R3 Conversions

11.3 4.3.2.260 Resource MedicationDispense - Content CodeSystem http://hl7.org/fhir/template-status-code

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 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.

Pharmacy FHIR Infrastructure Work Group

Maturity Level : 2   Trial Use 0

Security Category : Patient Compartments : Patient , Practitioner Informative

MedicationRequest An order Use Context : Country: World, Not Intended for both supply of the medication and the instructions Production use, Not Intended 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 Production use

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 Narrative
UML
• XML
• JSON
Turtle
• R3 Diff TTL
All

Structure Name Flags Card. Type Description & Constraints MedicationDispense I TU partOf 0..* Reference ( Procedure ) Event that dispense is part CodeableConcept statusReasonReference Reference ( DetectedIssue ) category 0..1 CodeableConcept Type of medication dispense Medication dispense category codes ( Preferred ) medication[x] Σ 1..1 What medication was supplied 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 Medication dispense performer function codes ( 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. 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 V3 Value SetActSubstanceAdminSubstitutionCode ( Example ) reason 0..* CodeableConcept Why was substitution made V3 Value SetSubstanceAdminSubstitutionReason ( Example ) 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 Documentation for this format

Official URL : DomainResource http://hl7.org/fhir/template-status-code 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 Version : 5.0.0-snapshot3
active as of status ?! Σ 1..1 code preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown Medication dispense status codes ( Required ) statusReason[x] 0..1 Why a dispense was not performed Medication dispense status reason codes ( Example ) 2022-12-14				statusReasonCodeableConcept Computable Name : TemplateStatusCode
SNOMED CT Medication Codes ( Example ) Flags : Experimental, CaseSensitive, Complete				medicationCodeableConcept OID : 2.16.840.1.113883.4.642.4.1903

UML Diagram ( Legend ) MedicationDispense ( DomainResource ) Identifiers associated with this Medication Dispense that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server 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) MedicationDispense Status ! » 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. (Strength=Example) MedicationDispense Status Rea... ?? » Indicates the type of medication dispense (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. (Strength=Preferred) MedicationDispense Category ? » Identifies the medication being administered. This Code system 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. (Strength=Example) 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) 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 » 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. (Strength=Example) MedicationDispense Performer ... ?? » 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. (Strength=Example) 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. (Strength=Example) v3.SubstanceAdminSubstitution... ?? » The person or organization that has primary responsibility for the substitution responsibleParty : Reference [0..*] « Practitioner | PractitionerRole » 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 < <!-- from --> <!-- from --> <</identifier> <</partOf> < <</statusReason[x]> <</category> <</medication[x]> <</subject> <</context> <</supportingInformation> < <</function> <| </actor> </performer> <</location> <</authorizingPrescription> <</type> <</quantity> <</daysSupply> < < <</destination> <</receiver> <</note> <</dosageInstruction> < < <</type> <</reason> <</responsibleParty> </substitution> <</detectedIssue> <</eventHistory> </MedicationDispense> JSON Template { "resourceType" : "", // from // from " " " " }, " }, " " }, " }, " " " " " "| }], " " " " " " " " " " " " " " " " }, " " } Turtle Template @prefix fhir: <http://hl7.org/fhir/> . [ a fhir:; fhir:nodeRole fhir:treeRoot; # if this is the parser root # from # from fhir: fhir: fhir: # . One of these 2 fhir: ] fhir:) ] fhir: # . One of these 2 fhir: ] fhir:) ] fhir: fhir: fhir: fhir: fhir: fhir: ], ...; fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir: ]; fhir: fhir: ] Changes since R3 MedicationDispense MedicationDispense.status Min Cardinality changed from 0 to 1 Change following value set from http://hl7.org/fhir/ValueSet/medication-dispense-status to http://hl7.org/fhir/ValueSet/medicationdispense-status|4.0.1 MedicationDispense.statusReason[x] Added Element MedicationDispense.performer.function Added Element MedicationDispense.performer.actor Type Reference: Added Target Type PractitionerRole MedicationDispense.location Added Element MedicationDispense.substitution.responsibleParty Type Reference: Added Target Type PractitionerRole MedicationDispense.performer.onBehalfOf deleted MedicationDispense.notDone deleted MedicationDispense.notDoneReason[x] sets:

• deleted ValueSet: TemplateStatusCode (Description Needed Here)

See the Full Difference for further information This analysis is available as XML or JSON . See R3 <--> R4 Conversion Maps (status = 31 tests that all execute ok. 6 fail round-trip testing and 31 r3 resources are invalid (0 errors). ) Structure Name Flags Card. Type Description & Constraints

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4.3.2.260.1 Definition MedicationDispense TU

TemplateStatusCode

DomainResource

Dispensing a medication to a named patient + Rule: whenHandedOver cannot be before whenPrepared 4.3.2.260.2 Content 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

UML Diagram ( Legend )  

MedicationDispense ( DomainResource ) Identifiers associated with this Medication Dispense that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server 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) MedicationDispense Status ! » 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. (Strength=Example) MedicationDispense Status Rea... ?? » Indicates the type of medication dispense (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. (Strength=Preferred) MedicationDispense Category ? » 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. (Strength=Example) 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) 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 » A summary of the events of interest that have occurred, such as when the dispense was verified eventHistory : Reference [0..*] « Provenance » Performer Distinguishes

See the type full registry 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. (Strength=Example) MedicationDispense Performer ... ?? » 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. (Strength=Example) 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. (Strength=Example) v3.SubstanceAdminSubstitution... ?? » The person or organization that has primary responsibility for the substitution responsibleParty : Reference [0..*] « Practitioner | PractitionerRole » Indicates who or what performed the event performer systems [0..*] Indicates whether or not substitution was made defined 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 < <!-- from --> <!-- from --> <</identifier> <</partOf> < <</statusReason[x]> <</category> <</medication[x]> <</subject> <</context> <</supportingInformation> < <</function> <| </actor> </performer> <</location> <</authorizingPrescription> <</type> <</quantity> <</daysSupply> < < <</destination> <</receiver> <</note> <</dosageInstruction> < < <</type> <</reason> <</responsibleParty> </substitution> <</detectedIssue> <</eventHistory> </MedicationDispense> JSON Template { "resourceType" : "", // from // from " " " " }, " }, " " }, " }, " " " " " "| }], " " " " " " " " " " " " " " " " }, " " } Turtle Template @prefix fhir: <http://hl7.org/fhir/> . [ a fhir:; fhir:nodeRole fhir:treeRoot; # if this is the parser root # from # from fhir: fhir: fhir: # . One of these 2 fhir: ] fhir:) ] fhir: # . One of these 2 fhir: ] fhir:) ] fhir: fhir: fhir: fhir: fhir: fhir: ], ...; fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir: ]; fhir: fhir: ] Changes since Release 3 FHIR.

MedicationDispense MedicationDispense.status Min Cardinality changed from 0 to 1 Change value set from http://hl7.org/fhir/ValueSet/medication-dispense-status to http://hl7.org/fhir/ValueSet/medicationdispense-status|4.0.1 MedicationDispense.statusReason[x] Added Element MedicationDispense.performer.function Added Element MedicationDispense.performer.actor Type Reference: Added Target Type PractitionerRole MedicationDispense.location Added Element MedicationDispense.substitution.responsibleParty Type Reference: Added Target Type PractitionerRole MedicationDispense.performer.onBehalfOf deleted MedicationDispense.notDone deleted MedicationDispense.notDoneReason[x] deleted

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See Explanation of the Full Difference for further information This analysis is available as XML or JSON . See R3 <--> R4 Conversion Maps (status = 31 tests columns that all execute ok. 6 fail round-trip testing and 31 r3 resources are invalid (0 errors). )   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 may appear on this page:

11.3.4.1 Terminology Bindings Path Definition Type Reference MedicationDispense.status A coded concept specifying the state of the dispense event. MedicationDispense Category Codes MedicationDispense.medication[x] A coded concept identifying which substance or product can be dispensed.

Required MedicationDispense Status Codes MedicationDispense.statusReason[x] A code describing why a dispense was not performed. Level	Example MedicationDispense Status Reason Codes MedicationDispense.category A few code lists that FHIR defines are hierarchical - each code describing where the dispensed medication is expected to be consumed or administered. Preferred assigned a level. See Code System for further information.
Example SNOMEDCTMedicationCodes MedicationDispense.performer.function A code describing the role an individual played in dispensing a medication. Source	Example MedicationDispense Performer Function Codes MedicationDispense.type Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion The source of Trial, Partial Fill, Emergency Fill, Samples, etc. Example 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 definition of the prescription. Example v3.ActSubstanceAdminSubstitutionCode MedicationDispense.substitution.reason A coded concept describing code (when the reason that a different medication should (or should not) be substituted from what was prescribed. Example v3.SubstanceAdminSubstitutionReason 11.3.4.2 Constraints id Level Location Description Expression value set draws in codes defined elsewhere)
mdd-1 Rule (base) whenHandedOver cannot be before whenPrepared Code	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 code (used as the code in REST, messaging, and services. Name Type Description Expression In Common the resource instance). If the code token Returns dispenses of is in italics, this medicine code (MedicationDispense.medication as CodeableConcept) 13 Resources context reference Returns dispenses with a specific context (episode or episode of care) MedicationDispense.context ( EpisodeOfCare , Encounter ) destination reference Returns dispenses indicates that should be sent to a specific destination MedicationDispense.destination ( Location ) identifier token Returns dispenses with this external identifier MedicationDispense.identifier 30 Resources medication reference Returns dispenses of this medicine resource (MedicationDispense.medication as Reference) ( Medication ) 3 Resources patient reference The identity of a patient to list dispenses for MedicationDispense.subject.where(resolve() the code is Patient) ( Patient ) 33 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 not selectable ('Abstract')
receiver reference Display	The identity display (used in the display element of a receiver to list dispenses for MedicationDispense.receiver ( Practitioner , Patient ) responsibleparty reference Coding Returns dispenses with ). If there is no display, implementers should not simply display the specified responsible party MedicationDispense.substitution.responsibleParty ( Practitioner , PractitionerRole ) status token Returns dispenses with a specified dispense status MedicationDispense.status 3 Resources code, but map the concept into their application
subject reference Definition	The identity An explanation of a patient for whom to list dispenses MedicationDispense.subject ( Group , Patient ) type token Returns dispenses the meaning of a specific type MedicationDispense.type whenhandedover date Returns dispenses handed over on this date MedicationDispense.whenHandedOver the concept
whenprepared date Returns dispenses prepared on this date MedicationDispense.whenPrepared Comments	Additional notes about how to use the code