>
 <dosageInstruction><!-- 0..* Dosage How the medication is to be used by the patient or administered by the caregiver --></dosageInstruction>
 <substitution>  <!-- 0..1 Whether a substitution was performed on the dispense -->
  <wasSubstituted value="[boolean]"/><!-- 1..1 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 --></type>
  <reason><!-- 0..* CodeableConcept Why was substitution made --></reason>
  <responsibleParty><!-- 0..* Reference(Practitioner) Who is responsible for the substitution --></responsibleParty>
 </substitution>
 <detectedIssue><!-- 0..* Reference(DetectedIssue) Clinical issue with action --></detectedIssue>
 <statusReason[x]><!-- 0..1 CodeableConcept|Reference(DetectedIssue) Why a dispense was not performed --></statusReason[x]>
 <eventHistory><!-- 0..* Reference(Provenance) A list of relevant lifecycle events --></eventHistory>
</MedicationDispense>

JSON Template 

{doco
  "resourceType" : "MedicationDispense",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External identifier
  "partOf" : [{ Reference(Procedure) }], // Event that dispense is part of
  "status" : "<code>", // R!  preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | unknown
  "

  "category" : { CodeableConcept }, // Type of medication dispense

  // medication[x]: What medication was supplied. One of these 2:
  "medicationCodeableConcept" : { CodeableConcept },
  "medicationReference" : { Reference(Medication) },
  "subject" : { Reference(Patient|Group) }, // Who the dispense is for
  "context" : { Reference(Encounter|EpisodeOfCare) }, // Encounter / Episode associated with event
  "supportingInformation" : [{ Reference(Any) }], // Information that supports the dispensing of the medication
  "performer" : [{ // Who performed event
    "function" : { CodeableConcept }, // Who performed the dispense and what they did
    "actor" : { Reference(Practitioner|PractitionerRole|Organization|Patient|
    Device|RelatedPerson) } // R!  Individual who was performing
  }],
  "location" : { Reference(Location) }, // Where the dispense occurred
  "authorizingPrescription" : [{ Reference(MedicationRequest) }], // Medication order that authorizes the dispense
  "type" : { CodeableConcept }, // Trial fill, partial fill, emergency fill, etc.
  "quantity" : { Quantity(SimpleQuantity) }, // Amount dispensed
  "daysSupply" : { Quantity(SimpleQuantity) }, // Amount of medication expressed as a timing amount
  "whenPrepared" : "<dateTime>", // When product was packaged and reviewed
  "whenHandedOver" : "<dateTime>", // When product was given out
  "destination" : { Reference(Location) }, // Where the medication was sent
  "receiver" : [{ Reference(Patient|Practitioner) }], // Who collected the medication
  "note" : [{ Annotation }], // Information about the dispense
  "dosageInstruction" : [{ Dosage }], // How the medication is to be used by the patient or administered by the caregiver
  "substitution" : { // Whether a substitution was performed on the dispense
    "wasSubstituted" : <boolean>, // R!  Whether a substitution was or was not performed on the dispense
    "type" : { CodeableConcept }, // Code signifying whether a different drug was dispensed from what was prescribed
    "reason" : [{ CodeableConcept }], // Why was substitution made
    "responsibleParty" : [{ Reference(Practitioner) }] // Who is responsible for the substitution
  },
  "detectedIssue" : [{ Reference(DetectedIssue) }], // Clinical issue with action
  // statusReason[x]: Why a dispense was not performed. One of these 2:
  "statusReasonCodeableConcept" : { CodeableConcept },
  "statusReasonReference" : { Reference(DetectedIssue) },
  "eventHistory" : [{ Reference(Provenance) }] // A list of relevant lifecycle events
}

Turtle Template 

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:MedicationDispense;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:MedicationDispense.identifier [ Identifier ], ... ; # 0..* External identifier
  fhir:MedicationDispense.partOf [ Reference(Procedure) ], ... ; # 0..* Event that dispense is part of
  fhir:MedicationDispense.status [ code ]; # 1..1 preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | unknown
  fhir:

  fhir:MedicationDispense.category [ CodeableConcept ]; # 0..1 Type of medication dispense

  # MedicationDispense.medication[x] : 1..1 What medication was supplied. One of these 2
    fhir:MedicationDispense.medicationCodeableConcept [ CodeableConcept ]
    fhir:MedicationDispense.medicationReference [ Reference(Medication) ]
  fhir:MedicationDispense.subject [ Reference(Patient|Group) ]; # 0..1 Who the dispense is for
  fhir:MedicationDispense.context [ Reference(Encounter|EpisodeOfCare) ]; # 0..1 Encounter / Episode associated with event
  fhir:MedicationDispense.supportingInformation [ Reference(Any) ], ... ; # 0..* Information that supports the dispensing of the medication
  fhir:MedicationDispense.performer [ # 0..* Who performed event
    fhir:MedicationDispense.performer.function [ CodeableConcept ]; # 0..1 Who performed the dispense and what they did
    fhir:MedicationDispense.performer.actor [ Reference(Practitioner|PractitionerRole|Organization|Patient|Device|RelatedPerson) ]; # 1..1 Individual who was performing
  ], ...;
  fhir:MedicationDispense.location [ Reference(Location) ]; # 0..1 Where the dispense occurred
  fhir:MedicationDispense.authorizingPrescription [ Reference(MedicationRequest) ], ... ; # 0..* Medication order that authorizes the dispense
  fhir:MedicationDispense.type [ CodeableConcept ]; # 0..1 Trial fill, partial fill, emergency fill, etc.
  fhir:MedicationDispense.quantity [ Quantity(SimpleQuantity) ]; # 0..1 Amount dispensed
  fhir:MedicationDispense.daysSupply [ Quantity(SimpleQuantity) ]; # 0..1 Amount of medication expressed as a timing amount
  fhir:MedicationDispense.whenPrepared [ dateTime ]; # 0..1 When product was packaged and reviewed
  fhir:MedicationDispense.whenHandedOver [ dateTime ]; # 0..1 When product was given out
  fhir:MedicationDispense.destination [ Reference(Location) ]; # 0..1 Where the medication was sent
  fhir:MedicationDispense.receiver [ Reference(Patient|Practitioner) ], ... ; # 0..* Who collected the medication
  fhir:MedicationDispense.note [ Annotation ], ... ; # 0..* Information about the dispense
  fhir:MedicationDispense.dosageInstruction [ Dosage ], ... ; # 0..* How the medication is to be used by the patient or administered by the caregiver
  fhir:MedicationDispense.substitution [ # 0..1 Whether a substitution was performed on the dispense
    fhir:MedicationDispense.substitution.wasSubstituted [ boolean ]; # 1..1 Whether a substitution was or was not performed on the dispense
    fhir:MedicationDispense.substitution.type [ CodeableConcept ]; # 0..1 Code signifying whether a different drug was dispensed from what was prescribed
    fhir:MedicationDispense.substitution.reason [ CodeableConcept ], ... ; # 0..* Why was substitution made
    fhir:MedicationDispense.substitution.responsibleParty [ Reference(Practitioner) ], ... ; # 0..* Who is responsible for the substitution
  ];
  fhir:MedicationDispense.detectedIssue [ Reference(DetectedIssue) ], ... ; # 0..* Clinical issue with action
  # MedicationDispense.statusReason[x] : 0..1 Why a dispense was not performed. One of these 2
    fhir:MedicationDispense.statusReasonCodeableConcept [ CodeableConcept ]
    fhir:MedicationDispense.statusReasonReference [ Reference(DetectedIssue) ]
  fhir:MedicationDispense.eventHistory [ Reference(Provenance) ], ... ; # 0..* A list of relevant lifecycle events
]

Changes since R3

MedicationDispense
MedicationDispense.status
  • Min Cardinality changed from 0 to 1
MedicationDispense.medication[x]
  • Remove Reference(Medication), Add Reference(Medication)
MedicationDispense.performer.function
  • Added Element
MedicationDispense.performer.actor
  • Type changed from Reference(Practitioner|Organization|Patient|Device|RelatedPerson) to Reference(Practitioner|PractitionerRole|Organization|Patient|Device|RelatedPerson)
MedicationDispense.location
  • Added Element
MedicationDispense.statusReason[x]
  • Added Element
MedicationDispense.performer.onBehalfOf
  • deleted
MedicationDispense.notDone
  • deleted
MedicationDispense.notDoneReason[x]
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

See R2 <--> R3 <--> R4 Conversion Maps (status = 7 31 tests that all of which 20 fail to execute ok. . 7 11 fail round-trip testing and 1 11 r3 resources are invalid (2 (0 errors). ). Note: these have note yet been updated to be R3 to R4 )

Structure

Name Flags Card. Type Description & Constraints doco
. . MedicationDispense I TU DomainResource Dispensing a medication to a named patient
+ Rule: whenHandedOver cannot be before whenPrepared
Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier 0..* Identifier External identifier
. . . partOf 0..* Reference ( Procedure ) Event that dispense is part of
. . . status ?! Σ 1..1 code preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | unknown
MedicationDispenseStatus ( Required )
. . . category 0..1 CodeableConcept Type of medication dispense
MedicationDispenseCategory ( Preferred )
. . . medication[x] Σ 1..1 What medication was supplied
SNOMED CT Medication Codes ( Example )
. . . . medicationCodeableConcept CodeableConcept
. . . . medicationReference Reference ( Medication )
. . . subject Σ 0..1 Reference ( Patient | Group ) Who the dispense is for
. . . context 0..1 Reference ( Encounter | EpisodeOfCare ) Encounter / Episode associated with event
. . . supportingInformation 0..* Reference ( Any ) Information that supports the dispensing of the medication
. . . performer 0..* BackboneElement Who performed event
. . . . function 0..1 CodeableConcept Who performed the dispense and what they did
MedicationDispensePerformerFunction ( Example )
. . . . actor 1..1 Reference ( Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson ) Individual who was performing
. . . location 0..1 Reference ( Location ) Where the dispense occurred
. . . authorizingPrescription 0..* Reference ( MedicationRequest ) Medication order that authorizes the dispense
. . . type 0..1 CodeableConcept Trial fill, partial fill, emergency fill, etc.
ActPharmacySupplyType V3 Value SetActPharmacySupplyType ( Example )
. . . quantity 0..1 SimpleQuantity Amount dispensed
. . . daysSupply 0..1 SimpleQuantity Amount of medication expressed as a timing amount
. . . whenPrepared Σ 0..1 dateTime When product was packaged and reviewed
. . . whenHandedOver 0..1 dateTime When product was given out
. . . 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 0..* Dosage How the medication is to be used by the patient or administered by the caregiver
. . . substitution 0..1 BackboneElement Whether a substitution was performed on the dispense
. . . . 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
ActSubstanceAdminSubstitutionCode V3 Value SetActSubstanceAdminSubstitutionCode ( Example )
. . . . reason 0..* CodeableConcept Why was substitution made
SubstanceAdminSubstitutionReason V3 Value SetSubstanceAdminSubstitutionReason ( Example )
. . . . responsibleParty 0..* Reference ( Practitioner ) Who is responsible for the substitution
. . . detectedIssue 0..* Reference ( DetectedIssue ) Clinical issue with action
. . . statusReason[x] 0..1 Why a dispense was not performed
MedicationDispenseStatusReason ( Example )
. . . . statusReasonCodeableConcept CodeableConcept
. . . . statusReasonReference Reference ( DetectedIssue )
. . . eventHistory 0..* Reference ( Provenance ) A list of relevant lifecycle events

doco Documentation for this format

UML Diagram ( Legend )

MedicationDispense ( DomainResource ) Identifier assigned by the dispensing facility - this is an identifier assigned outside FHIR identifier : Identifier [0..*] The procedure that trigger the dispense partOf : Reference [0..*] « Procedure » A code specifying the state of the set of dispense events (this element modifies the meaning of other elements) status : code [1..1] « A coded concept specifying the state of the dispense event. (Strength=Required) MedicationDispenseStatus ! » Indicates the type of medication dispense and (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)) category : CodeableConcept [0..1] « A code describing where the dispensed medication is expected to be consumed or administered administered. (Strength=Preferred) MedicationDispenseCategory ? » 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 medication[x] : Type [1..1] « CodeableConcept | Reference ( Medication ); A coded concept identifying which substance or product can be dispensed dispensed. (Strength=Example) SNOMED CT Medication SNOMEDCTMedicationCodes ?? » A link to a resource representing the person or the group to whom the medication will be given subject : Reference [0..1] « Patient | Group » The encounter or episode of care that establishes the context for this event context : Reference [0..1] « Encounter | EpisodeOfCare » Additional information that supports the medication being dispensed supportingInformation : Reference [0..*] « Any » The principal physical location where the dispense was performed location : Reference [0..1] « Location » Indicates the medication order that is being dispensed against authorizingPrescription : Reference [0..*] « MedicationRequest » Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc type : CodeableConcept [0..1] « Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc. (Strength=Example) ActPharmacySupplyType v3.ActPharmacySupplyType ?? » The amount of medication that has been dispensed. Includes unit of measure quantity : Quantity ( SimpleQuantity ) [0..1] The amount of medication expressed as a timing amount daysSupply : Quantity ( SimpleQuantity ) [0..1] The time when the dispensed product was packaged and reviewed whenPrepared : dateTime [0..1] The time the dispensed product was provided to the patient or their representative whenHandedOver : dateTime [0..1] Identification of the facility/location where the medication was shipped to, as part of the dispense event destination : Reference [0..1] « Location » 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 receiver : Reference [0..*] « Patient | Practitioner » Extra information about the dispense that could not be conveyed in the other attributes note : Annotation [0..*] Indicates how the medication is to be used by the patient dosageInstruction : Dosage [0..*] 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 detectedIssue : Reference [0..*] « DetectedIssue » Indicates the reason why a dispense was not performed statusReason[x] : Type [0..1] « CodeableConcept | Reference ( DetectedIssue ); A code describing why a dispense was not performed performed. (Strength=Example) MedicationDispenseStatusReason ?? » A summary of the events of interest that have occurred, such as when the dispense was verified eventHistory : Reference [0..*] « Provenance » Performer Distinguishes the type of performer in the dispense. For example, date enterer, packager, final checker function : CodeableConcept [0..1] « A code describing the role an individual played in dispensing a medication medication. (Strength=Example) MedicationDispensePerformerFu... ?? » The device, practitioner, etc. who performed the action. It should be assumed that the actor is the dispenser of the medication actor : Reference [1..1] « Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson » Substitution True if the dispenser dispensed a different drug or product from what was prescribed wasSubstituted : boolean [1..1] A code signifying whether a different drug was dispensed from what was prescribed type : CodeableConcept [0..1] « A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription prescription. (Strength=Example) ActSubstanceAdminSubstitution... v3.ActSubstanceAdminSubstitut... ?? » Indicates the reason for the substitution (or lack of substitution) from what was prescribed reason : CodeableConcept [0..*] « A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed prescribed. (Strength=Example) SubstanceAdminSubstitutionRea... v3.SubstanceAdminSubstitution... ?? » The person or organization that has primary responsibility for the substitution responsibleParty : Reference [0..*] « Practitioner » Indicates who or what performed the event performer [0..*] 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 substitution [0..1]

XML Template 

<MedicationDispense xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier External identifier --></identifier>
 <partOf><!-- 0..* Reference(Procedure) Event that dispense is part of --></partOf>
 <status value="[code]"/><!-- 1..1 preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | unknown -->
 <</category>

 <category><!-- 0..1 CodeableConcept Type of medication dispense --></category>

 <medication[x]><!-- 1..1 CodeableConcept|Reference(Medication) What medication was supplied --></medication[x]>
 <subject><!-- 0..1 Reference(Patient|Group) Who the dispense is for --></subject>
 <context><!-- 0..1 Reference(Encounter|EpisodeOfCare) Encounter / Episode associated with event --></context>
 <supportingInformation><!-- 0..* Reference(Any) Information that supports the dispensing of the medication --></supportingInformation>
 <performer>  <!-- 0..* Who performed event -->
  <function><!-- 0..1 CodeableConcept Who performed the dispense and what they did --></function>
  <actor><!-- 1..1 Reference(Practitioner|PractitionerRole|Organization|Patient|
    Device|RelatedPerson) Individual who was performing --></actor>
 </performer>
 <location><!-- 0..1 Reference(Location) Where the dispense occurred --></location>
 <authorizingPrescription><!-- 0..* Reference(MedicationRequest) Medication order that authorizes the dispense --></authorizingPrescription>
 <type><!-- 0..1 CodeableConcept Trial fill, partial fill, emergency fill, etc. --></type>
 <quantity><!-- 0..1 Quantity(SimpleQuantity) Amount dispensed --></quantity>
 <daysSupply><!-- 0..1 Quantity(SimpleQuantity) Amount of medication expressed as a timing amount --></daysSupply>
 <whenPrepared value="[dateTime]"/><!-- 0..1 When product was packaged and reviewed -->
 <whenHandedOver value="[dateTime]"/><!-- 0..1 When product was given out -->
 <destination><!-- 0..1 Reference(Location) Where the medication was sent --></destination>
 <receiver><!-- 0..* Reference(Patient|Practitioner) Who collected the medication --></receiver>
 <note><!-- 0..* Annotation Information about the dispense --></note>
 <dosageInstruction><!-- 0..* Dosage How the medication is to be used by the patient or administered by the caregiver --></dosageInstruction>
 <substitution>  <!-- 0..1 Whether a substitution was performed on the dispense -->
  <wasSubstituted value="[boolean]"/><!-- 1..1 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 --></type>
  <reason><!-- 0..* CodeableConcept Why was substitution made --></reason>
  <responsibleParty><!-- 0..* Reference(Practitioner) Who is responsible for the substitution --></responsibleParty>
 </substitution>
 <detectedIssue><!-- 0..* Reference(DetectedIssue) Clinical issue with action --></detectedIssue>
 <statusReason[x]><!-- 0..1 CodeableConcept|Reference(DetectedIssue) Why a dispense was not performed --></statusReason[x]>
 <eventHistory><!-- 0..* Reference(Provenance) A list of relevant lifecycle events --></eventHistory>
</MedicationDispense>

JSON Template 

{doco
  "resourceType" : "MedicationDispense",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External identifier
  "partOf" : [{ Reference(Procedure) }], // Event that dispense is part of
  "status" : "<code>", // R!  preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | unknown
  "

  "category" : { CodeableConcept }, // Type of medication dispense

  // medication[x]: What medication was supplied. One of these 2:
  "medicationCodeableConcept" : { CodeableConcept },
  "medicationReference" : { Reference(Medication) },
  "subject" : { Reference(Patient|Group) }, // Who the dispense is for
  "context" : { Reference(Encounter|EpisodeOfCare) }, // Encounter / Episode associated with event
  "supportingInformation" : [{ Reference(Any) }], // Information that supports the dispensing of the medication
  "performer" : [{ // Who performed event
    "function" : { CodeableConcept }, // Who performed the dispense and what they did
    "actor" : { Reference(Practitioner|PractitionerRole|Organization|Patient|
    Device|RelatedPerson) } // R!  Individual who was performing
  }],
  "location" : { Reference(Location) }, // Where the dispense occurred
  "authorizingPrescription" : [{ Reference(MedicationRequest) }], // Medication order that authorizes the dispense
  "type" : { CodeableConcept }, // Trial fill, partial fill, emergency fill, etc.
  "quantity" : { Quantity(SimpleQuantity) }, // Amount dispensed
  "daysSupply" : { Quantity(SimpleQuantity) }, // Amount of medication expressed as a timing amount
  "whenPrepared" : "<dateTime>", // When product was packaged and reviewed
  "whenHandedOver" : "<dateTime>", // When product was given out
  "destination" : { Reference(Location) }, // Where the medication was sent
  "receiver" : [{ Reference(Patient|Practitioner) }], // Who collected the medication
  "note" : [{ Annotation }], // Information about the dispense
  "dosageInstruction" : [{ Dosage }], // How the medication is to be used by the patient or administered by the caregiver
  "substitution" : { // Whether a substitution was performed on the dispense
    "wasSubstituted" : <boolean>, // R!  Whether a substitution was or was not performed on the dispense
    "type" : { CodeableConcept }, // Code signifying whether a different drug was dispensed from what was prescribed
    "reason" : [{ CodeableConcept }], // Why was substitution made
    "responsibleParty" : [{ Reference(Practitioner) }] // Who is responsible for the substitution
  },
  "detectedIssue" : [{ Reference(DetectedIssue) }], // Clinical issue with action
  // statusReason[x]: Why a dispense was not performed. One of these 2:
  "statusReasonCodeableConcept" : { CodeableConcept },
  "statusReasonReference" : { Reference(DetectedIssue) },
  "eventHistory" : [{ Reference(Provenance) }] // A list of relevant lifecycle events
}

Turtle Template 

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:MedicationDispense;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:MedicationDispense.identifier [ Identifier ], ... ; # 0..* External identifier
  fhir:MedicationDispense.partOf [ Reference(Procedure) ], ... ; # 0..* Event that dispense is part of
  fhir:MedicationDispense.status [ code ]; # 1..1 preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | unknown
  fhir:

  fhir:MedicationDispense.category [ CodeableConcept ]; # 0..1 Type of medication dispense

  # MedicationDispense.medication[x] : 1..1 What medication was supplied. One of these 2
    fhir:MedicationDispense.medicationCodeableConcept [ CodeableConcept ]
    fhir:MedicationDispense.medicationReference [ Reference(Medication) ]
  fhir:MedicationDispense.subject [ Reference(Patient|Group) ]; # 0..1 Who the dispense is for
  fhir:MedicationDispense.context [ Reference(Encounter|EpisodeOfCare) ]; # 0..1 Encounter / Episode associated with event
  fhir:MedicationDispense.supportingInformation [ Reference(Any) ], ... ; # 0..* Information that supports the dispensing of the medication
  fhir:MedicationDispense.performer [ # 0..* Who performed event
    fhir:MedicationDispense.performer.function [ CodeableConcept ]; # 0..1 Who performed the dispense and what they did
    fhir:MedicationDispense.performer.actor [ Reference(Practitioner|PractitionerRole|Organization|Patient|Device|RelatedPerson) ]; # 1..1 Individual who was performing
  ], ...;
  fhir:MedicationDispense.location [ Reference(Location) ]; # 0..1 Where the dispense occurred
  fhir:MedicationDispense.authorizingPrescription [ Reference(MedicationRequest) ], ... ; # 0..* Medication order that authorizes the dispense
  fhir:MedicationDispense.type [ CodeableConcept ]; # 0..1 Trial fill, partial fill, emergency fill, etc.
  fhir:MedicationDispense.quantity [ Quantity(SimpleQuantity) ]; # 0..1 Amount dispensed
  fhir:MedicationDispense.daysSupply [ Quantity(SimpleQuantity) ]; # 0..1 Amount of medication expressed as a timing amount
  fhir:MedicationDispense.whenPrepared [ dateTime ]; # 0..1 When product was packaged and reviewed
  fhir:MedicationDispense.whenHandedOver [ dateTime ]; # 0..1 When product was given out
  fhir:MedicationDispense.destination [ Reference(Location) ]; # 0..1 Where the medication was sent
  fhir:MedicationDispense.receiver [ Reference(Patient|Practitioner) ], ... ; # 0..* Who collected the medication
  fhir:MedicationDispense.note [ Annotation ], ... ; # 0..* Information about the dispense
  fhir:MedicationDispense.dosageInstruction [ Dosage ], ... ; # 0..* How the medication is to be used by the patient or administered by the caregiver
  fhir:MedicationDispense.substitution [ # 0..1 Whether a substitution was performed on the dispense
    fhir:MedicationDispense.substitution.wasSubstituted [ boolean ]; # 1..1 Whether a substitution was or was not performed on the dispense
    fhir:MedicationDispense.substitution.type [ CodeableConcept ]; # 0..1 Code signifying whether a different drug was dispensed from what was prescribed
    fhir:MedicationDispense.substitution.reason [ CodeableConcept ], ... ; # 0..* Why was substitution made
    fhir:MedicationDispense.substitution.responsibleParty [ Reference(Practitioner) ], ... ; # 0..* Who is responsible for the substitution
  ];
  fhir:MedicationDispense.detectedIssue [ Reference(DetectedIssue) ], ... ; # 0..* Clinical issue with action
  # MedicationDispense.statusReason[x] : 0..1 Why a dispense was not performed. One of these 2
    fhir:MedicationDispense.statusReasonCodeableConcept [ CodeableConcept ]
    fhir:MedicationDispense.statusReasonReference [ Reference(DetectedIssue) ]
  fhir:MedicationDispense.eventHistory [ Reference(Provenance) ], ... ; # 0..* A list of relevant lifecycle events
]

Changes since DSTU2 Release 3

MedicationDispense
MedicationDispense.status
  • Min Cardinality changed from 0 to 1
MedicationDispense.medication[x]
  • Remove Reference(Medication), Add Reference(Medication)
MedicationDispense.performer.function
  • Added Element
MedicationDispense.performer.actor
  • Type changed from Reference(Practitioner|Organization|Patient|Device|RelatedPerson) to Reference(Practitioner|PractitionerRole|Organization|Patient|Device|RelatedPerson)
MedicationDispense.location
  • Added Element
MedicationDispense.statusReason[x]
  • Added Element
MedicationDispense.performer.onBehalfOf
  • deleted
MedicationDispense.notDone
  • deleted
MedicationDispense.notDoneReason[x]
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

See R2 <--> R3 <--> R4 Conversion Maps (status = 7 31 tests that all of which 20 fail to execute ok. . 7 11 fail round-trip testing and 1 11 r3 resources are invalid (2 (0 errors). ). Note: these have note yet been updated to be R3 to R4 )

 

Alternate See the Profiles & Extensions and the alternate definitions: Master Definition XML + JSON , XML Schema / Schematron + JSON Schema , ShEx (for Turtle ) + see the extensions & the dependency analysis

11.3.4.1 Terminology Bindings

Path Definition Type Reference
MedicationDispense.status A coded concept specifying the state of the dispense event. Required MedicationDispenseStatus
MedicationDispense.category A code describing where the dispensed medication is expected to be consumed or administered administered. Preferred MedicationDispenseCategory
MedicationDispense.medication[x] A coded concept identifying which substance or product can be dispensed dispensed. Example SNOMED CT Medication Codes SNOMEDCTMedicationCodes
MedicationDispense.performer.function A code describing the role an individual played in dispensing a medication medication. Example MedicationDispensePerformerFunction
MedicationDispense.type Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc. Example ActPharmacySupplyType v3.ActPharmacySupplyType
MedicationDispense.substitution.type A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription prescription. Example ActSubstanceAdminSubstitutionCode v3.ActSubstanceAdminSubstitutionCode
MedicationDispense.substitution.reason A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed prescribed. Example SubstanceAdminSubstitutionReason v3.SubstanceAdminSubstitutionReason
MedicationDispense.statusReason[x] A code describing why a dispense was not performed performed. Example MedicationDispenseStatusReason

11.3.4.2 Constraints

id Level Location Description Expression
mdd-1 : Rule (base) whenHandedOver cannot be before whenPrepared ( expression : whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared )

11.3.5 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name Type Description Expression In Common
code token Returns dispenses of this medicine code MedicationDispense.medication.as(CodeableConcept) (MedicationDispense.medication as CodeableConcept) 4 13 Resources
context reference Returns dispenses with a specific context (episode or episode of care) MedicationDispense.context
( EpisodeOfCare , Encounter )
destination reference Returns dispenses that should be sent to a specific destination MedicationDispense.destination
( Location )
identifier token Returns dispenses with this external identifier MedicationDispense.identifier 3 30 Resources
medication reference Returns dispenses of this medicine resource MedicationDispense.medication.as(Reference) (MedicationDispense.medication as Reference)
( Medication ) 		3 Resources
patient reference The identity of a patient to list dispenses for MedicationDispense.subject MedicationDispense.subject.where(resolve() is Patient)
( Patient ) 		3 Resources
performer reference Returns dispenses performed by a specific individual MedicationDispense.performer.actor
( Practitioner , Organization , Device , Patient , PractitionerRole , RelatedPerson )
prescription reference The identity of a prescription to list dispenses from MedicationDispense.authorizingPrescription
( MedicationRequest ) 		1 Resources
receiver reference The identity of a receiver to list dispenses for MedicationDispense.receiver
( Practitioner , Patient )
responsibleparty reference Returns dispenses with the specified responsible party MedicationDispense.substitution.responsibleParty
( Practitioner )
status token Returns dispenses with a specified dispense status MedicationDispense.status 3 Resources
subject reference The identity of a patient for whom to list dispenses MedicationDispense.subject
( Group , Patient )
type token Returns dispenses of a specific type MedicationDispense.type
whenhandedover date Returns dispenses handed over on this date MedicationDispense.whenHandedOver
whenprepared date Returns dispenses prepared on this date MedicationDispense.whenPrepared