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11.3 Resource MedicationDispense - Content

Pharmacy

Work Group

Maturity Level: 2

Trial Use

Security Category: Patient

Compartments: Encounter, Patient, Practitioner

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.

11.3.1 Scope and Usage

This resource covers the supply of medications to a patient. Examples include dispensing and pick-up from an outpatient or community pharmacy, dispensing patient-specific medications from inpatient pharmacy to ward, as well as issuing a single dose from ward stock to a patient for consumption. The medication dispense can be the result of a pharmacy system responding to a medication order.

MedicationDispense is an event resource from a FHIR workflow perspective - see Workflow Event

11.3.2 Boundaries and Relationships

The Medication domain includes a number of related resources

MedicationRequest	An order for both supply of the medication and the instructions for administration of the medicine to a patient.
MedicationDispense	Provision of a supply of a medication with the intention that it is subsequently consumed by a patient (usually in response to a prescription).
MedicationAdministration	When a patient actually consumes a medicine, or the medication is otherwise administered to them
MedicationStatement	This is a record of a medication being taken by a patient or that a medication has been given to a patient, where the record is the result of a report from the patient or another clinician. A medication statement is not a part of the prescribe->dispense->administer sequence but is a report that such a sequence (or at least a part of it) did take place, resulting in a belief that the patient has received a particular medication.

This resource does not deal with the supply or transfer of non-medication related items to a patient.

11.3.3 Background and Context

The supply and the associated administration instructions might not exactly follow the original order (prescription), either because some details were left for completion at this point in the process or because the dispenser exercised their clinical judgment to make some appropriate modification.

11.3.4 References to this Resource

Implements: Event
Resource References: ChargeItem, MedicationAdministration and Observation

Structure

Name	Flags	Card.	Type	Description & Constraints
MedicationDispense	TU		DomainResource	Dispensing a medication to a named patient + Rule: whenHandedOver cannot be before whenPrepared Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier		0..*	Identifier	External identifier
basedOn		0..*	Reference(CarePlan)	Plan that is fulfilled by this dispense
partOf		0..*	Reference(Procedure \| MedicationAdministration)	Event that dispense is part of
status	?!Σ	1..1	code	preparation \| in-progress \| cancelled \| on-hold \| completed \| entered-in-error \| stopped \| declined \| unknown Binding: MedicationDispense Status Codes (Required)
notPerformedReason		0..1	CodeableReference(DetectedIssue)	Why a dispense was not performed Binding: MedicationDispense Status Reason Codes (Example)
statusChanged		0..1	dateTime	When the status changed
category		0..*	CodeableConcept	Type of medication dispense Binding: MedicationDispense Administration Location Codes (Example)
medication	Σ	1..1	CodeableReference(Medication)	What medication was supplied Binding: SNOMED CT Medication Codes (Example)
subject	Σ	1..1	Reference(Patient \| Group)	Who the dispense is for
encounter		0..1	Reference(Encounter)	Encounter associated with event
supportingInformation		0..*	Reference(Any)	Information that supports the dispensing of the medication
performer		0..*	BackboneElement	Who performed event
function		0..1	CodeableConcept	Who performed the dispense and what they did Binding: MedicationDispense Performer Function Codes (Example)
actor		1..1	Reference(Practitioner \| PractitionerRole \| Organization \| Patient \| Device \| RelatedPerson \| CareTeam)	Individual who was performing
location		0..1	Reference(Location)	Where the dispense occurred
authorizingPrescription		0..*	Reference(MedicationRequest)	Medication order that authorizes the dispense
type		0..1	CodeableConcept	Trial fill, partial fill, emergency fill, etc Binding: ActPharmacySupplyType (Example)
quantity		0..1	SimpleQuantity	Amount dispensed
daysSupply		0..1	SimpleQuantity	Amount of medication expressed as a timing amount
recorded		0..1	dateTime	When the recording of the dispense started
whenPrepared	Σ C	0..1	dateTime	When product was packaged and reviewed
whenHandedOver	C	0..1	dateTime	When product was given out
destination		0..1	Reference(Location)	Where the medication was/will be sent
receiver		0..*	Reference(Patient \| Practitioner \| RelatedPerson \| Location \| PractitionerRole)	Who collected the medication or where the medication was delivered
note		0..*	Annotation	Information about the dispense
renderedDosageInstruction		0..1	markdown	Full representation of the dosage instructions
dosageInstruction		0..*	Dosage	How the medication is to be used by the patient or administered by the caregiver
substitution		0..1	BackboneElement	Whether a substitution was performed on the dispense
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)
reason		0..*	CodeableConcept	Why was substitution made Binding: SubstanceAdminSubstitutionReason (Example)
responsibleParty		0..1	Reference(Practitioner \| PractitionerRole \| Organization)	Who is responsible for the substitution
eventHistory		0..*	Reference(Provenance)	A list of relevant lifecycle events
Documentation for this format

See the Extensions for this resource

UML Diagram (Legend)

XML Template

<MedicationDispense xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier External identifier --></identifier>
 <basedOn><!-- 0..* Reference(CarePlan) Plan that is fulfilled by this dispense --></basedOn>
 <partOf><!-- 0..* Reference(MedicationAdministration|Procedure) Event that dispense is part of --></partOf>
 <status value="[code]"/><!-- 1..1 preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown -->
 <notPerformedReason><!-- 0..1 CodeableReference(DetectedIssue) Why a dispense was not performed --></notPerformedReason>
 <statusChanged value="[dateTime]"/><!-- 0..1 When the status changed -->
 <category><!-- 0..* CodeableConcept Type of medication dispense --></category>
 <medication><!-- 1..1 CodeableReference(Medication) What medication was supplied --></medication>
 <subject><!-- 1..1 Reference(Group|Patient) Who the dispense is for --></subject>
 <encounter><!-- 0..1 Reference(Encounter) Encounter associated with event --></encounter>
 <supportingInformation><!-- 0..* Reference(Any) Information that supports the dispensing of the medication --></supportingInformation>
 <performer>  <!-- 0..* Who performed event -->
  <function><!-- 0..1 CodeableConcept Who performed the dispense and what they did --></function>
  <actor><!-- 1..1 Reference(CareTeam|Device|Organization|Patient|Practitioner|
    PractitionerRole|RelatedPerson) Individual who was performing --></actor>
 </performer>
 <location><!-- 0..1 Reference(Location) Where the dispense occurred --></location>
 <authorizingPrescription><!-- 0..* Reference(MedicationRequest) Medication order that authorizes the dispense --></authorizingPrescription>
 <type><!-- 0..1 CodeableConcept Trial fill, partial fill, emergency fill, etc  --></type>
 <quantity><!-- 0..1 Quantity(SimpleQuantity) Amount dispensed --></quantity>
 <daysSupply><!-- 0..1 Quantity(SimpleQuantity) Amount of medication expressed as a timing amount --></daysSupply>
 <recorded value="[dateTime]"/><!-- 0..1 When the recording of the dispense started -->
 <whenPrepared value="[dateTime]"/><!-- I 0..1 When product was packaged and reviewed -->
 <whenHandedOver value="[dateTime]"/><!-- I 0..1 When product was given out -->
 <destination><!-- 0..1 Reference(Location) Where the medication was/will be sent --></destination>
 <receiver><!-- 0..* Reference(Location|Patient|Practitioner|PractitionerRole|
   RelatedPerson) Who collected the medication or where the medication was delivered --></receiver>
 <note><!-- 0..* Annotation Information about the dispense --></note>
 <renderedDosageInstruction value="[markdown]"/><!-- 0..1 Full representation of the dosage instructions -->
 <dosageInstruction><!-- 0..* Dosage How the medication is to be used by the patient or administered by the caregiver --></dosageInstruction>
 <substitution>  <!-- 0..1 Whether a substitution was performed on the dispense -->
  <wasSubstituted value="[boolean]"/><!-- 1..1 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  --></type>
  <reason><!-- 0..* CodeableConcept Why was substitution made  --></reason>
  <responsibleParty><!-- 0..1 Reference(Organization|Practitioner|
    PractitionerRole) Who is responsible for the substitution --></responsibleParty>
 </substitution>
 <eventHistory><!-- 0..* Reference(Provenance) A list of relevant lifecycle events --></eventHistory>
</MedicationDispense>

JSON Template

{
  "resourceType" : "MedicationDispense",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External identifier
  "basedOn" : [{ Reference(CarePlan) }], // Plan that is fulfilled by this dispense
  "partOf" : [{ Reference(MedicationAdministration|Procedure) }], // Event that dispense is part of
  "status" : "<code>", // R!  preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
  "notPerformedReason" : { CodeableReference(DetectedIssue) }, // Why a dispense was not performed
  "statusChanged" : "<dateTime>", // When the status changed
  "category" : [{ CodeableConcept }], // Type of medication dispense
  "medication" : { CodeableReference(Medication) }, // R!  What medication was supplied
  "subject" : { Reference(Group|Patient) }, // R!  Who the dispense is for
  "encounter" : { Reference(Encounter) }, // Encounter associated with event
  "supportingInformation" : [{ Reference(Any) }], // Information that supports the dispensing of the medication
  "performer" : [{ // Who performed event
    "function" : { CodeableConcept }, // Who performed the dispense and what they did
    "actor" : { Reference(CareTeam|Device|Organization|Patient|Practitioner|
    PractitionerRole|RelatedPerson) } // R!  Individual who was performing
  }],
  "location" : { Reference(Location) }, // Where the dispense occurred
  "authorizingPrescription" : [{ Reference(MedicationRequest) }], // Medication order that authorizes the dispense
  "type" : { CodeableConcept }, // Trial fill, partial fill, emergency fill, etc 
  "quantity" : { Quantity(SimpleQuantity) }, // Amount dispensed
  "daysSupply" : { Quantity(SimpleQuantity) }, // Amount of medication expressed as a timing amount
  "recorded" : "<dateTime>", // When the recording of the dispense started
  "whenPrepared" : "<dateTime>", // I When product was packaged and reviewed
  "whenHandedOver" : "<dateTime>", // I When product was given out
  "destination" : { Reference(Location) }, // Where the medication was/will be sent
  "receiver" : [{ Reference(Location|Patient|Practitioner|PractitionerRole|
   RelatedPerson) }], // Who collected the medication or where the medication was delivered
  "note" : [{ Annotation }], // Information about the dispense
  "renderedDosageInstruction" : "<markdown>", // Full representation of the dosage instructions
  "dosageInstruction" : [{ Dosage }], // How the medication is to be used by the patient or administered by the caregiver
  "substitution" : { // Whether a substitution was performed on the dispense
    "wasSubstituted" : <boolean>, // R!  Whether a substitution was or was not performed on the dispense
    "type" : { CodeableConcept }, // Code signifying whether a different drug was dispensed from what was prescribed 
    "reason" : [{ CodeableConcept }], // Why was substitution made 
    "responsibleParty" : { Reference(Organization|Practitioner|
    PractitionerRole) } // Who is responsible for the substitution
  },
  "eventHistory" : [{ Reference(Provenance) }] // A list of relevant lifecycle events
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .


[ a fhir:MedicationDispense;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* External identifier
  fhir:basedOn  ( [ Reference(CarePlan) ] ... ) ; # 0..* Plan that is fulfilled by this dispense
  fhir:partOf  ( [ Reference(MedicationAdministration|Procedure) ] ... ) ; # 0..* Event that dispense is part of
  fhir:status [ code ] ; # 1..1 preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
  fhir:notPerformedReason [ CodeableReference(DetectedIssue) ] ; # 0..1 Why a dispense was not performed
  fhir:statusChanged [ dateTime ] ; # 0..1 When the status changed
  fhir:category  ( [ CodeableConcept ] ... ) ; # 0..* Type of medication dispense
  fhir:medication [ CodeableReference(Medication) ] ; # 1..1 What medication was supplied
  fhir:subject [ Reference(Group|Patient) ] ; # 1..1 Who the dispense is for
  fhir:encounter [ Reference(Encounter) ] ; # 0..1 Encounter associated with event
  fhir:supportingInformation  ( [ Reference(Any) ] ... ) ; # 0..* Information that supports the dispensing of the medication
  fhir:performer ( [ # 0..* Who performed event
    fhir:function [ CodeableConcept ] ; # 0..1 Who performed the dispense and what they did
    fhir:actor [ Reference(CareTeam|Device|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ; # 1..1 Individual who was performing
  ] ... ) ;
  fhir:location [ Reference(Location) ] ; # 0..1 Where the dispense occurred
  fhir:authorizingPrescription  ( [ Reference(MedicationRequest) ] ... ) ; # 0..* Medication order that authorizes the dispense
  fhir:type [ CodeableConcept ] ; # 0..1 Trial fill, partial fill, emergency fill, etc
  fhir:quantity [ Quantity(SimpleQuantity) ] ; # 0..1 Amount dispensed
  fhir:daysSupply [ Quantity(SimpleQuantity) ] ; # 0..1 Amount of medication expressed as a timing amount
  fhir:recorded [ dateTime ] ; # 0..1 When the recording of the dispense started
  fhir:whenPrepared [ dateTime ] ; # 0..1 I When product was packaged and reviewed
  fhir:whenHandedOver [ dateTime ] ; # 0..1 I When product was given out
  fhir:destination [ Reference(Location) ] ; # 0..1 Where the medication was/will be sent
  fhir:receiver  ( [ Reference(Location|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ... ) ; # 0..* Who collected the medication or where the medication was delivered
  fhir:note  ( [ Annotation ] ... ) ; # 0..* Information about the dispense
  fhir:renderedDosageInstruction [ markdown ] ; # 0..1 Full representation of the dosage instructions
  fhir:dosageInstruction  ( [ Dosage ] ... ) ; # 0..* How the medication is to be used by the patient or administered by the caregiver
  fhir:substitution [ # 0..1 Whether a substitution was performed on the dispense
    fhir:wasSubstituted [ boolean ] ; # 1..1 Whether a substitution was or was not performed on the dispense
    fhir:type [ CodeableConcept ] ; # 0..1 Code signifying whether a different drug was dispensed from what was prescribed
    fhir:reason  ( [ CodeableConcept ] ... ) ; # 0..* Why was substitution made
    fhir:responsibleParty [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 0..1 Who is responsible for the substitution
  ] ;
  fhir:eventHistory  ( [ Reference(Provenance) ] ... ) ; # 0..* A list of relevant lifecycle events
]

Changes from both R4 and R4B

MedicationDispense

MedicationDispense.basedOn

Added Element

MedicationDispense.partOf

Type Reference: Added Target Type MedicationAdministration

MedicationDispense.notPerformedReason

Added Element

MedicationDispense.statusChanged

Added Element

MedicationDispense.category

Max Cardinality changed from 1 to *

MedicationDispense.medication

Renamed from medication[x] to medication
Add Type CodeableReference
Remove Types CodeableConcept, Reference(Medication)

MedicationDispense.subject

Min Cardinality changed from 0 to 1

MedicationDispense.encounter

Added Element

MedicationDispense.performer.actor

Type Reference: Added Target Type CareTeam

MedicationDispense.recorded

Added Element

MedicationDispense.receiver

Type Reference: Added Target Types RelatedPerson, Location, PractitionerRole

MedicationDispense.renderedDosageInstruction

Added Element

MedicationDispense.substitution.responsibleParty

Max Cardinality changed from * to 1
Type Reference: Added Target Type Organization

MedicationDispense.statusReason[x]

Deleted

MedicationDispense.context

Deleted

MedicationDispense.detectedIssue

Deleted

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

See R4 <--> R5 Conversion Maps (status = See Conversions Summary.)

Structure

Name	Flags	Card.	Type	Description & Constraints
MedicationDispense	TU		DomainResource	Dispensing a medication to a named patient + Rule: whenHandedOver cannot be before whenPrepared Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier		0..*	Identifier	External identifier
basedOn		0..*	Reference(CarePlan)	Plan that is fulfilled by this dispense
partOf		0..*	Reference(Procedure \| MedicationAdministration)	Event that dispense is part of
status	?!Σ	1..1	code	preparation \| in-progress \| cancelled \| on-hold \| completed \| entered-in-error \| stopped \| declined \| unknown Binding: MedicationDispense Status Codes (Required)
notPerformedReason		0..1	CodeableReference(DetectedIssue)	Why a dispense was not performed Binding: MedicationDispense Status Reason Codes (Example)
statusChanged		0..1	dateTime	When the status changed
category		0..*	CodeableConcept	Type of medication dispense Binding: MedicationDispense Administration Location Codes (Example)
medication	Σ	1..1	CodeableReference(Medication)	What medication was supplied Binding: SNOMED CT Medication Codes (Example)
subject	Σ	1..1	Reference(Patient \| Group)	Who the dispense is for
encounter		0..1	Reference(Encounter)	Encounter associated with event
supportingInformation		0..*	Reference(Any)	Information that supports the dispensing of the medication
performer		0..*	BackboneElement	Who performed event
function		0..1	CodeableConcept	Who performed the dispense and what they did Binding: MedicationDispense Performer Function Codes (Example)
actor		1..1	Reference(Practitioner \| PractitionerRole \| Organization \| Patient \| Device \| RelatedPerson \| CareTeam)	Individual who was performing
location		0..1	Reference(Location)	Where the dispense occurred
authorizingPrescription		0..*	Reference(MedicationRequest)	Medication order that authorizes the dispense
type		0..1	CodeableConcept	Trial fill, partial fill, emergency fill, etc Binding: ActPharmacySupplyType (Example)
quantity		0..1	SimpleQuantity	Amount dispensed
daysSupply		0..1	SimpleQuantity	Amount of medication expressed as a timing amount
recorded		0..1	dateTime	When the recording of the dispense started
whenPrepared	Σ C	0..1	dateTime	When product was packaged and reviewed
whenHandedOver	C	0..1	dateTime	When product was given out
destination		0..1	Reference(Location)	Where the medication was/will be sent
receiver		0..*	Reference(Patient \| Practitioner \| RelatedPerson \| Location \| PractitionerRole)	Who collected the medication or where the medication was delivered
note		0..*	Annotation	Information about the dispense
renderedDosageInstruction		0..1	markdown	Full representation of the dosage instructions
dosageInstruction		0..*	Dosage	How the medication is to be used by the patient or administered by the caregiver
substitution		0..1	BackboneElement	Whether a substitution was performed on the dispense
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)
reason		0..*	CodeableConcept	Why was substitution made Binding: SubstanceAdminSubstitutionReason (Example)
responsibleParty		0..1	Reference(Practitioner \| PractitionerRole \| Organization)	Who is responsible for the substitution
eventHistory		0..*	Reference(Provenance)	A list of relevant lifecycle events
Documentation for this format

See the Extensions for this resource

UML Diagram (Legend)

XML Template

<MedicationDispense xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier External identifier --></identifier>
 <basedOn><!-- 0..* Reference(CarePlan) Plan that is fulfilled by this dispense --></basedOn>
 <partOf><!-- 0..* Reference(MedicationAdministration|Procedure) Event that dispense is part of --></partOf>
 <status value="[code]"/><!-- 1..1 preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown -->
 <notPerformedReason><!-- 0..1 CodeableReference(DetectedIssue) Why a dispense was not performed --></notPerformedReason>
 <statusChanged value="[dateTime]"/><!-- 0..1 When the status changed -->
 <category><!-- 0..* CodeableConcept Type of medication dispense --></category>
 <medication><!-- 1..1 CodeableReference(Medication) What medication was supplied --></medication>
 <subject><!-- 1..1 Reference(Group|Patient) Who the dispense is for --></subject>
 <encounter><!-- 0..1 Reference(Encounter) Encounter associated with event --></encounter>
 <supportingInformation><!-- 0..* Reference(Any) Information that supports the dispensing of the medication --></supportingInformation>
 <performer>  <!-- 0..* Who performed event -->
  <function><!-- 0..1 CodeableConcept Who performed the dispense and what they did --></function>
  <actor><!-- 1..1 Reference(CareTeam|Device|Organization|Patient|Practitioner|
    PractitionerRole|RelatedPerson) Individual who was performing --></actor>
 </performer>
 <location><!-- 0..1 Reference(Location) Where the dispense occurred --></location>
 <authorizingPrescription><!-- 0..* Reference(MedicationRequest) Medication order that authorizes the dispense --></authorizingPrescription>
 <type><!-- 0..1 CodeableConcept Trial fill, partial fill, emergency fill, etc  --></type>
 <quantity><!-- 0..1 Quantity(SimpleQuantity) Amount dispensed --></quantity>
 <daysSupply><!-- 0..1 Quantity(SimpleQuantity) Amount of medication expressed as a timing amount --></daysSupply>
 <recorded value="[dateTime]"/><!-- 0..1 When the recording of the dispense started -->
 <whenPrepared value="[dateTime]"/><!-- I 0..1 When product was packaged and reviewed -->
 <whenHandedOver value="[dateTime]"/><!-- I 0..1 When product was given out -->
 <destination><!-- 0..1 Reference(Location) Where the medication was/will be sent --></destination>
 <receiver><!-- 0..* Reference(Location|Patient|Practitioner|PractitionerRole|
   RelatedPerson) Who collected the medication or where the medication was delivered --></receiver>
 <note><!-- 0..* Annotation Information about the dispense --></note>
 <renderedDosageInstruction value="[markdown]"/><!-- 0..1 Full representation of the dosage instructions -->
 <dosageInstruction><!-- 0..* Dosage How the medication is to be used by the patient or administered by the caregiver --></dosageInstruction>
 <substitution>  <!-- 0..1 Whether a substitution was performed on the dispense -->
  <wasSubstituted value="[boolean]"/><!-- 1..1 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  --></type>
  <reason><!-- 0..* CodeableConcept Why was substitution made  --></reason>
  <responsibleParty><!-- 0..1 Reference(Organization|Practitioner|
    PractitionerRole) Who is responsible for the substitution --></responsibleParty>
 </substitution>
 <eventHistory><!-- 0..* Reference(Provenance) A list of relevant lifecycle events --></eventHistory>
</MedicationDispense>

JSON Template

{
  "resourceType" : "MedicationDispense",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External identifier
  "basedOn" : [{ Reference(CarePlan) }], // Plan that is fulfilled by this dispense
  "partOf" : [{ Reference(MedicationAdministration|Procedure) }], // Event that dispense is part of
  "status" : "<code>", // R!  preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
  "notPerformedReason" : { CodeableReference(DetectedIssue) }, // Why a dispense was not performed
  "statusChanged" : "<dateTime>", // When the status changed
  "category" : [{ CodeableConcept }], // Type of medication dispense
  "medication" : { CodeableReference(Medication) }, // R!  What medication was supplied
  "subject" : { Reference(Group|Patient) }, // R!  Who the dispense is for
  "encounter" : { Reference(Encounter) }, // Encounter associated with event
  "supportingInformation" : [{ Reference(Any) }], // Information that supports the dispensing of the medication
  "performer" : [{ // Who performed event
    "function" : { CodeableConcept }, // Who performed the dispense and what they did
    "actor" : { Reference(CareTeam|Device|Organization|Patient|Practitioner|
    PractitionerRole|RelatedPerson) } // R!  Individual who was performing
  }],
  "location" : { Reference(Location) }, // Where the dispense occurred
  "authorizingPrescription" : [{ Reference(MedicationRequest) }], // Medication order that authorizes the dispense
  "type" : { CodeableConcept }, // Trial fill, partial fill, emergency fill, etc 
  "quantity" : { Quantity(SimpleQuantity) }, // Amount dispensed
  "daysSupply" : { Quantity(SimpleQuantity) }, // Amount of medication expressed as a timing amount
  "recorded" : "<dateTime>", // When the recording of the dispense started
  "whenPrepared" : "<dateTime>", // I When product was packaged and reviewed
  "whenHandedOver" : "<dateTime>", // I When product was given out
  "destination" : { Reference(Location) }, // Where the medication was/will be sent
  "receiver" : [{ Reference(Location|Patient|Practitioner|PractitionerRole|
   RelatedPerson) }], // Who collected the medication or where the medication was delivered
  "note" : [{ Annotation }], // Information about the dispense
  "renderedDosageInstruction" : "<markdown>", // Full representation of the dosage instructions
  "dosageInstruction" : [{ Dosage }], // How the medication is to be used by the patient or administered by the caregiver
  "substitution" : { // Whether a substitution was performed on the dispense
    "wasSubstituted" : <boolean>, // R!  Whether a substitution was or was not performed on the dispense
    "type" : { CodeableConcept }, // Code signifying whether a different drug was dispensed from what was prescribed 
    "reason" : [{ CodeableConcept }], // Why was substitution made 
    "responsibleParty" : { Reference(Organization|Practitioner|
    PractitionerRole) } // Who is responsible for the substitution
  },
  "eventHistory" : [{ Reference(Provenance) }] // A list of relevant lifecycle events
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .


[ a fhir:MedicationDispense;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* External identifier
  fhir:basedOn  ( [ Reference(CarePlan) ] ... ) ; # 0..* Plan that is fulfilled by this dispense
  fhir:partOf  ( [ Reference(MedicationAdministration|Procedure) ] ... ) ; # 0..* Event that dispense is part of
  fhir:status [ code ] ; # 1..1 preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
  fhir:notPerformedReason [ CodeableReference(DetectedIssue) ] ; # 0..1 Why a dispense was not performed
  fhir:statusChanged [ dateTime ] ; # 0..1 When the status changed
  fhir:category  ( [ CodeableConcept ] ... ) ; # 0..* Type of medication dispense
  fhir:medication [ CodeableReference(Medication) ] ; # 1..1 What medication was supplied
  fhir:subject [ Reference(Group|Patient) ] ; # 1..1 Who the dispense is for
  fhir:encounter [ Reference(Encounter) ] ; # 0..1 Encounter associated with event
  fhir:supportingInformation  ( [ Reference(Any) ] ... ) ; # 0..* Information that supports the dispensing of the medication
  fhir:performer ( [ # 0..* Who performed event
    fhir:function [ CodeableConcept ] ; # 0..1 Who performed the dispense and what they did
    fhir:actor [ Reference(CareTeam|Device|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ; # 1..1 Individual who was performing
  ] ... ) ;
  fhir:location [ Reference(Location) ] ; # 0..1 Where the dispense occurred
  fhir:authorizingPrescription  ( [ Reference(MedicationRequest) ] ... ) ; # 0..* Medication order that authorizes the dispense
  fhir:type [ CodeableConcept ] ; # 0..1 Trial fill, partial fill, emergency fill, etc
  fhir:quantity [ Quantity(SimpleQuantity) ] ; # 0..1 Amount dispensed
  fhir:daysSupply [ Quantity(SimpleQuantity) ] ; # 0..1 Amount of medication expressed as a timing amount
  fhir:recorded [ dateTime ] ; # 0..1 When the recording of the dispense started
  fhir:whenPrepared [ dateTime ] ; # 0..1 I When product was packaged and reviewed
  fhir:whenHandedOver [ dateTime ] ; # 0..1 I When product was given out
  fhir:destination [ Reference(Location) ] ; # 0..1 Where the medication was/will be sent
  fhir:receiver  ( [ Reference(Location|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ... ) ; # 0..* Who collected the medication or where the medication was delivered
  fhir:note  ( [ Annotation ] ... ) ; # 0..* Information about the dispense
  fhir:renderedDosageInstruction [ markdown ] ; # 0..1 Full representation of the dosage instructions
  fhir:dosageInstruction  ( [ Dosage ] ... ) ; # 0..* How the medication is to be used by the patient or administered by the caregiver
  fhir:substitution [ # 0..1 Whether a substitution was performed on the dispense
    fhir:wasSubstituted [ boolean ] ; # 1..1 Whether a substitution was or was not performed on the dispense
    fhir:type [ CodeableConcept ] ; # 0..1 Code signifying whether a different drug was dispensed from what was prescribed
    fhir:reason  ( [ CodeableConcept ] ... ) ; # 0..* Why was substitution made
    fhir:responsibleParty [ Reference(Organization|Practitioner|PractitionerRole) ] ; # 0..1 Who is responsible for the substitution
  ] ;
  fhir:eventHistory  ( [ Reference(Provenance) ] ... ) ; # 0..* A list of relevant lifecycle events
]

Changes from both R4 and R4B

MedicationDispense

MedicationDispense.basedOn

Added Element

MedicationDispense.partOf

Type Reference: Added Target Type MedicationAdministration

MedicationDispense.notPerformedReason

Added Element

MedicationDispense.statusChanged

Added Element

MedicationDispense.category

Max Cardinality changed from 1 to *

MedicationDispense.medication

Renamed from medication[x] to medication
Add Type CodeableReference
Remove Types CodeableConcept, Reference(Medication)

MedicationDispense.subject

Min Cardinality changed from 0 to 1

MedicationDispense.encounter

Added Element

MedicationDispense.performer.actor

Type Reference: Added Target Type CareTeam

MedicationDispense.recorded

Added Element

MedicationDispense.receiver

Type Reference: Added Target Types RelatedPerson, Location, PractitionerRole

MedicationDispense.renderedDosageInstruction

Added Element

MedicationDispense.substitution.responsibleParty

Max Cardinality changed from * to 1
Type Reference: Added Target Type Organization

MedicationDispense.statusReason[x]

Deleted

MedicationDispense.context

Deleted

MedicationDispense.detectedIssue

Deleted

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

See R4 <--> R5 Conversion Maps (status = See Conversions Summary.)

Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis

11.3.5.1 Terminology Bindings

Path	ValueSet	Type	Documentation
MedicationDispense.status	MedicationDispenseStatusCodes	Required	MedicationDispense Status Codes
MedicationDispense.notPerformedReason	MedicationDispenseStatusReasonCodes	Example	MedicationDispense Status Reason Codes
MedicationDispense.category	MedicationDispenseAdministrationLocationCodes	Example	MedicationDispense Administration Location Codes
MedicationDispense.medication	SNOMEDCTMedicationCodes	Example	This value set includes all drug or medicament substance codes and all pharmaceutical/biologic products from SNOMED CT - provided as an exemplar value set.
MedicationDispense.performer.function	MedicationDispensePerformerFunctionCodes	Example	MedicationDispense Performer Function Codes
MedicationDispense.type	ActPharmacySupplyType	Example	Identifies types of dispensing events
MedicationDispense.substitution.type	ActSubstanceAdminSubstitutionCode	Example	No description
MedicationDispense.substitution.reason	SubstanceAdminSubstitutionReason	Example	No description

Path

ValueSet

Type

Documentation

MedicationDispense.status

MedicationDispenseStatusCodes

Required

MedicationDispense Status Codes

MedicationDispense.notPerformedReason

MedicationDispenseStatusReasonCodes

Example

MedicationDispense Status Reason Codes

MedicationDispense.category

MedicationDispenseAdministrationLocationCodes

Example

MedicationDispense Administration Location Codes

MedicationDispense.medication

SNOMEDCTMedicationCodes

Example

This value set includes all drug or medicament substance codes and all pharmaceutical/biologic products from SNOMED CT - provided as an exemplar value set.

MedicationDispense.performer.function

MedicationDispensePerformerFunctionCodes

Example

MedicationDispense Performer Function Codes

MedicationDispense.type

ActPharmacySupplyType icon

Example

Identifies types of dispensing events

MedicationDispense.substitution.type

ActSubstanceAdminSubstitutionCode icon

Example

No description

MedicationDispense.substitution.reason

SubstanceAdminSubstitutionReason icon

Example

No description

11.3.5.2 Constraints

UniqueKey

Level

Location

Description

Expression

mdd-1

Rule

(base)

whenHandedOver cannot be before whenPrepared

whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared

11.3.6 Search Parameters

Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name	Type	Description	Expression	In Common
code	token	Returns dispenses of this medicine code	MedicationDispense.medication.concept	22 Resources
destination	reference	Returns dispenses that should be sent to a specific destination	MedicationDispense.destination (Location)
encounter	reference	Returns dispenses with a specific encounter	MedicationDispense.encounter (Encounter)	29 Resources
identifier	token	Returns dispenses with this external identifier	MedicationDispense.identifier	65 Resources
location	reference	Returns dispense for a given location	MedicationDispense.location (Location)
medication	reference	Returns dispenses of this medicine resource	MedicationDispense.medication.reference	4 Resources
patient	reference	The identity of a patient to list dispenses for	MedicationDispense.subject.where(resolve() is Patient) (Patient)	66 Resources
performer	reference	Returns dispenses performed by a specific individual	MedicationDispense.performer.actor (Practitioner, Organization, CareTeam, Device, Patient, PractitionerRole, RelatedPerson)
prescription	reference	The identity of a prescription to list dispenses from	MedicationDispense.authorizingPrescription (MedicationRequest)	1 Resources
receiver	reference	The identity of a receiver to list dispenses for	MedicationDispense.receiver (Practitioner, Patient, PractitionerRole, RelatedPerson, Location)
recorded	date	Returns dispenses where dispensing activity began on this date	MedicationDispense.recorded
responsibleparty	reference	Returns dispenses with the specified responsible party	MedicationDispense.substitution.responsibleParty (Practitioner, Organization, PractitionerRole)
status	token	Returns dispenses with a specified dispense status	MedicationDispense.status	4 Resources
subject	reference	The identity of a patient for whom to list dispenses	MedicationDispense.subject (Group, Patient)
type	token	Returns dispenses of a specific type	MedicationDispense.type	11 Resources
whenhandedover	date	Returns dispenses handed over on this date	MedicationDispense.whenHandedOver
whenprepared	date	Returns dispenses prepared on this date	MedicationDispense.whenPrepared