type: resourceresource: MedicationDispense

MedicationDispense

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

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.

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.

StructureDefinition

Elements (Simplified)

MedicationDispense [0..*]: - Dispensing a medication to a named patient
MedicationDispense.identifier [0..*]: Identifier External identifier
MedicationDispense.basedOn [0..*]: Reference(CarePlan) Plan that is fulfilled by this dispense
MedicationDispense.partOf [0..*]: [Reference(Procedure](/Reference(Procedure), MedicationAdministration)) Event that dispense is part of
MedicationDispense.status [1..1]: code required:medicationdispense-status preparation | in-progress | cancelled | on-hold | completed | entered-in-error | unfulfilled | declined | unknown
MedicationDispense.notPerformedReason [0..1]: CodeableReference example:medicationdispense-status-reason Why a dispense was not performed
MedicationDispense.statusChanged [0..1]: dateTime When the status changed
MedicationDispense.category [0..*]: CodeableConcept example:medicationdispense-category Type of medication dispense
MedicationDispense.medication [1..1]: CodeableReference example:medication-codes What medication was (or was intended to be) supplied
MedicationDispense.subject [1..1]: [Reference(Patient](/Reference(Patient), Group)) Who the dispense is for
MedicationDispense.encounter [0..1]: Reference(Encounter) Encounter associated with event
MedicationDispense.supportingInformation [0..*]: Reference(Resource) Information that supports the dispensing of the medication
MedicationDispense.performer [0..*]: BackboneElement Who performed event
MedicationDispense.performer.function [0..1]: CodeableConcept example:medicationdispense-performer-function Who performed the dispense and what they did
MedicationDispense.performer.actor [1..1]: [Reference(Practitioner](/Reference(Practitioner), PractitionerRole, Organization, Patient, Device, RelatedPerson, CareTeam, Group)) Individual who was performing
MedicationDispense.location [0..1]: Reference(Location) Where the dispense occurred
MedicationDispense.authorizingPrescription [0..*]: Reference(MedicationRequest) Medication order that authorizes the dispense
MedicationDispense.type [0..1]: CodeableConcept example:v3-ActPharmacySupplyType Trial fill, partial fill, emergency fill, etc
MedicationDispense.quantity [0..1]: Quantity(SimpleQuantity) Amount of medication
MedicationDispense.daysSupply [0..1]: Quantity(SimpleQuantity) Amount of medication expressed as a timing amount
MedicationDispense.fillNumber [0..1]: positiveInt A number that represents the known fill this dispense represents
MedicationDispense.recorded [0..1]: dateTime When the recording of the dispense started
MedicationDispense.whenPrepared [0..1]: dateTime When product was packaged and reviewed
MedicationDispense.whenHandedOver [0..1]: dateTime When product was given out
MedicationDispense.destination [0..1]: Reference(Location) Where the medication was/will be sent
MedicationDispense.receiver [0..*]: [Reference(Patient](/Reference(Patient), Practitioner, RelatedPerson, Location, PractitionerRole, Organization, Group)) Who collected the medication or where the medication was delivered
MedicationDispense.note [0..*]: Annotation Information about the dispense
MedicationDispense.dosageInstruction [0..1]: DosageDetails How the medication is to be used by the patient or administered by the caregiver
MedicationDispense.doseAdministrationAid [0..1]: CodeableConcept example:medication-dose-aid Type of adherence packaging to use for the dispense
MedicationDispense.substitution [0..1]: BackboneElement Whether a substitution was performed on the dispense
MedicationDispense.substitution.wasSubstituted [1..1]: boolean Whether a substitution was or was not performed on the dispense
MedicationDispense.substitution.type [0..1]: CodeableConcept example:v3-ActSubstanceAdminSubstitutionCode Code signifying whether a different drug was dispensed from what was prescribed
MedicationDispense.substitution.reason [0..*]: CodeableConcept example:v3-SubstanceAdminSubstitutionReason Why was substitution made
MedicationDispense.substitution.responsibleParty [0..1]: [Reference(Practitioner](/Reference(Practitioner), PractitionerRole, Organization)) Who is responsible for the substitution
MedicationDispense.eventHistory [0..*]: Reference(Provenance) A list of relevant lifecycle events

Mappings

MedicationDispense Mappings — 75 mapping entries

Implementation Guide

implementationguide-MedicationDispense-core.xml

<?xml version="1.0" encoding="UTF-8"?>

<ImplementationGuide xmlns="http://hl7.org/fhir">
  <id value="MedicationDispense-core"/>
  <version value="0.1"/>
  <name value="MedicationDispenseHL7Extensions"/>
  <title value="Medication Dispense  H L7  Extensions"/>
  <status value="draft"/>
  <date value="2019-03-23T00:00:00.000"/>
  <publisher value="Health Level Seven, Inc. - FHIR WG"/>
  <description value="Defines common extensions used with or related to the MedicationDispense resource"/>
</ImplementationGuide>

Resource Packs

list-MedicationDispense-packs.xml

<?xml version="1.0" encoding="UTF-8"?>

<List xmlns="http://hl7.org/fhir" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://hl7.org/fhir ../../publish/List.xsd">
  <id value="MedicationDispense-packs"/>
  <status value="current"/>
  <mode value="working"/>
  <entry>
    <item>
      <reference value="ImplementationGuide/MedicationDispense-core"/>
    </item>
  </entry>
</List>

Search Parameters

code — token — Returns dispenses of this medicine code — MedicationDispense.medication.concept
destination — reference — Returns dispenses that should be sent to a specific destination — MedicationDispense.destination
encounter — reference — Returns dispenses with a specific encounter — MedicationDispense.encounter
identifier — token — Returns dispenses with this external identifier — MedicationDispense.identifier
medication — reference — Returns dispenses of this medicine resource — MedicationDispense.medication.reference
patient — reference — The identity of a patient to list dispenses for — MedicationDispense.subject.where(resolve() is Patient)
performer — reference — Returns dispenses performed by a specific individual — MedicationDispense.performer.actor
prescription — reference — The identity of a prescription to list dispenses from — MedicationDispense.authorizingPrescription
receiver — reference — The identity of a receiver to list dispenses for — MedicationDispense.receiver
responsibleparty — reference — Returns dispenses with the specified responsible party — MedicationDispense.substitution.responsibleParty
status — token — Returns dispenses with a specified dispense status — MedicationDispense.status
subject — reference — The identity of a patient for whom to list dispenses — MedicationDispense.subject
type — token — Returns dispenses of a specific type — MedicationDispense.type
whenhandedover — date — Returns dispenses handed over on this date — MedicationDispense.whenHandedOver
whenprepared — date — Returns dispenses prepared on this date — MedicationDispense.whenPrepared
recorded — date — Returns dispenses where dispensing activity began on this date — MedicationDispense.recorded
location — reference — Returns dispense for a given location — MedicationDispense.location

Full Search Parameters

Examples

meddisp008 — medicationdispenseexample8 — Dispense for Oral Chemotherapy - Capecitabine (RxNorm code)
meddisp0301 — medicationdispense0301 — Dispense for IV Antibiotic - in progress - Vancomycin IV (NDC Code) - in-progress
meddisp0302 — medicationdispense0302 — Dispense for Subcutaneous injection with multiple dosage lines - Insulin - Novolog (NDC Code) - active - includes Destination, Receiver, note. Dosage includes additionalInstructions as text
meddisp0303 — medicationdispense0303 — Dispense for Oxycodone (RxNorm code) - PRN dose with dose range, coded additional instructions and PRN coded pre-condition
meddisp0304 — medicationdispense0304 — Dispense for Intravenous Antibiotic with a Dosage Rate - Piperacillin (NDC code) - completed with a coded site and route of administration and a rate expressed as a ratio
meddisp0305 — medicationdispense0305 — Dispense for Prednisone (RxNorm code) Tapering Dose - entered-in-error with multiple Dosage lines that include coded additionalInstructions and multiple EventHistory elements
meddisp0306 — medicationdispense0306 — Dispense for Intravenous Chemotherapy (inpatient order) - Alemtuzumab (RxNorm Code) - completed with multiple dosageInstruction lines
meddisp0307 — medicationdispense0307 — Dispense for Busulfan (Myleran) - completed
meddisp0308 — medicationdispense0308 — Dispense for Timoptic Opthalmic Drops - (NDC code) - completed
meddisp0309 — medicationdispense0309 — Dispense for Nystatin drops (Snomed Code) - entered-in-error
meddisp0310 — medicationdispense0310 — Dispense for Percocet (NDC Code) - in-progress with additionalInstructions, and as needed dosage with condition
meddisp0311 — medicationdispense0311 — Dispense for Paracetamol Suppositories - completed
meddisp0312 — medicationdispense0312 — Dispense for Over the Counter medication - Tylenol PM (NDC code) - on hold with as needed dosage with a condition, a dose Range and an Event History
meddisp0313 — medicationdispense0313 — Dispense for Potassium Chloride Admixture - stopped - with eventHistory and rate range for dosage
meddisp0314 — medicationdispense0314 — Dispense for Lorazepam (Rx norm code) - completed with rate range
meddisp0315 — medicationdispense0315 — Dispense for Alprazolam (Rx Norm code) - in progress
meddisp0316 — medicationdispense0316 — Dispense for Insulin (Lantus) (NDC code) - in-progress with SC dosage
meddisp0317 — medicationdispense0317 — Dispense for Brentuximab Vedotin (NDC code) - IV Chemo - stopped
meddisp0318 — medicationdispense0318 — Dispense for Levothyroxine (NDC code) in-progress with authorizing prescription
meddisp0319 — medicationdispense0319 — Dispense for Azithromycin (NDC code) - completed with multiple dosage lines
meddisp0320 — medicationdispense0320 — Dispense for a TPN solution - completed
meddisp0321 — medicationdispense0321 — Dispense for Vicodin - in progress - PRN with pre-condition
meddisp0322 — medicationdispense0322 — Dispense for Dilantin Oral Suspension (NDC code) - completed
meddisp0324 — medicationdispense0324 — Dispense for Nystatin Topical Ointment (RxNorm code) - completed
meddisp0325 — medicationdispense0325 — Dispense for Fentanyl Patch (NDC code) - in progress
meddisp0326 — medicationdispense0326 — Dispense for Azithromycin (RxNorm Code) - in-progress with coded additionalInstructions
meddisp0327 — medicationdispense0327 — Dispense for Proventil (RxNorm Code) - completed - with additionalInstructions as text
meddisp0328 — medicationdispense0328 — Dispense for Nasonex Inhaler (RxNorm Code) - in progress with additionalInstructions as text
meddisp0329 — medicationdispense0329 — Dispense for compounded ointment - completed with additionalInstructions as text and a coded site in dosageInstructions
meddisp0330 — medicationdispense0330 — Dispense for Warfarin 5mg (NDC Code) where the product is dispensed as multiple strengths based on prescribe dosage
meddisp0331 — medicationdispense0331 — Dispense for Warfarin 2mg (NDC Code) where the product is dispensed as multiple strengths based on prescribe dosage
meddisp0332 — medicationdispense0332 — Dispense with future dated event and bounds period
meddisp0334 — medicationdispense0334 — Declined Dispense - out of stock
meddisp0335 — medicationdispense0335 — Declined Dispense - not picked up
medicationdispense-example — medicationdispense-example
medicationdispense-examples-header — medicationdispense-examples-header

Full Examples

Mapping Exceptions