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

A 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.

An Extension

R5: MedicationDispense.renderedDosageInstruction (new:markdown)

Element MedicationDispense.renderedDosageInstruction has a context of MedicationDispense based on following the parent source element upwards and mapping to MedicationDispense. Element MedicationDispense.renderedDosageInstruction has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). The content of the renderedDosageInstructions must not be different than the dose represented in the dosageInstruction content.

EHDSDosage

R5: MedicationDispense.recorded (new:dateTime)

HIQA EP 6.2 Date and time of issuing the dispense record (Mandatory 1..1); 1..1 inherited from HL7 Europe MPD.

HIQA EP 6.4.3 Related person is the receiver (Optional): the person (e.g. carer or family member) who collected the dispensed medication on the patient's behalf. R4 MedicationDispense.receiver allows only Patient or Practitioner.

May 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).

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.

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.

Identifiers associated with this Medication Dispense that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server.

HIQA EP 6.1 Dispensation identifier (Required 0..*). IE Medication Events requires at least one.

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

HIQA EP 6.3.1 Dispensation status (Mandatory). A non-dispensation uses declined or stopped with a reason (invariant ie-md-status-1).

A coded concept specifying the state of the dispense event.

Indicates the reason why a dispense was not performed.

HIQA EP 6.3.2 Dispensation status reason (Optional): coded (6.3.2.1) or free text (6.3.2.2, in statusReasonCodeableConcept.text). IE Medication Events requires a reason for a non-dispensation (safety: the prescriber needs to know why).

A code describing why a dispense was not performed.

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

HIQA EP 6.6 Dispensed medication (Mandatory 1..1); see Section 4.

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

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

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

SubstanceAdministration->subject->Patient.

Indicates who or what performed the event.

HIQA EP Section 2 (dispenser and pharmacy). Dispensers are registered pharmacists or registered pharmaceutical assistants.

May 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).

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.

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.

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

Indicates the medication order that is being dispensed against.

HIQA EP 6.5 Prescription item identifier with related request (Required 0..1). IE Medication Events requires exactly one (stricter than HIQA, IE Core OI-012): this profile covers dispensing against an electronic prescription; emergency supply uses the base IEMpdMedicationDispense.

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

HIQA EP 6.7 Dispensed quantity (Mandatory 1..1).

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

HIQA EP 6.8 Date of dispensation (Mandatory) and 6.9 Time of dispensation (Required). Required when the status is completed (invariant ie-md-handover-1).

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

HIQA EP 6.4 Receiver (Optional): the patient (6.4.1) or a health practitioner (6.4.2). A related person (6.4.3) goes in extension[receiverRelatedPerson].

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

HIQA EP 6.12 Additional information (Optional).

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

HIQA EP 6.11 Dosage instructions (Required); see Section 5 and IEMpdDosage.

Indicates whether or not substitution was made as part of the dispense. In some cases, substitution will be expected but does not happen, in other cases substitution is not expected but does happen. This block explains what substitution did or did not happen and why. If nothing is specified, substitution was not done.

May 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).

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.

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.

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

HIQA EP 6.10 Substitution occurred (Optional).

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

A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription.

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

A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.

HIQA EP 6.2 Date and time of issuing the dispense record (Mandatory 1..1); 1..1 inherited from HL7 Europe MPD.

HIQA EP 6.1 Dispensation identifier (Required 0..*). IE Medication Events requires at least one.

HIQA EP 6.3.1 Dispensation status (Mandatory). A non-dispensation uses declined or stopped with a reason (invariant ie-md-status-1).

HIQA EP 6.3.2 Dispensation status reason (Optional): coded (6.3.2.1) or free text (6.3.2.2, in statusReasonCodeableConcept.text). IE Medication Events requires a reason for a non-dispensation (safety: the prescriber needs to know why).

HIQA EP 6.6 Dispensed medication (Mandatory 1..1); see Section 4.

HIQA EP Section 2 (dispenser and pharmacy). Dispensers are registered pharmacists or registered pharmaceutical assistants.

HIQA EP 6.5 Prescription item identifier with related request (Required 0..1). IE Medication Events requires exactly one (stricter than HIQA, IE Core OI-012): this profile covers dispensing against an electronic prescription; emergency supply uses the base IEMpdMedicationDispense.

HIQA EP 6.7 Dispensed quantity (Mandatory 1..1).

HIQA EP 6.8 Date of dispensation (Mandatory) and 6.9 Time of dispensation (Required). Required when the status is completed (invariant ie-md-handover-1).

HIQA EP 6.4 Receiver (Optional): the patient (6.4.1) or a health practitioner (6.4.2). A related person (6.4.3) goes in extension[receiverRelatedPerson].

HIQA EP 6.12 Additional information (Optional).

HIQA EP 6.11 Dosage instructions (Required); see Section 5 and IEMpdDosage.

HIQA EP 6.10 Substitution occurred (Optional).

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

The 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.

The 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.

A 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.

The 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).

A human language.

A 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.

These 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.

An Extension

R5: MedicationDispense.renderedDosageInstruction (new:markdown)

Element MedicationDispense.renderedDosageInstruction has a context of MedicationDispense based on following the parent source element upwards and mapping to MedicationDispense. Element MedicationDispense.renderedDosageInstruction has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). The content of the renderedDosageInstructions must not be different than the dose represented in the dosageInstruction content.

EHDSDosage

R5: MedicationDispense.recorded (new:dateTime)

HIQA EP 6.2 Date and time of issuing the dispense record (Mandatory 1..1); 1..1 inherited from HL7 Europe MPD.

HIQA EP 6.4.3 Related person is the receiver (Optional): the person (e.g. carer or family member) who collected the dispensed medication on the patient's behalf. R4 MedicationDispense.receiver allows only Patient or Practitioner.

May 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).

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.

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.

Identifiers associated with this Medication Dispense that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server.

HIQA EP 6.1 Dispensation identifier (Required 0..*). IE Medication Events requires at least one.

The procedure that trigger the dispense.

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

HIQA EP 6.3.1 Dispensation status (Mandatory). A non-dispensation uses declined or stopped with a reason (invariant ie-md-status-1).

A coded concept specifying the state of the dispense event.

Indicates the reason why a dispense was not performed.

HIQA EP 6.3.2 Dispensation status reason (Optional): coded (6.3.2.1) or free text (6.3.2.2, in statusReasonCodeableConcept.text). IE Medication Events requires a reason for a non-dispensation (safety: the prescriber needs to know why).

A code describing why a dispense was not performed.

Indicates 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.

A code describing where the dispensed medication is expected to be consumed or administered.

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

HIQA EP 6.6 Dispensed medication (Mandatory 1..1); see Section 4.

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

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

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

SubstanceAdministration->subject->Patient.

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

Additional information that supports the medication being dispensed.

Indicates who or what performed the event.

HIQA EP Section 2 (dispenser and pharmacy). Dispensers are registered pharmacists or registered pharmaceutical assistants.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May 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.

May 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).

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.

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.

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

A code describing the role an individual played in dispensing a medication.

Allows disambiguation of the types of involvement of different performers.

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

The principal physical location where the dispense was performed.

Indicates the medication order that is being dispensed against.

HIQA EP 6.5 Prescription item identifier with related request (Required 0..1). IE Medication Events requires exactly one (stricter than HIQA, IE Core OI-012): this profile covers dispensing against an electronic prescription; emergency supply uses the base IEMpdMedicationDispense.

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

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

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

HIQA EP 6.7 Dispensed quantity (Mandatory 1..1).

The amount of medication expressed as a timing amount.

The time when the dispensed product was packaged and reviewed.

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

HIQA EP 6.8 Date of dispensation (Mandatory) and 6.9 Time of dispensation (Required). Required when the status is completed (invariant ie-md-handover-1).

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

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

HIQA EP 6.4 Receiver (Optional): the patient (6.4.1) or a health practitioner (6.4.2). A related person (6.4.3) goes in extension[receiverRelatedPerson].

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

HIQA EP 6.12 Additional information (Optional).

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

HIQA EP 6.11 Dosage instructions (Required); see Section 5 and IEMpdDosage.

Indicates whether or not substitution was made as part of the dispense. In some cases, substitution will be expected but does not happen, in other cases substitution is not expected but does happen. This block explains what substitution did or did not happen and why. If nothing is specified, substitution was not done.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May 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.

May 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).

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.

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.

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

HIQA EP 6.10 Substitution occurred (Optional).

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

A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription.

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

A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.

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

Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. drug-drug interaction, duplicate therapy, dosage alert etc.

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.

A 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.).