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

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

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

A code specifying the state of The procedure that the set of dispense events. is done because of.

A link to a resource representing code specifying the person to whom state of the medication will be given. set of dispense events.

Indicates This element is labeled as a modifier because the medication order status contains codes that is being dispensed against. mark the resource as not currently valid.

Indicates the type of dispensing event that medication dispense and where the medication is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc. expected to be consumed or administered.

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

If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended. Note: do not use Medication.name to describe the dispensed medication. When the only available information is a text description of recommended.  For example if you require form or lot number, then you must reference the medication, Medication.code.text should be used. Medication resource. .

The time when A link to a resource representing the dispensed product was packaged and reviewed. person or the group to whom the medication will be given.

SubstanceAdministration->subject->Patient.

The time the dispensed product was provided to the patient encounter or their representative. episode of care that establishes the context for this event.

Identification of the facility/location where Additional information that supports the medication was shipped to, as part of the dispense event. being dispensed.

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

The performer will be reviewed as part of STU4.

Identifies the person The device, practitioner, etc. who picked up performed the medication. This will usually be a patient or their caregiver, but some cases exist where it can action. It should be a healthcare professional. assumed that the actor is the dispenser of the medication.

Extra information about the dispense that could not be conveyed in The organization the other attributes. device or practitioner was acting on behalf of.

Indicates how the medication order that is to be used by the patient. being dispensed against.

When the dose or rate is intended to change over the entire administration period (e.g. Tapering dose prescriptions), multiple instances of dosage instructions will need to be supplied Maps to convey the different doses/rates. basedOn in Event logical model.

Free text dosage instructions can be used for cases where the instructions are too complex to code. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering Indicates the medication. type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc.

Additional instructions such as "Swallow with plenty The amount of water" which may or may not be coded. medication that has been dispensed. Includes unit of measure.

The amount of medication expressed as a timing amount.

The timing schedule for giving the medication to time when the patient. The Schedule data type allows many different expressions. For example, "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 dispensed product was packaged and 1 Nov 2013". reviewed.

Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept). Specifically if 'boolean' datatype is selected, then The time the following logic applies: If set dispensed product was provided to True, this indicates that the medication is only taken when needed, within the specified schedule. patient or their representative.

A coded specification Identification of the anatomic site facility/location where the medication first enters was shipped to, as part of the body. dispense event.

A code specifying Identifies the route or physiological path of administration of person who picked up the medication. This will usually be a therapeutic agent into patient or onto their caregiver, but some cases exist where it can be a subject. healthcare professional.

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

A coded value indicating the method by which Indicates how the medication is intended to be or was introduced into or on used by the body. patient.

This attribute will most often NOT be populated. It is most commonly used for injections. For example, Slow Push, Deep IV. One of the reasons this attribute is not used often, is that When the method dose or rate is often pre-coordinated with intended to change over the route and/or form entire administration period (e.g. Tapering dose prescriptions), multiple instances of administration. This means the codes used in route or form may pre-coordinate the method in the route code or dosage instructions will need to be supplied to convey the form code. different doses/rates. The implementation decision about what coding system pharmacist reviews the medication order prior to use for route or form code will determine how frequently dispense and updates the method code will be populated e.g. if route or form code pre-coordinate method code, then this attribute will not be populated often; if there is no pre-coordination then method code may be used frequently. dosageInstruction based on the actual product being dispensed.

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

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

Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Currently we do not specify A code signifying whether a default of '1' in the denominator, but this is being discussed. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. different drug was dispensed from what was prescribed.

The maximum total quantity of a therapeutic substance that may be administered to a subject over Indicates the period reason for the substitution of time, e.g. 1000mg in 24 hours. (or lack of substitution) from what was prescribed.

Indicates whether The person or not substitution was made as part of organization that has primary responsibility for 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. substitution.

A code signifying whether Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a different drug was dispensed from what was prescribed. patient; e.g. Drug-drug interaction, duplicate therapy, dosage alert etc.

True if the dispense was not performed for some reason.

Indicates the reason for the substitution of (or lack of substitution) from what why a dispense was prescribed. not performed.

The person or organization A summary of the events of interest that has primary responsibility for have occurred, such as when the substitution. dispense was verified.

This may not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.).