| UKCoreMedicationDispense (MedicationDispense) | C | | MedicationDispense | There are no (further) constraints on this element Element idMedicationDispense Short descriptionDispensing a medication to a named patient DefinitionIndicates 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.
MedicationDispense Constraints- dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
contained.contained.empty() - dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() - dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() - dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
contained.meta.security.empty() - dom-6: A resource should have narrative for robust management
text.`div`.exists() - mdd-1: whenHandedOver cannot be before whenPrepared
whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared
Mappings- rim: Entity. Role, or Act
- workflow: Event
- rim: Supply[moodCode=EVN]
|
| id | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationDispense.id Short descriptionLogical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
string |
| meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idMedicationDispense.meta Short descriptionMetadata about the resource DefinitionThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Meta Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idMedicationDispense.implicitRules Short descriptionA set of rules under which this content was created DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
uri Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| language | | 0..1 | codeBinding | There are no (further) constraints on this element Element idMedicationDispense.language Short descriptionLanguage of the resource content DefinitionThe base language in which the resource is written.
Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
code BindingCommonLanguages (preferred) Binding extensionsConstraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
|
| text | | 0..1 | Narrative | There are no (further) constraints on this element Element idMedicationDispense.text Short descriptionText summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
Narrative Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |
| contained | | 0..* | Resource | There are no (further) constraints on this element Element idMedicationDispense.contained Short descriptionContained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Resource Mappings |
| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationDispense.extension Short descriptionAdditional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| modifierExtension | ?! C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationDispense.modifierExtension Short descriptionExtensions that cannot be ignored Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| identifier | S | 0..* | Identifier | There are no (further) constraints on this element Element idMedicationDispense.identifier Short descriptionExternal identifier DefinitionIdentifiers 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.
This is a business identifier, not a resource identifier.
Identifier Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- workflow: Event.identifier
- w5: FiveWs.identifier
- rim: .id
- rx-dispense-rmim: CombinedMedicationDispense.id
|
| partOf | | 0..* | Reference(Procedure) | There are no (further) constraints on this element Element idMedicationDispense.partOf Short descriptionEvent that dispense is part of DefinitionThe procedure that trigger the dispense.
Reference(Procedure) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- workflow: Event.partOf
- rim: .outboundRelationship[typeCode=COMP]/target[classCode=PROC,moodCode=EVN]
|
| status | S Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element idMedicationDispense.status Short descriptionpreparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown DefinitionA code specifying the state of the set of dispense events.
This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
code BindingA coded concept specifying the state of the dispense event.
MedicationDispense Status Codes (required) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- workflow: Event.status
- w5: FiveWs.status
- rim: .statusCode
- rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.statusCode
|
| statusReason[x] | | 0..1 | | There are no (further) constraints on this element Element idMedicationDispense.statusReason[x] Short descriptionWhy a dispense was not performed DefinitionIndicates the reason why a dispense was not performed.
A code describing why a dispense was not performed.
MedicationDispense Status Reason Codes (example) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- workflow: Event.statusReason
- rim: .outboundRelationship[typeCode=RSON]/target[classCode=OBS,moodCode=EVN, code="not done reason"].value
|
| statusReasonCodeableConcept | | | CodeableConcept | There are no (further) constraints on this element Data typeCodeableConcept |
| statusReasonReference | | | Reference(DetectedIssue) | There are no (further) constraints on this element Data typeReference(DetectedIssue) |
| category | | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idMedicationDispense.category Short descriptionType of medication dispense DefinitionIndicates the type of medication dispense (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)).
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.
CodeableConcept BindingA code describing where the dispensed medication is expected to be consumed or administered.
MedicationDispense Category Codes (preferred) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: .inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="type of medication dispense"].value
|
| medication[x] | S Σ | 1..1 | Binding | Element idMedicationDispense.medication[x] Short descriptionWhat medication was supplied DefinitionIdentifies 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. For example, if you require form or lot number, then you must reference the Medication resource.
A coded concept identifying which substance or product can be dispensed.
UKCoreMedicationCode (preferred) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- workflow: Event.code
- w5: FiveWs.what[x]
- v2: RXD-2-Dispense/Give Code
- rim: .participation[typeCode=PRD].role
- rx-dispense-rmim: CombinedMedicationRequest.component1.AdministrationRequest.consumable
|
| medicationCodeableConcept | | | CodeableConcept | There are no (further) constraints on this element Data typeCodeableConcept |
| medicationReference | | | Reference(Medication) | There are no (further) constraints on this element Data typeReference(Medication) |
| subject | S Σ | 0..1 | Reference(Patient | Group) | There are no (further) constraints on this element Element idMedicationDispense.subject Short descriptionWho the dispense is for DefinitionA link to a resource representing the person or the group to whom the medication will be given.
SubstanceAdministration->subject->Patient.
Reference(Patient | Group) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- workflow: Event.subject
- w5: FiveWs.subject[x]
- v2: PID-3-Patient ID List
- rim: .participation[typeCode=SBJ].role[classCode=PAT]
- w5: FiveWs.subject
|
| context | | 0..1 | Reference(Encounter | EpisodeOfCare) | There are no (further) constraints on this element Element idMedicationDispense.context Short descriptionEncounter / Episode associated with event DefinitionThe encounter or episode of care that establishes the context for this event.
Reference(Encounter | EpisodeOfCare) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- workflow: Event.context
- rim: .inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code="type of encounter or episode"]
|
| supportingInformation | | 0..* | Reference(Resource) | There are no (further) constraints on this element Element idMedicationDispense.supportingInformation Short descriptionInformation that supports the dispensing of the medication DefinitionAdditional information that supports the medication being dispensed.
Reference(Resource) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- w5: FiveWs.context
- rim: .outboundRelationship[typeCode=PERT].target[A_SupportingClinicalStatement CMET minimal with many different choices of classCodes(ORG, ENC, PROC, SPLY, SBADM, OBS) and each of the act class codes draws from one or more of the following moodCodes (EVN, DEF, INT PRMS, RQO, PRP, APT, ARQ, GOL)]
|
| performer | S | 0..* | BackboneElement | There are no (further) constraints on this element Element idMedicationDispense.performer Short descriptionWho performed event DefinitionIndicates who or what performed the event.
BackboneElement Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- workflow: Event.performer
- rim: .participation[typeCode=PRF]
|
| id | | 0..1 | string | There are no (further) constraints on this element Element idMedicationDispense.performer.id Short descriptionUnique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
string Mappings |
| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationDispense.performer.extension Short descriptionAdditional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationDispense.performer.modifierExtension Short descriptionExtensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| function | | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idMedicationDispense.performer.function Short descriptionWho performed the dispense and what they did DefinitionDistinguishes the type of performer in the dispense. For example, date enterer, packager, final checker.
Allows disambiguation of the types of involvement of different performers.
CodeableConcept BindingA code describing the role an individual played in dispensing a medication.
MedicationDispense Performer Function Codes (example) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: participation[typeCode=PRF].functionCode
|
| actor | | 1..1 | Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson) | There are no (further) constraints on this element Element idMedicationDispense.performer.actor Short descriptionIndividual who was performing DefinitionThe device, practitioner, etc. who performed the action. It should be assumed that the actor is the dispenser of the medication.
Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- workflow: Event.performer.actor
- rim: .role
|
| location | | 0..1 | Reference(Location) | There are no (further) constraints on this element Element idMedicationDispense.location Short descriptionWhere the dispense occurred DefinitionThe principal physical location where the dispense was performed.
Reference(Location) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: .participation[typeCode=LOC].role
|
| authorizingPrescription | | 0..* | Reference(MedicationRequest) | There are no (further) constraints on this element Element idMedicationDispense.authorizingPrescription Short descriptionMedication order that authorizes the dispense DefinitionIndicates the medication order that is being dispensed against.
Maps to basedOn in Event logical model.
Reference(MedicationRequest) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- workflow: Event.basedOn
- v2: ORC-2 Placer Order Number
- rim: .outboundRelationship[typeCode=FLFS].target[moodCode=RQO]
- rx-dispense-rmim: CombinedMedicationDispense.inFulfillmentOf
|
| type | | 0..1 | CodeableConceptBinding | Element idMedicationDispense.type Short descriptionTrial fill, partial fill, emergency fill, etc. DefinitionIndicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc.
CodeableConcept BindingIndicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc.
UKCoreMedicationSupplyType (extensible) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: RXD-33-Dispense Type
- rim: .code
- rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.code
|
| quantity | S | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idMedicationDispense.quantity Short descriptionAmount dispensed DefinitionThe amount of medication that has been dispensed. Includes unit of measure.
SimpleQuantity Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: RXD-4-Actual Dispense Amount / RXD-5.1-Actual Dispense Units.code / RXD-5.3-Actual Dispense Units.name of coding system
- rim: .quantity
- rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.quantity
|
| daysSupply | | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idMedicationDispense.daysSupply Short descriptionAmount of medication expressed as a timing amount DefinitionThe amount of medication expressed as a timing amount.
SimpleQuantity Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: TQ1.6 Timing/Quantity Segment Service Duration.
Prior to v2.5, ORC.7.3 Common Order Segment / Quantity/Timing / Duration component. This is a formatted string, first character for the time unit (e.g., D=days), followed by the value. For example, “D14” represents “14 days supply”
From v2.5 on, TQ1.6 Timing/Quantity Segment / Service Duration. This is a CQ data type (<Quantity (NM)> ^ <Units (CWE)>), thus for days supply, assuming the unit of measure is “days”, the numeric value is TQ1.6.1 (…|14^
For backwards compatibility, ORC.7 was permitted through v2.6. Both forms (field and segment) may be present in v2.5, v2.5.1, and v2.6
- rim: effectiveUseTime
|
| whenPrepared | S Σ | 0..1 | dateTime | There are no (further) constraints on this element Element idMedicationDispense.whenPrepared Short descriptionWhen product was packaged and reviewed DefinitionThe time when the dispensed product was packaged and reviewed.
dateTime Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: RXD-3-Date/Time Dispensed
- rim: .effectiveTime[xmi:type=IVL_TS].low
- rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.effectiveTime
|
| whenHandedOver | | 0..1 | dateTime | There are no (further) constraints on this element Element idMedicationDispense.whenHandedOver Short descriptionWhen product was given out DefinitionThe time the dispensed product was provided to the patient or their representative.
dateTime Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- workflow: Event.occurrence[x]
- v2: RXD-3-Date/Time Dispensed
- rim: .effectiveTime[xmi:type=IVL_TS].high
- rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.effectiveTime
|
| destination | | 0..1 | Reference(Location) | There are no (further) constraints on this element Element idMedicationDispense.destination Short descriptionWhere the medication was sent DefinitionIdentification of the facility/location where the medication was shipped to, as part of the dispense event.
Reference(Location) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: RXD-13 Dispense-to Location; RXD-30 Dispense to Pharmacy; RXD-31 Dispense to Pharmacy Address
- rim: .participation[typeCode=DST].role
- rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.destination
|
| receiver | | 0..* | Reference(Patient | Practitioner) | There are no (further) constraints on this element Element idMedicationDispense.receiver Short descriptionWho collected the medication DefinitionIdentifies 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.
Reference(Patient | Practitioner) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: .participation[typeCode=RCV].role
- rx-dispense-rmim: CombinedMedicationDispense.SupplyEvent.receiver
|
| note | | 0..* | Annotation | There are no (further) constraints on this element Element idMedicationDispense.note Short descriptionInformation about the dispense DefinitionExtra information about the dispense that could not be conveyed in the other attributes.
Annotation Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- workflow: Event.note
- v2: RXD-9 Dispense Notes
- rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=ACT,moodCode=EVN]
|
| dosageInstruction | S | 0..* | Dosage | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction Short descriptionHow the medication is to be used by the patient or administered by the caregiver DefinitionIndicates how the medication is to be used by the patient.
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.
Dosage Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: .outboundRelationship[typeCode=COMP].target[classCode=SBADM, moodCode=INT]
|
| id | | 0..1 | string | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.id Short descriptionUnique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
string Mappings |
| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.extension Short descriptionAdditional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension SlicingUnordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.modifierExtension Short descriptionExtensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| sequence | Σ | 0..1 | integer | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.sequence Short descriptionThe order of the dosage instructions DefinitionIndicates the order in which the dosage instructions should be applied or interpreted.
If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. If the sequence number is different, then the Dosages are intended to be sequential.
integer Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |
| text | S Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.text Short descriptionFree text dosage instructions e.g. SIG DefinitionFree text dosage instructions e.g. SIG.
Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing. Additional information about administration or preparation of the medication should be included as text.
string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: RXO-6; RXE-21
- rim: .text
|
| additionalInstruction | Σ | 0..* | CodeableConcept | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.additionalInstruction Short descriptionSupplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness" DefinitionSupplemental instructions to the patient on how to take the medication (e.g. "with meals" or"take half to one hour before food") or warnings for the patient about the medication (e.g. "may cause drowsiness" or "avoid exposure of skin to direct sunlight or sunlamps").
Additional instruction is intended to be coded, but where no code exists, the element could include text. For example, "Swallow with plenty of water" which might or might not be coded.
Information about administration or preparation of the medication (e.g. "infuse as rapidly as possibly via intraperitoneal port" or "immediately following drug x") should be populated in dosage.text.
CodeableConcept BindingA coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
SNOMEDCTAdditionalDosageInstructions (example) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |
| patientInstruction | Σ | 0..1 | string | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.patientInstruction Short descriptionPatient or consumer oriented instructions DefinitionInstructions in terms that are understood by the patient or consumer.
string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |
| timing | S Σ | 0..1 | Timing | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.timing Short descriptionWhen medication should be administered DefinitionWhen medication should be administered.
The timing schedule for giving the medication to the patient. This 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 and 1 Nov 2013". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.
This attribute might not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.
Timing Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |
| asNeeded[x] | Σ | 0..1 | Binding | Element idMedicationDispense.dosageInstruction.asNeeded[x] Short descriptionTake "as needed" (for x) DefinitionIndicates 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).
Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not "prn" or "as needed".
A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.
SNOMEDCTMedicationAsNeededReasonCodes (preferred) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: TQ1-9
- rim: .outboundRelationship[typeCode=PRCN].target[classCode=OBS, moodCode=EVN, code="as needed"].value=boolean or codable concept
|
| asNeededBoolean | | | boolean | There are no (further) constraints on this element Data typeboolean |
| asNeededCodeableConcept | | | CodeableConcept | There are no (further) constraints on this element Data typeCodeableConcept |
| site | Σ | 0..1 | CodeableConceptBinding | Element idMedicationDispense.dosageInstruction.site Short descriptionBody site to administer to DefinitionBody site to administer to.
A coded specification of the anatomic site where the medication first enters the body.
If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.
CodeableConcept BindingA coded concept describing the site location the medicine enters into or onto the body.
UKCoreBodySite (preferred) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: RXR-2
- rim: .approachSiteCode
|
| route | Σ | 0..1 | CodeableConceptBinding | Element idMedicationDispense.dosageInstruction.route Short descriptionHow drug should enter body DefinitionHow drug should enter body.
A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.
CodeableConcept BindingA coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
UKCoreSubstanceOrProductAdministrationRoute (preferred) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |
| method | Σ | 0..1 | CodeableConceptBinding | Element idMedicationDispense.dosageInstruction.method Short descriptionTechnique for administering medication DefinitionTechnique for administering medication.
A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV.
Terminologies used often pre-coordinate this term with the route and or form of administration.
CodeableConcept BindingA coded concept describing the technique by which the medicine is administered.
UKCoreMedicationDosageMethod (preferred) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: RXR-4
- rim: .doseQuantity
|
| doseAndRate | S Σ | 0..* | Element | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.doseAndRate Short descriptionAmount of medication administered DefinitionThe amount of medication administered.
Element Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |
| id | | 0..1 | string | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.doseAndRate.id Short descriptionUnique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
string Mappings |
| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.doseAndRate.extension Short descriptionAdditional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension SlicingUnordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| type | Σ | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.doseAndRate.type Short descriptionThe kind of dose or rate specified DefinitionThe kind of dose or rate specified, for example, ordered or calculated.
If the type is not populated, assume to be "ordered".
CodeableConcept BindingThe kind of dose or rate specified.
DoseAndRateType (example) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |
| dose[x] | S Σ | 0..1 | | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.doseAndRate.dose[x] Short descriptionAmount of medication per dose DefinitionAmount of medication per dose.
The amount of therapeutic or other substance given at one administration event.
Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.
- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: RXO-2, RXE-3
- rim: .doseQuantity
|
| doseRange | | | Range | There are no (further) constraints on this element Data typeRange |
| doseQuantity | | | SimpleQuantity | There are no (further) constraints on this element Data typeSimpleQuantity |
| rate[x] | S Σ | 0..1 | | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.doseAndRate.rate[x] Short descriptionAmount of medication per unit of time DefinitionAmount of medication per unit of time.
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. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.
It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate.
It is possible to specify a rate over time (for example, 100 ml/hour) using either the rateRatio and rateQuantity. The rateQuantity approach requires systems to have the capability to parse UCUM grammer where ml/hour is included rather than a specific ratio where the time is specified as the denominator. Where a rate such as 500ml over 2 hours is specified, the use of rateRatio may be more semantically correct than specifying using a rateQuantity of 250 mg/hour.
- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: RXE22, RXE23, RXE-24
- rim: .rateQuantity
|
| rateRatio | | | Ratio | There are no (further) constraints on this element Data typeRatio |
| rateRange | | | Range | There are no (further) constraints on this element Data typeRange |
| rateQuantity | | | SimpleQuantity | There are no (further) constraints on this element Data typeSimpleQuantity |
| maxDosePerPeriod | Σ | 0..1 | Ratio | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.maxDosePerPeriod Short descriptionUpper limit on medication per unit of time DefinitionUpper limit on medication per unit of time.
The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours.
This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".
Ratio Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: RXO-23, RXE-19
- rim: .maxDoseQuantity
|
| maxDosePerAdministration | Σ | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.maxDosePerAdministration Short descriptionUpper limit on medication per administration DefinitionUpper limit on medication per administration.
The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.
This is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg.
SimpleQuantity Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |
| maxDosePerLifetime | Σ | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idMedicationDispense.dosageInstruction.maxDosePerLifetime Short descriptionUpper limit on medication per lifetime of the patient DefinitionUpper limit on medication per lifetime of the patient.
The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.
SimpleQuantity Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |
| substitution | | 0..1 | BackboneElement | There are no (further) constraints on this element Element idMedicationDispense.substitution Short descriptionWhether a substitution was performed on the dispense DefinitionIndicates 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.
BackboneElement Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: .outboundRelationship[typeCode=COMP].target[classCode=SUBST, moodCode=EVN]
- rx-dispense-rmim: CombinedMedicationDispense.substitutionMade
|
| id | | 0..1 | string | There are no (further) constraints on this element Element idMedicationDispense.substitution.id Short descriptionUnique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
string Mappings |
| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationDispense.substitution.extension Short descriptionAdditional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idMedicationDispense.substitution.modifierExtension Short descriptionExtensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
Mappings |
| wasSubstituted | | 1..1 | boolean | There are no (further) constraints on this element Element idMedicationDispense.substitution.wasSubstituted Short descriptionWhether a substitution was or was not performed on the dispense DefinitionTrue if the dispenser dispensed a different drug or product from what was prescribed.
boolean Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings |
| type | | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idMedicationDispense.substitution.type Short descriptionCode signifying whether a different drug was dispensed from what was prescribed DefinitionA code signifying whether a different drug was dispensed from what was prescribed.
CodeableConcept BindingA coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription.
v3.ActSubstanceAdminSubstitutionCode (example) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- v2: RXO-9-Allow Substitutions / RXE-9-Substitution Status
- rim: .code
- rx-dispense-rmim: CombinedMedicationDispense.substitutionMade.code
|
| reason | | 0..* | CodeableConcept | There are no (further) constraints on this element Element idMedicationDispense.substitution.reason Short descriptionWhy was substitution made DefinitionIndicates the reason for the substitution (or lack of substitution) from what was prescribed.
CodeableConcept BindingA coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
v3.SubstanceAdminSubstitutionReason (example) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: .reasonCode
- rx-dispense-rmim: CombinedMedicationDispense.substitutionMade.reasonCode
|
| responsibleParty | | 0..* | Reference(Practitioner | PractitionerRole) | There are no (further) constraints on this element Element idMedicationDispense.substitution.responsibleParty Short descriptionWho is responsible for the substitution DefinitionThe person or organization that has primary responsibility for the substitution.
Reference(Practitioner | PractitionerRole) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: .participation[typeCode=PFM].role[classCode=ASSIGN]
- rx-dispense-rmim: CombinedMedicationDispense.substitutionMade.ResponsibleParty
|
| detectedIssue | | 0..* | Reference(DetectedIssue) | There are no (further) constraints on this element Element idMedicationDispense.detectedIssue Short descriptionClinical issue with action Alternate namesContraindication, Drug Utilization Review (DUR), Alert DefinitionIndicates 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.
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.
Reference(DetectedIssue) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=ALRT,moodCode=EVN].value
|
| eventHistory | | 0..* | Reference(Provenance) | There are no (further) constraints on this element Element idMedicationDispense.eventHistory Short descriptionA list of relevant lifecycle events DefinitionA summary of the events of interest that have occurred, such as when the dispense was verified.
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.).
Reference(Provenance) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Mappings- rim: .inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]
|
