Name	Flags	Card.	Type	Description & Constraints
MedicationDispense	C	0..*	MedicationDispense	Dispensing a medication to a named patient dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management mdd-1: whenHandedOver cannot be before whenPrepared
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
status	?!SΣC	1..1	code	preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event. ele-1: All FHIR elements must have a @value or children mdp-25-1577: If (52-60 > 52.2-8) is not null then fixed value #completed mdp-25-1578: If (52-60 > 52.2-8) is null then fixed value #in-progress
category	S	0..1	CodeableConcept	Type of medication dispense Binding: MedicationDispense Category Codes (preferred): A code describing where the dispensed medication is expected to be consumed or administered. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/fhir/CodeSystem/medicationdispense-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: outpatient
Slices for medication[x]	Σ	1..1		What medication was supplied Slice: Unordered, Open by type:$this Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying which substance or product can be dispensed. ele-1: All FHIR elements must have a @value or children
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(Medication)
medication[x]:medicationCodeableConcept	Σ	0..1	CodeableConcept	What medication was supplied Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying which substance or product can be dispensed. ele-1: All FHIR elements must have a @value or children
coding	Σ	0..*	Coding	Code defined by a terminology system ele-1: All FHIR elements must have a @value or children
system	SΣ	0..1	uri	Identity of the terminology system ele-1: All FHIR elements must have a @value or children Required Pattern: urn:oid:2.16.840.1.113883.6.233
code	SΣ	0..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children
text	SΣ	0..1	string	Plain text representation of the concept ele-1: All FHIR elements must have a @value or children
subject	SΣ	0..1	Reference(Patient)	Who the dispense is for ele-1: All FHIR elements must have a @value or children
performer		0..*	BackboneElement	Who performed event ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
actor	S	1..1	Reference(Practitioner)	Individual who was performing ele-1: All FHIR elements must have a @value or children
location	S	0..1	Reference(Location)	Where the dispense occurred ele-1: All FHIR elements must have a @value or children
authorizingPrescription	S	0..*	Reference(MedicationRequest: Outpatient)	Medication order that authorizes the dispense ele-1: All FHIR elements must have a @value or children
type	S	0..1	CodeableConcept	Trial fill, partial fill, emergency fill, etc. Binding: ActPharmacySupplyType (example): Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
code		1..1	code	Symbol in syntax defined by the system Fixed Value: PF
quantity		0..1	SimpleQuantity	Amount dispensed ele-1: All FHIR elements must have a @value or children
value	SΣ	0..1	decimal	Numerical value (with implicit precision) ele-1: All FHIR elements must have a @value or children
daysSupply	S	0..1	SimpleQuantity	Amount of medication expressed as a timing amount ele-1: All FHIR elements must have a @value or children
whenPrepared	SΣ	0..1	dateTime	When product was packaged and reviewed ele-1: All FHIR elements must have a @value or children
destination		0..1	Reference(Location)	Where the medication was sent ele-1: All FHIR elements must have a @value or children
display	SΣ	0..1	string	Text alternative for the resource ele-1: All FHIR elements must have a @value or children
note		0..*	Annotation	Information about the dispense ele-1: All FHIR elements must have a @value or children
text	SΣ	1..1	markdown	The annotation - text content (as markdown) ele-1: All FHIR elements must have a @value or children
dosageInstruction		0..*	Dosage	How the medication is to be used by the patient or administered by the caregiver ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
text	SΣ	0..1	string	Free text dosage instructions e.g. SIG ele-1: All FHIR elements must have a @value or children
patientInstruction	SΣ	0..1	string	Patient or consumer oriented instructions ele-1: All FHIR elements must have a @value or children
doseAndRate	Σ	0..*	Element	Amount of medication administered ele-1: All FHIR elements must have a @value or children
Slices for dose[x]	Σ	0..1		Amount of medication per dose Slice: Unordered, Open by type:$this ele-1: All FHIR elements must have a @value or children
doseRange			Range
doseQuantity			Quantity(SimpleQuantity)
dose[x]:doseQuantity	Σ	0..1	SimpleQuantity	Amount of medication per dose ele-1: All FHIR elements must have a @value or children
value	SΣC	0..1	decimal	Numerical value (with implicit precision) ele-1: All FHIR elements must have a @value or children mdp-25-1570: If number then source value from (52-113 > 52.0113-.01)
unit	SΣ	0..1	string	Unit representation ele-1: All FHIR elements must have a @value or children
code	SΣ	0..1	code	Coded form of the unit Binding: DoseUnits FHIR (required): see mapping VF_DoseUnits ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
MedicationDispense.status	required	MedicationDispense Status Codes http://hl7.org/fhir/ValueSet/medicationdispense-status|4.0.1 from the FHIR Standard
MedicationDispense.category	preferred	Pattern: outpatient http://hl7.org/fhir/ValueSet/medicationdispense-category from the FHIR Standard
MedicationDispense.medication[x]	example	SNOMEDCTMedicationCodes http://hl7.org/fhir/ValueSet/medication-codes from the FHIR Standard
MedicationDispense.medication[x]:medicationCodeableConcept	example	SNOMEDCTMedicationCodes http://hl7.org/fhir/ValueSet/medication-codes from the FHIR Standard
MedicationDispense.type	example	Pattern: PF http://terminology.hl7.org/ValueSet/v3-ActPharmacySupplyType
MedicationDispense.dosageInstruction.doseAndRate.dose[x]:doseQuantity.code	required	DoseUnits http://va.gov/fhir/ValueSet/DoseUnits from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MedicationDispense	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MedicationDispense	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	error	MedicationDispense	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	error	MedicationDispense	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MedicationDispense	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
mdd-1	error	MedicationDispense	whenHandedOver cannot be before whenPrepared : whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared
mdp-25-1570	warning	MedicationDispense.dosageInstruction.doseAndRate.dose[x]:doseQuantity.value	If number then source value from (52-113 > 52.0113-.01) : true
mdp-25-1577	warning	MedicationDispense.status	If (52-60 > 52.2-8) is not null then fixed value #completed : true
mdp-25-1578	warning	MedicationDispense.status	If (52-60 > 52.2-8) is null then fixed value #in-progress : true

Name	Flags	Card.	Type	Description & Constraints
MedicationDispense			MedicationDispense
status	SC	1..1	code	preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown mdp-25-1577: If (52-60 > 52.2-8) is not null then fixed value #completed mdp-25-1578: If (52-60 > 52.2-8) is null then fixed value #in-progress
category	S	0..1	CodeableConcept	Type of medication dispense Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/fhir/CodeSystem/medicationdispense-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: outpatient
Slices for medication[x]		1..1	CodeableConcept, Reference(Medication)	What medication was supplied Slice: Unordered, Open by type:$this
medication[x]:medicationCodeableConcept		0..1	CodeableConcept	What medication was supplied
coding
system	S	0..1	uri	Identity of the terminology system Required Pattern: urn:oid:2.16.840.1.113883.6.233
code	S	0..1	code	Symbol in syntax defined by the system
text	S	0..1	string	Plain text representation of the concept
subject	S	0..1	Reference(Patient)	Who the dispense is for
performer
actor	S	1..1	Reference(Practitioner)	Individual who was performing
location	S	0..1	Reference(Location)	Where the dispense occurred
authorizingPrescription	S	0..*	Reference(MedicationRequest: Outpatient)	Medication order that authorizes the dispense
type	S	0..1	CodeableConcept	Trial fill, partial fill, emergency fill, etc. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
code		1..1	code	Symbol in syntax defined by the system Fixed Value: PF
quantity
value	S	0..1	decimal	Numerical value (with implicit precision)
daysSupply	S	0..1	SimpleQuantity	Amount of medication expressed as a timing amount
whenPrepared	S	0..1	dateTime	When product was packaged and reviewed
destination
display	S	0..1	string	Text alternative for the resource
note
text	S	1..1	markdown	The annotation - text content (as markdown)
dosageInstruction
text	S	0..1	string	Free text dosage instructions e.g. SIG
patientInstruction	S	0..1	string	Patient or consumer oriented instructions
doseAndRate
Slices for dose[x]		0..1	Range, SimpleQuantity	Amount of medication per dose Slice: Unordered, Open by type:$this
dose[x]:doseQuantity		0..1	SimpleQuantity	Amount of medication per dose
value	SC	0..1	decimal	Numerical value (with implicit precision) mdp-25-1570: If number then source value from (52-113 > 52.0113-.01)
unit	S	0..1	string	Unit representation
code	S	0..1	code	Coded form of the unit Binding: DoseUnits FHIR (required): see mapping VF_DoseUnits
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
MedicationDispense.dosageInstruction.doseAndRate.dose[x]:doseQuantity.code	required	DoseUnits http://va.gov/fhir/ValueSet/DoseUnits from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
mdp-25-1570	warning	MedicationDispense.dosageInstruction.doseAndRate.dose[x]:doseQuantity.value	If number then source value from (52-113 > 52.0113-.01) : true
mdp-25-1577	warning	MedicationDispense.status	If (52-60 > 52.2-8) is not null then fixed value #completed : true
mdp-25-1578	warning	MedicationDispense.status	If (52-60 > 52.2-8) is null then fixed value #in-progress : true

Name	Flags	Card.	Type	Description & Constraints
MedicationDispense	C	0..*	MedicationDispense	Dispensing a medication to a named patient mdd-1: whenHandedOver cannot be before whenPrepared
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		0..*	Identifier	External identifier
partOf		0..*	Reference(Procedure)	Event that dispense is part of
status	?!SΣC	1..1	code	preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event. mdp-25-1577: If (52-60 > 52.2-8) is not null then fixed value #completed mdp-25-1578: If (52-60 > 52.2-8) is null then fixed value #in-progress
statusReason[x]		0..1		Why a dispense was not performed Binding: MedicationDispense Status Reason Codes (example): A code describing why a dispense was not performed.
statusReasonCodeableConcept			CodeableConcept
statusReasonReference			Reference(DetectedIssue)
category	S	0..1	CodeableConcept	Type of medication dispense Binding: MedicationDispense Category Codes (preferred): A code describing where the dispensed medication is expected to be consumed or administered. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/fhir/CodeSystem/medicationdispense-category
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: outpatient
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Slices for medication[x]	Σ	1..1		What medication was supplied Slice: Unordered, Open by type:$this Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying which substance or product can be dispensed.
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(Medication)
medication[x]:medicationCodeableConcept	Σ	0..1	CodeableConcept	What medication was supplied Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying which substance or product can be dispensed.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	0..1	uri	Identity of the terminology system Required Pattern: urn:oid:2.16.840.1.113883.6.233
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	SΣ	0..1	string	Plain text representation of the concept
subject	SΣ	0..1	Reference(Patient)	Who the dispense is for
context		0..1	Reference(Encounter | EpisodeOfCare)	Encounter / Episode associated with event
supportingInformation		0..*	Reference(Resource)	Information that supports the dispensing of the medication
performer		0..*	BackboneElement	Who performed event
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
function		0..1	CodeableConcept	Who performed the dispense and what they did Binding: MedicationDispense Performer Function Codes (example): A code describing the role an individual played in dispensing a medication.
actor	S	1..1	Reference(Practitioner)	Individual who was performing
location	S	0..1	Reference(Location)	Where the dispense occurred
authorizingPrescription	S	0..*	Reference(MedicationRequest: Outpatient)	Medication order that authorizes the dispense
type	S	0..1	CodeableConcept	Trial fill, partial fill, emergency fill, etc. Binding: ActPharmacySupplyType (example): Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: PF
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
quantity		0..1	SimpleQuantity	Amount dispensed
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	SΣ	0..1	decimal	Numerical value (with implicit precision)
unit	Σ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form
code	Σ	0..1	code	Coded form of the unit
daysSupply	S	0..1	SimpleQuantity	Amount of medication expressed as a timing amount
whenPrepared	SΣ	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
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	SΣ	0..1	string	Text alternative for the resource
receiver		0..*	Reference(Patient | Practitioner)	Who collected the medication
note		0..*	Annotation	Information about the dispense
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
author[x]	Σ	0..1		Individual responsible for the annotation
authorReference			Reference(Practitioner | Patient | RelatedPerson | Organization)
authorString			string
time	Σ	0..1	dateTime	When the annotation was made
text	SΣ	1..1	markdown	The annotation - text content (as markdown)
dosageInstruction		0..*	Dosage	How the medication is to be used by the patient or administered by the caregiver
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	Σ	0..1	integer	The order of the dosage instructions
text	SΣ	0..1	string	Free text dosage instructions e.g. SIG
additionalInstruction	Σ	0..*	CodeableConcept	Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness" Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
patientInstruction	SΣ	0..1	string	Patient or consumer oriented instructions
timing	Σ	0..1	Timing	When medication should be administered
asNeeded[x]	Σ	0..1		Take "as needed" (for x) Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): 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.
asNeededBoolean			boolean
asNeededCodeableConcept			CodeableConcept
site	Σ	0..1	CodeableConcept	Body site to administer to Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.
route	Σ	0..1	CodeableConcept	How drug should enter body Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
method	Σ	0..1	CodeableConcept	Technique for administering medication Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.
doseAndRate	Σ	0..*	Element	Amount of medication administered
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
type	Σ	0..1	CodeableConcept	The kind of dose or rate specified Binding: DoseAndRateType (example): The kind of dose or rate specified.
Slices for dose[x]	Σ	0..1		Amount of medication per dose Slice: Unordered, Open by type:$this
doseRange			Range
doseQuantity			Quantity(SimpleQuantity)
dose[x]:doseQuantity	Σ	0..1	SimpleQuantity	Amount of medication per dose
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	SΣC	0..1	decimal	Numerical value (with implicit precision) mdp-25-1570: If number then source value from (52-113 > 52.0113-.01)
unit	SΣ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form
code	SΣ	0..1	code	Coded form of the unit Binding: DoseUnits FHIR (required): see mapping VF_DoseUnits
rate[x]	Σ	0..1		Amount of medication per unit of time
rateRatio			Ratio
rateRange			Range
rateQuantity			Quantity(SimpleQuantity)
maxDosePerPeriod	Σ	0..1	Ratio	Upper limit on medication per unit of time
maxDosePerAdministration	Σ	0..1	SimpleQuantity	Upper limit on medication per administration
maxDosePerLifetime	Σ	0..1	SimpleQuantity	Upper limit on medication per lifetime of the patient
substitution		0..1	BackboneElement	Whether a substitution was performed on the dispense
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
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 Binding: ActSubstanceAdminSubstitutionCode (example): A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription.
reason		0..*	CodeableConcept	Why was substitution made Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
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

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
MedicationDispense.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
MedicationDispense.status	required	MedicationDispense Status Codes http://hl7.org/fhir/ValueSet/medicationdispense-status|4.0.1 from the FHIR Standard
MedicationDispense.statusReason[x]	example	MedicationDispense Status Reason Codes http://hl7.org/fhir/ValueSet/medicationdispense-status-reason from the FHIR Standard
MedicationDispense.category	preferred	Pattern: outpatient http://hl7.org/fhir/ValueSet/medicationdispense-category from the FHIR Standard
MedicationDispense.medication[x]	example	SNOMEDCTMedicationCodes http://hl7.org/fhir/ValueSet/medication-codes from the FHIR Standard
MedicationDispense.medication[x]:medicationCodeableConcept	example	SNOMEDCTMedicationCodes http://hl7.org/fhir/ValueSet/medication-codes from the FHIR Standard
MedicationDispense.performer.function	example	MedicationDispense Performer Function Codes http://hl7.org/fhir/ValueSet/medicationdispense-performer-function from the FHIR Standard
MedicationDispense.type	example	Pattern: PF http://terminology.hl7.org/ValueSet/v3-ActPharmacySupplyType
MedicationDispense.destination.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
MedicationDispense.dosageInstruction.additionalInstruction	example	SNOMEDCTAdditionalDosageInstructions http://hl7.org/fhir/ValueSet/additional-instruction-codes from the FHIR Standard
MedicationDispense.dosageInstruction.asNeeded[x]	example	SNOMEDCTMedicationAsNeededReasonCodes http://hl7.org/fhir/ValueSet/medication-as-needed-reason from the FHIR Standard
MedicationDispense.dosageInstruction.site	example	SNOMEDCTAnatomicalStructureForAdministrationSiteCodes http://hl7.org/fhir/ValueSet/approach-site-codes from the FHIR Standard
MedicationDispense.dosageInstruction.route	example	SNOMEDCTRouteCodes http://hl7.org/fhir/ValueSet/route-codes from the FHIR Standard
MedicationDispense.dosageInstruction.method	example	SNOMEDCTAdministrationMethodCodes http://hl7.org/fhir/ValueSet/administration-method-codes from the FHIR Standard
MedicationDispense.dosageInstruction.doseAndRate.type	example	DoseAndRateType http://hl7.org/fhir/ValueSet/dose-rate-type from the FHIR Standard
MedicationDispense.dosageInstruction.doseAndRate.dose[x]:doseQuantity.code	required	DoseUnits http://va.gov/fhir/ValueSet/DoseUnits from this IG
MedicationDispense.substitution.type	example	ActSubstanceAdminSubstitutionCode http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode
MedicationDispense.substitution.reason	example	SubstanceAdminSubstitutionReason http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MedicationDispense	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MedicationDispense	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	error	MedicationDispense	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	error	MedicationDispense	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MedicationDispense	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
mdd-1	error	MedicationDispense	whenHandedOver cannot be before whenPrepared : whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared
mdp-25-1570	warning	MedicationDispense.dosageInstruction.doseAndRate.dose[x]:doseQuantity.value	If number then source value from (52-113 > 52.0113-.01) : true
mdp-25-1577	warning	MedicationDispense.status	If (52-60 > 52.2-8) is not null then fixed value #completed : true
mdp-25-1578	warning	MedicationDispense.status	If (52-60 > 52.2-8) is null then fixed value #in-progress : true

Summary

Must-Support: 20 elements

Structures

This structure refers to these other structures:

• Patient (http://va.gov/fhir/StructureDefinition/Patient)
• Practitioner (http://va.gov/fhir/StructureDefinition/Practitioner)
• Location (http://va.gov/fhir/StructureDefinition/Location)
• MedicationRequest: Outpatient (http://va.gov/fhir/StructureDefinition/MedicationRequestOutpatient)
• SimpleQuantity (http://hl7.org/fhir/StructureDefinition/SimpleQuantity)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of MedicationDispense.medication[x]
• The element 1 is sliced based on the value of MedicationDispense.dosageInstruction.doseAndRate.dose[x]

Name	Flags	Card.	Type	Description & Constraints
MedicationDispense	C	0..*	MedicationDispense	Dispensing a medication to a named patient dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management mdd-1: whenHandedOver cannot be before whenPrepared
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
status	?!SΣC	1..1	code	preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event. ele-1: All FHIR elements must have a @value or children mdp-25-1577: If (52-60 > 52.2-8) is not null then fixed value #completed mdp-25-1578: If (52-60 > 52.2-8) is null then fixed value #in-progress
category	S	0..1	CodeableConcept	Type of medication dispense Binding: MedicationDispense Category Codes (preferred): A code describing where the dispensed medication is expected to be consumed or administered. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/fhir/CodeSystem/medicationdispense-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: outpatient
Slices for medication[x]	Σ	1..1		What medication was supplied Slice: Unordered, Open by type:$this Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying which substance or product can be dispensed. ele-1: All FHIR elements must have a @value or children
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(Medication)
medication[x]:medicationCodeableConcept	Σ	0..1	CodeableConcept	What medication was supplied Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying which substance or product can be dispensed. ele-1: All FHIR elements must have a @value or children
coding	Σ	0..*	Coding	Code defined by a terminology system ele-1: All FHIR elements must have a @value or children
system	SΣ	0..1	uri	Identity of the terminology system ele-1: All FHIR elements must have a @value or children Required Pattern: urn:oid:2.16.840.1.113883.6.233
code	SΣ	0..1	code	Symbol in syntax defined by the system ele-1: All FHIR elements must have a @value or children
text	SΣ	0..1	string	Plain text representation of the concept ele-1: All FHIR elements must have a @value or children
subject	SΣ	0..1	Reference(Patient)	Who the dispense is for ele-1: All FHIR elements must have a @value or children
performer		0..*	BackboneElement	Who performed event ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
actor	S	1..1	Reference(Practitioner)	Individual who was performing ele-1: All FHIR elements must have a @value or children
location	S	0..1	Reference(Location)	Where the dispense occurred ele-1: All FHIR elements must have a @value or children
authorizingPrescription	S	0..*	Reference(MedicationRequest: Outpatient)	Medication order that authorizes the dispense ele-1: All FHIR elements must have a @value or children
type	S	0..1	CodeableConcept	Trial fill, partial fill, emergency fill, etc. Binding: ActPharmacySupplyType (example): Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc. ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
code		1..1	code	Symbol in syntax defined by the system Fixed Value: PF
quantity		0..1	SimpleQuantity	Amount dispensed ele-1: All FHIR elements must have a @value or children
value	SΣ	0..1	decimal	Numerical value (with implicit precision) ele-1: All FHIR elements must have a @value or children
daysSupply	S	0..1	SimpleQuantity	Amount of medication expressed as a timing amount ele-1: All FHIR elements must have a @value or children
whenPrepared	SΣ	0..1	dateTime	When product was packaged and reviewed ele-1: All FHIR elements must have a @value or children
destination		0..1	Reference(Location)	Where the medication was sent ele-1: All FHIR elements must have a @value or children
display	SΣ	0..1	string	Text alternative for the resource ele-1: All FHIR elements must have a @value or children
note		0..*	Annotation	Information about the dispense ele-1: All FHIR elements must have a @value or children
text	SΣ	1..1	markdown	The annotation - text content (as markdown) ele-1: All FHIR elements must have a @value or children
dosageInstruction		0..*	Dosage	How the medication is to be used by the patient or administered by the caregiver ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
text	SΣ	0..1	string	Free text dosage instructions e.g. SIG ele-1: All FHIR elements must have a @value or children
patientInstruction	SΣ	0..1	string	Patient or consumer oriented instructions ele-1: All FHIR elements must have a @value or children
doseAndRate	Σ	0..*	Element	Amount of medication administered ele-1: All FHIR elements must have a @value or children
Slices for dose[x]	Σ	0..1		Amount of medication per dose Slice: Unordered, Open by type:$this ele-1: All FHIR elements must have a @value or children
doseRange			Range
doseQuantity			Quantity(SimpleQuantity)
dose[x]:doseQuantity	Σ	0..1	SimpleQuantity	Amount of medication per dose ele-1: All FHIR elements must have a @value or children
value	SΣC	0..1	decimal	Numerical value (with implicit precision) ele-1: All FHIR elements must have a @value or children mdp-25-1570: If number then source value from (52-113 > 52.0113-.01)
unit	SΣ	0..1	string	Unit representation ele-1: All FHIR elements must have a @value or children
code	SΣ	0..1	code	Coded form of the unit Binding: DoseUnits FHIR (required): see mapping VF_DoseUnits ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
MedicationDispense.status	required	MedicationDispense Status Codes http://hl7.org/fhir/ValueSet/medicationdispense-status|4.0.1 from the FHIR Standard
MedicationDispense.category	preferred	Pattern: outpatient http://hl7.org/fhir/ValueSet/medicationdispense-category from the FHIR Standard
MedicationDispense.medication[x]	example	SNOMEDCTMedicationCodes http://hl7.org/fhir/ValueSet/medication-codes from the FHIR Standard
MedicationDispense.medication[x]:medicationCodeableConcept	example	SNOMEDCTMedicationCodes http://hl7.org/fhir/ValueSet/medication-codes from the FHIR Standard
MedicationDispense.type	example	Pattern: PF http://terminology.hl7.org/ValueSet/v3-ActPharmacySupplyType
MedicationDispense.dosageInstruction.doseAndRate.dose[x]:doseQuantity.code	required	DoseUnits http://va.gov/fhir/ValueSet/DoseUnits from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MedicationDispense	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MedicationDispense	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	error	MedicationDispense	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	error	MedicationDispense	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MedicationDispense	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
mdd-1	error	MedicationDispense	whenHandedOver cannot be before whenPrepared : whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared
mdp-25-1570	warning	MedicationDispense.dosageInstruction.doseAndRate.dose[x]:doseQuantity.value	If number then source value from (52-113 > 52.0113-.01) : true
mdp-25-1577	warning	MedicationDispense.status	If (52-60 > 52.2-8) is not null then fixed value #completed : true
mdp-25-1578	warning	MedicationDispense.status	If (52-60 > 52.2-8) is null then fixed value #in-progress : true

Name	Flags	Card.	Type	Description & Constraints
MedicationDispense			MedicationDispense
status	SC	1..1	code	preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown mdp-25-1577: If (52-60 > 52.2-8) is not null then fixed value #completed mdp-25-1578: If (52-60 > 52.2-8) is null then fixed value #in-progress
category	S	0..1	CodeableConcept	Type of medication dispense Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/fhir/CodeSystem/medicationdispense-category
code		1..1	code	Symbol in syntax defined by the system Fixed Value: outpatient
Slices for medication[x]		1..1	CodeableConcept, Reference(Medication)	What medication was supplied Slice: Unordered, Open by type:$this
medication[x]:medicationCodeableConcept		0..1	CodeableConcept	What medication was supplied
coding
system	S	0..1	uri	Identity of the terminology system Required Pattern: urn:oid:2.16.840.1.113883.6.233
code	S	0..1	code	Symbol in syntax defined by the system
text	S	0..1	string	Plain text representation of the concept
subject	S	0..1	Reference(Patient)	Who the dispense is for
performer
actor	S	1..1	Reference(Practitioner)	Individual who was performing
location	S	0..1	Reference(Location)	Where the dispense occurred
authorizingPrescription	S	0..*	Reference(MedicationRequest: Outpatient)	Medication order that authorizes the dispense
type	S	0..1	CodeableConcept	Trial fill, partial fill, emergency fill, etc. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
code		1..1	code	Symbol in syntax defined by the system Fixed Value: PF
quantity
value	S	0..1	decimal	Numerical value (with implicit precision)
daysSupply	S	0..1	SimpleQuantity	Amount of medication expressed as a timing amount
whenPrepared	S	0..1	dateTime	When product was packaged and reviewed
destination
display	S	0..1	string	Text alternative for the resource
note
text	S	1..1	markdown	The annotation - text content (as markdown)
dosageInstruction
text	S	0..1	string	Free text dosage instructions e.g. SIG
patientInstruction	S	0..1	string	Patient or consumer oriented instructions
doseAndRate
Slices for dose[x]		0..1	Range, SimpleQuantity	Amount of medication per dose Slice: Unordered, Open by type:$this
dose[x]:doseQuantity		0..1	SimpleQuantity	Amount of medication per dose
value	SC	0..1	decimal	Numerical value (with implicit precision) mdp-25-1570: If number then source value from (52-113 > 52.0113-.01)
unit	S	0..1	string	Unit representation
code	S	0..1	code	Coded form of the unit Binding: DoseUnits FHIR (required): see mapping VF_DoseUnits
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
MedicationDispense.dosageInstruction.doseAndRate.dose[x]:doseQuantity.code	required	DoseUnits http://va.gov/fhir/ValueSet/DoseUnits from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
mdp-25-1570	warning	MedicationDispense.dosageInstruction.doseAndRate.dose[x]:doseQuantity.value	If number then source value from (52-113 > 52.0113-.01) : true
mdp-25-1577	warning	MedicationDispense.status	If (52-60 > 52.2-8) is not null then fixed value #completed : true
mdp-25-1578	warning	MedicationDispense.status	If (52-60 > 52.2-8) is null then fixed value #in-progress : true

Name	Flags	Card.	Type	Description & Constraints
MedicationDispense	C	0..*	MedicationDispense	Dispensing a medication to a named patient mdd-1: whenHandedOver cannot be before whenPrepared
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		0..*	Identifier	External identifier
partOf		0..*	Reference(Procedure)	Event that dispense is part of
status	?!SΣC	1..1	code	preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown Binding: MedicationDispense Status Codes (required): A coded concept specifying the state of the dispense event. mdp-25-1577: If (52-60 > 52.2-8) is not null then fixed value #completed mdp-25-1578: If (52-60 > 52.2-8) is null then fixed value #in-progress
statusReason[x]		0..1		Why a dispense was not performed Binding: MedicationDispense Status Reason Codes (example): A code describing why a dispense was not performed.
statusReasonCodeableConcept			CodeableConcept
statusReasonReference			Reference(DetectedIssue)
category	S	0..1	CodeableConcept	Type of medication dispense Binding: MedicationDispense Category Codes (preferred): A code describing where the dispensed medication is expected to be consumed or administered. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/fhir/CodeSystem/medicationdispense-category
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: outpatient
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Slices for medication[x]	Σ	1..1		What medication was supplied Slice: Unordered, Open by type:$this Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying which substance or product can be dispensed.
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(Medication)
medication[x]:medicationCodeableConcept	Σ	0..1	CodeableConcept	What medication was supplied Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying which substance or product can be dispensed.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	0..1	uri	Identity of the terminology system Required Pattern: urn:oid:2.16.840.1.113883.6.233
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	SΣ	0..1	string	Plain text representation of the concept
subject	SΣ	0..1	Reference(Patient)	Who the dispense is for
context		0..1	Reference(Encounter | EpisodeOfCare)	Encounter / Episode associated with event
supportingInformation		0..*	Reference(Resource)	Information that supports the dispensing of the medication
performer		0..*	BackboneElement	Who performed event
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
function		0..1	CodeableConcept	Who performed the dispense and what they did Binding: MedicationDispense Performer Function Codes (example): A code describing the role an individual played in dispensing a medication.
actor	S	1..1	Reference(Practitioner)	Individual who was performing
location	S	0..1	Reference(Location)	Where the dispense occurred
authorizingPrescription	S	0..*	Reference(MedicationRequest: Outpatient)	Medication order that authorizes the dispense
type	S	0..1	CodeableConcept	Trial fill, partial fill, emergency fill, etc. Binding: ActPharmacySupplyType (example): Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: PF
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
quantity		0..1	SimpleQuantity	Amount dispensed
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	SΣ	0..1	decimal	Numerical value (with implicit precision)
unit	Σ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form
code	Σ	0..1	code	Coded form of the unit
daysSupply	S	0..1	SimpleQuantity	Amount of medication expressed as a timing amount
whenPrepared	SΣ	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
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
display	SΣ	0..1	string	Text alternative for the resource
receiver		0..*	Reference(Patient | Practitioner)	Who collected the medication
note		0..*	Annotation	Information about the dispense
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
author[x]	Σ	0..1		Individual responsible for the annotation
authorReference			Reference(Practitioner | Patient | RelatedPerson | Organization)
authorString			string
time	Σ	0..1	dateTime	When the annotation was made
text	SΣ	1..1	markdown	The annotation - text content (as markdown)
dosageInstruction		0..*	Dosage	How the medication is to be used by the patient or administered by the caregiver
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
sequence	Σ	0..1	integer	The order of the dosage instructions
text	SΣ	0..1	string	Free text dosage instructions e.g. SIG
additionalInstruction	Σ	0..*	CodeableConcept	Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness" Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
patientInstruction	SΣ	0..1	string	Patient or consumer oriented instructions
timing	Σ	0..1	Timing	When medication should be administered
asNeeded[x]	Σ	0..1		Take "as needed" (for x) Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): 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.
asNeededBoolean			boolean
asNeededCodeableConcept			CodeableConcept
site	Σ	0..1	CodeableConcept	Body site to administer to Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.
route	Σ	0..1	CodeableConcept	How drug should enter body Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
method	Σ	0..1	CodeableConcept	Technique for administering medication Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.
doseAndRate	Σ	0..*	Element	Amount of medication administered
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
type	Σ	0..1	CodeableConcept	The kind of dose or rate specified Binding: DoseAndRateType (example): The kind of dose or rate specified.
Slices for dose[x]	Σ	0..1		Amount of medication per dose Slice: Unordered, Open by type:$this
doseRange			Range
doseQuantity			Quantity(SimpleQuantity)
dose[x]:doseQuantity	Σ	0..1	SimpleQuantity	Amount of medication per dose
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
value	SΣC	0..1	decimal	Numerical value (with implicit precision) mdp-25-1570: If number then source value from (52-113 > 52.0113-.01)
unit	SΣ	0..1	string	Unit representation
system	ΣC	0..1	uri	System that defines coded unit form
code	SΣ	0..1	code	Coded form of the unit Binding: DoseUnits FHIR (required): see mapping VF_DoseUnits
rate[x]	Σ	0..1		Amount of medication per unit of time
rateRatio			Ratio
rateRange			Range
rateQuantity			Quantity(SimpleQuantity)
maxDosePerPeriod	Σ	0..1	Ratio	Upper limit on medication per unit of time
maxDosePerAdministration	Σ	0..1	SimpleQuantity	Upper limit on medication per administration
maxDosePerLifetime	Σ	0..1	SimpleQuantity	Upper limit on medication per lifetime of the patient
substitution		0..1	BackboneElement	Whether a substitution was performed on the dispense
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
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 Binding: ActSubstanceAdminSubstitutionCode (example): A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription.
reason		0..*	CodeableConcept	Why was substitution made Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
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

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
MedicationDispense.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
MedicationDispense.status	required	MedicationDispense Status Codes http://hl7.org/fhir/ValueSet/medicationdispense-status|4.0.1 from the FHIR Standard
MedicationDispense.statusReason[x]	example	MedicationDispense Status Reason Codes http://hl7.org/fhir/ValueSet/medicationdispense-status-reason from the FHIR Standard
MedicationDispense.category	preferred	Pattern: outpatient http://hl7.org/fhir/ValueSet/medicationdispense-category from the FHIR Standard
MedicationDispense.medication[x]	example	SNOMEDCTMedicationCodes http://hl7.org/fhir/ValueSet/medication-codes from the FHIR Standard
MedicationDispense.medication[x]:medicationCodeableConcept	example	SNOMEDCTMedicationCodes http://hl7.org/fhir/ValueSet/medication-codes from the FHIR Standard
MedicationDispense.performer.function	example	MedicationDispense Performer Function Codes http://hl7.org/fhir/ValueSet/medicationdispense-performer-function from the FHIR Standard
MedicationDispense.type	example	Pattern: PF http://terminology.hl7.org/ValueSet/v3-ActPharmacySupplyType
MedicationDispense.destination.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
MedicationDispense.dosageInstruction.additionalInstruction	example	SNOMEDCTAdditionalDosageInstructions http://hl7.org/fhir/ValueSet/additional-instruction-codes from the FHIR Standard
MedicationDispense.dosageInstruction.asNeeded[x]	example	SNOMEDCTMedicationAsNeededReasonCodes http://hl7.org/fhir/ValueSet/medication-as-needed-reason from the FHIR Standard
MedicationDispense.dosageInstruction.site	example	SNOMEDCTAnatomicalStructureForAdministrationSiteCodes http://hl7.org/fhir/ValueSet/approach-site-codes from the FHIR Standard
MedicationDispense.dosageInstruction.route	example	SNOMEDCTRouteCodes http://hl7.org/fhir/ValueSet/route-codes from the FHIR Standard
MedicationDispense.dosageInstruction.method	example	SNOMEDCTAdministrationMethodCodes http://hl7.org/fhir/ValueSet/administration-method-codes from the FHIR Standard
MedicationDispense.dosageInstruction.doseAndRate.type	example	DoseAndRateType http://hl7.org/fhir/ValueSet/dose-rate-type from the FHIR Standard
MedicationDispense.dosageInstruction.doseAndRate.dose[x]:doseQuantity.code	required	DoseUnits http://va.gov/fhir/ValueSet/DoseUnits from this IG
MedicationDispense.substitution.type	example	ActSubstanceAdminSubstitutionCode http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode
MedicationDispense.substitution.reason	example	SubstanceAdminSubstitutionReason http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MedicationDispense	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MedicationDispense	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	error	MedicationDispense	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	error	MedicationDispense	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MedicationDispense	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
mdd-1	error	MedicationDispense	whenHandedOver cannot be before whenPrepared : whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared
mdp-25-1570	warning	MedicationDispense.dosageInstruction.doseAndRate.dose[x]:doseQuantity.value	If number then source value from (52-113 > 52.0113-.01) : true
mdp-25-1577	warning	MedicationDispense.status	If (52-60 > 52.2-8) is not null then fixed value #completed : true
mdp-25-1578	warning	MedicationDispense.status	If (52-60 > 52.2-8) is null then fixed value #in-progress : true