Release 4 5 Preview #3
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Pharmacy Work Group Maturity Level : 2   Trial Use Security Category : Patient Compartments : Encounter , Patient , Practitioner

Detailed Descriptions for the elements in the MedicationDispense resource.

[x] Note See Choice of Data Types for further information about how to use [x]
MedicationDispense
Element Id MedicationDispense
Definition

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.

Cardinality 0..*
Type DomainResource
Invariants
Defined on this element
mdd-1 Rule whenHandedOver cannot be before whenPrepared whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared
MedicationDispense.identifier
Element Id MedicationDispense.identifier
Definition

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.

Note This is a business identifier, not a resource identifier (see discussion )
Cardinality 0..*
Type Identifier
Comments

This is a business identifier, not a resource identifier.

MedicationDispense.basedOn
Element Id MedicationDispense.basedOn
Definition

A plan that is fulfilled in whole or in part by this MedicationDispense.

Cardinality 0..*
Type Reference ( CarePlan )
MedicationDispense.partOf
Element Id MedicationDispense.partOf
Definition

The procedure or medication administration that trigger triggered the dispense.

Cardinality 0..*
Type Reference ( Procedure | MedicationAdministration )
Patterns Reference(Procedure,MedicationAdministration): Common patterns = Event
Comments

While both a procedure and a medication administration may have triggered the dispense, but it is not expected that multiple procedures and/or multiple medication administrations would be triggers.

MedicationDispense.status
Element Id MedicationDispense.status
Definition

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

Cardinality 1..1
Terminology Binding Medication dispense status codes ( Required )
Type code
Is Modifier true (Reason: This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid)
Summary true
Comments

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

MedicationDispense.statusReason[x] MedicationDispense.statusReason
Element Id MedicationDispense.statusReason[x] MedicationDispense.statusReason
Definition

Indicates the reason why a dispense was not performed.

Cardinality 0..1
Terminology Binding Medication dispense status reason codes ( Example )
Type CodeableConcept | Reference CodeableReference ( DetectedIssue )
MedicationDispense.category
Element Id MedicationDispense.category
Definition

Indicates the type of medication dispense (for example, drug classification like ATC, where the medication is expected to meds would be consumed or administered (i.e. inpatient or outpatient)). administered, legal category of the medication.).

Cardinality 0..1 0..*
Terminology Binding Medication dispense category administration location codes ( Preferred Example )
Type CodeableConcept
Comments

The category can be used to include where the medication is expected to be consumed or other types of dispenses. Invariants can be used to bind to different value sets when profiling to bind.

MedicationDispense.medication[x] MedicationDispense.medication
Element Id MedicationDispense.medication[x] MedicationDispense.medication
Definition

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.

Cardinality 1..1
Terminology Binding SNOMED CT Medication Codes ( Example )
Type CodeableConcept | Reference CodeableReference ( Medication )
[x] Note See Choice of Data Types for further information about how to use [x] Summary true
Comments

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

MedicationDispense.subject
Element Id MedicationDispense.subject
Definition

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

Cardinality 0..1 1..1
Type Reference ( Patient | Group )
Patterns Reference(Patient,Group): Common patterns = Participant
Summary true
Comments

SubstanceAdministration->subject->Patient.

MedicationDispense.context MedicationDispense.encounter
Element Id MedicationDispense.context MedicationDispense.encounter
Definition

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

Cardinality 0..1
Type Reference ( Encounter | EpisodeOfCare )
MedicationDispense.supportingInformation
Element Id MedicationDispense.supportingInformation
Definition

Additional information that supports the medication being dispensed. For example, there may be requirements that a specific lab test has been completed prior to dispensing or the patient's weight at the time of dispensing is documented.

Cardinality 0..*
Type Reference ( Any )
MedicationDispense.performer
Element Id MedicationDispense.performer
Definition

Indicates who or what performed the event.

Cardinality 0..*
MedicationDispense.performer.function
Element Id MedicationDispense.performer.function
Definition

Distinguishes the type of performer in the dispense. For example, date enterer, packager, final checker.

Cardinality 0..1
Terminology Binding Medication dispense performer function codes ( Example )
Type CodeableConcept
Requirements

Allows disambiguation of the types of involvement of different performers.

MedicationDispense.performer.actor
Element Id MedicationDispense.performer.actor
Definition

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

Cardinality 1..1
Type Reference ( Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson | CareTeam )
Patterns Reference(Practitioner,PractitionerRole,Organization,Patient,Device,RelatedPerson,CareTeam): Common patterns = Participant
MedicationDispense.location
Element Id MedicationDispense.location
Definition

The principal physical location where the dispense was performed.

Cardinality 0..1
Type Reference ( Location )
MedicationDispense.authorizingPrescription
Element Id MedicationDispense.authorizingPrescription
Definition

Indicates the medication order that is being dispensed against.

Cardinality 0..*
Type Reference ( MedicationRequest )
Comments

Maps to basedOn in Event logical model.

MedicationDispense.type
Element Id MedicationDispense.type
Definition

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

Cardinality 0..1
Terminology Binding V3 Value SetActPharmacySupplyType ActPharmacySupplyType ( Example )
Type CodeableConcept
MedicationDispense.quantity
Element Id MedicationDispense.quantity
Definition

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

Cardinality 0..1
Type SimpleQuantity
MedicationDispense.daysSupply
Element Id MedicationDispense.daysSupply
Definition

The amount of medication expressed as a timing amount.

Cardinality 0..1
Type SimpleQuantity
MedicationDispense.whenPrepared
Element Id MedicationDispense.whenPrepared
Definition

The time when the dispensed product was packaged and reviewed.

Cardinality 0..1
Type dateTime
Summary true
MedicationDispense.whenHandedOver
Element Id MedicationDispense.whenHandedOver
Definition

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

Cardinality 0..1
Type dateTime
MedicationDispense.destination
Element Id MedicationDispense.destination
Definition

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

Cardinality 0..1
Type Reference ( Location )
MedicationDispense.receiver
Element Id MedicationDispense.receiver
Definition

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

Cardinality 0..*
Type Reference ( Patient | Practitioner | RelatedPerson | Location | PractitionerRole )
Patterns Reference(Patient,Practitioner,RelatedPerson,Location,PractitionerRole): Common patterns = Participant
MedicationDispense.note
Element Id MedicationDispense.note
Definition

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

Cardinality 0..*
Type Annotation
MedicationDispense.renderedDosageInstruction
Element Id MedicationDispense.renderedDosageInstruction
Definition

The full representation of the dose of the medication included in all dosage instructions. To be used when multiple dosage instructions are included to represent complex dosing such as increasing or tapering doses.

Cardinality 0..1
Type string
Comments

The content of the renderedDosageInstructions must not be different than the dose represented in the dosageInstruction content.

MedicationDispense.dosageInstruction
Element Id MedicationDispense.dosageInstruction
Definition

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

Cardinality 0..*
Type Dosage
Comments

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

MedicationDispense.substitution
Element Id MedicationDispense.substitution
Definition

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.

Cardinality 0..1
MedicationDispense.substitution.wasSubstituted
Element Id MedicationDispense.substitution.wasSubstituted
Definition

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

Cardinality 1..1
Type boolean
MedicationDispense.substitution.type
Element Id MedicationDispense.substitution.type
Definition

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

Cardinality 0..1
Terminology Binding V3 Value SetActSubstanceAdminSubstitutionCode ActSubstanceAdminSubstitutionCode ( Example )
Type CodeableConcept
MedicationDispense.substitution.reason
Element Id MedicationDispense.substitution.reason
Definition

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

Cardinality 0..*
Terminology Binding V3 Value SetSubstanceAdminSubstitutionReason SubstanceAdminSubstitutionReason ( Example )
Type CodeableConcept
MedicationDispense.substitution.responsibleParty
Element Id MedicationDispense.substitution.responsibleParty
Definition

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

Cardinality 0..* 0..1
Type Reference ( Practitioner | PractitionerRole | Organization )
Patterns Reference(Practitioner,PractitionerRole,Organization): Common patterns = Participant
MedicationDispense.detectedIssue
Element Id MedicationDispense.detectedIssue
Definition

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.

Cardinality 0..*
Type Reference ( DetectedIssue )
Alternate Names Contraindication; Drug Utilization Review (DUR); Alert
Comments

This element can include a detected issue that has been identified either by a decision support system or by a clinician and may include information on the steps that were taken to address the issue.

MedicationDispense.eventHistory
Element Id MedicationDispense.eventHistory
Definition

A summary of the events of interest that have occurred, such as when the dispense was verified.

Cardinality 0..*
Type Reference ( Provenance )
Comments

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