type: resource-definitionsresource: MedicationDispense

MedicationDispense Definitions

MedicationDispense

Dispensing a medication to a named patient

Definition: 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.

Cardinality: 0..*

Constraints: mdd-1 | error | whenHandedOver cannot be before whenPrepared | (whenHandedOver.hasValue() and whenPrepared.hasValue()) implies whenHandedOver >= whenPrepared

Mappings: workflow=Event; rim=Supply[moodCode=EVN]; w5=clinical.medication

MedicationDispense.identifier

External identifier

Definition: 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.

Comments: This is a business identifier, not a resource identifier.

Cardinality: 0..*

Type: Identifier

Mappings: workflow=Event.identifier; w5=FiveWs.identifier; rim=.id; rx-dispense-rmim=CombinedMedicationDispense.id

MedicationDispense.basedOn

Plan that is fulfilled by this dispense

Definition: A plan that is fulfilled in whole or in part by this MedicationDispense.

Cardinality: 0..*

Type: Reference(CarePlan)

Mappings: rim=.outboundRelationship[typeCode=FLFS].target

MedicationDispense.partOf

Event that dispense is part of

Definition: The procedure or medication administration that triggered the dispense.

Comments: While both a procedure and a medication administration may have triggered the dispense, but it is not expected that multiple procedures and/or multiple medication administrations would be triggers.

Cardinality: 0..*

Type: Reference(Procedure, MedicationAdministration)

Mappings: workflow=Event.partOf; rim=.outboundRelationship[typeCode=COMP]/target[classCode=PROC,moodCode=EVN]

MedicationDispense.status

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

Comments: This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Cardinality: 1..1

Type: code

Binding: required:medicationdispense-status

Summary: true

Is Modifier: true (Reason: This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid)

Mappings: workflow=Event.status; w5=FiveWs.status; rim=.statusCode; rx-dispense-rmim=CombinedMedicationDispense.SupplyEvent.statusCode

MedicationDispense.notPerformedReason

Why a dispense was not performed

Definition: Indicates the reason why a dispense was not performed.

Cardinality: 0..1

Type: CodeableReference

Binding: example:medicationdispense-status-reason

MedicationDispense.statusChanged

When the status changed

Definition: The date (and maybe time) when the status of the dispense record changed.

Cardinality: 0..1

Type: dateTime

Mappings: rim=.subjectOf Observation[code = statusChange].value = date

MedicationDispense.category

Type of medication dispense

Definition: Indicates the type of medication dispense (for example, drug classification like ATC, where meds would be administered, legal category of the medication.).

Comments: 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.

The committee will revisit these codes, expecting to use a codesystem from terminology.hl7.org.

Cardinality: 0..*

Type: CodeableConcept

Binding: example:medicationdispense-category

Mappings: rim=.inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="type of medication dispense"].value

MedicationDispense.medication

What medication was (or was intended to be) supplied

Definition: Identifies the medication supplied (or intended to be supplied). 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.

Comments: 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.

Cardinality: 1..1

Type: CodeableReference

Binding: example:medication-codes

Summary: true

Mappings: workflow=Event.code; w5=FiveWs.what[x]; v2=RXD-2 Dispense/Give Code; rim=.participation[typeCode=PRD].role; rx-dispense-rmim=CombinedMedicationRequest.component1.AdministrationRequest.consumable

MedicationDispense.subject

Who the dispense is for

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

Comments: SubstanceAdministration->subject->Patient.

Cardinality: 1..1

Type: Reference(Patient, Group)

Summary: true

Mappings: workflow=Event.subject; w5=FiveWs.subject; v2=PID-3 Patient ID List; rim=.participation[typeCode=SBJ].role[classCode=PAT]

MedicationDispense.encounter

Encounter associated with event

Definition: The encounter that establishes the context for this event.

Cardinality: 0..1

Type: Reference(Encounter)

Mappings: workflow=Event.encounter; rim=.inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code="type of encounter or episode"]

MedicationDispense.supportingInformation

Information that supports the dispensing of the medication

Definition: Additional information that supports the medication being dispensed. For example, there may be requirements that a specific lab test has been completed prior to dispensing or the patient's weight at the time of dispensing is documented.

Cardinality: 0..*

Type: Reference(Resource)

Mappings: w5=FiveWs.context; rim=.outboundRelationship[typeCode=PERT].target[A_SupportingClinicalStatement CMET minimal with many different choices of classCodes(ORG, ENC, PROC, SPLY, SBADM, OBS) and each of the act class codes draws from one or more of the following moodCodes (EVN, DEF, INT PRMS, RQO, PRP, APT, ARQ, GOL)]

MedicationDispense.performer

Who performed event

Definition: Indicates who or what performed the event.

Cardinality: 0..*

Type: BackboneElement

Mappings: workflow=Event.performer; rim=.participation[typeCode=PRF]

MedicationDispense.performer.function

Who performed the dispense and what they did

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

Requirements: Allows disambiguation of the types of involvement of different performers.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:medicationdispense-performer-function

Mappings: rim=participation[typeCode=PRF].functionCode

MedicationDispense.performer.actor

Individual who was performing

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

Comments: The different performer functions within a dispense process can vary - and some of these functions may be restricted to clinical professionals - such distinction is usually specific to a jurisdiction and context. While performer.function and performer.actor don't add restrictions on which resources can be referenced, this element is expected to be used according to the local restrictions, for example not allowing Group (e.g., household) or RelatedPerson to be the dispenser.

Cardinality: 1..1

Type: Reference(Practitioner, PractitionerRole, Organization, Patient, Device, RelatedPerson, CareTeam, Group)

Mappings: workflow=Event.performer.actor; rim=.role

MedicationDispense.location

Where the dispense occurred

Definition: The principal physical location where the dispense was performed.

Cardinality: 0..1

Type: Reference(Location)

Mappings: rim=.participation[typeCode=LOC].role

MedicationDispense.authorizingPrescription

Medication order that authorizes the dispense

Definition: Indicates the medication order that is being dispensed against.

Comments: Maps to basedOn in Event logical model.

Cardinality: 0..*

Type: Reference(MedicationRequest)

Mappings: workflow=Event.basedOn; v2=ORC-2 Placer Order Number; rim=.outboundRelationship[typeCode=FLFS].target[moodCode=RQO]; rx-dispense-rmim=CombinedMedicationDispense.inFulfillmentOf

MedicationDispense.type

Trial fill, partial fill, emergency fill, etc

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

Cardinality: 0..1

Type: CodeableConcept

Binding: example:v3-ActPharmacySupplyType

Mappings: v2=RXD-33 Dispense Type; rim=.code; rx-dispense-rmim=CombinedMedicationDispense.SupplyEvent.code

MedicationDispense.quantity

Amount of medication

Definition: The amount of medication that has been (or was intended to be) dispensed. Includes unit of measure.

Cardinality: 0..1

Type: Quantity(SimpleQuantity)

Mappings: v2=RXD-4 Actual Dispense Amount / RXD-5.1 Actual Dispense Units.code / RXD-5.3 Actual Dispense Units.name of coding system; rim=.quantity; rx-dispense-rmim=CombinedMedicationDispense.SupplyEvent.quantity

MedicationDispense.daysSupply

Amount of medication expressed as a timing amount

Definition: The amount of medication expressed as a timing amount.

Cardinality: 0..1

Type: Quantity(SimpleQuantity)

Mappings: v2=TQ1.6 Timing/Quantity Segment Service Duration. Prior to v2.5, ORC.7.3 Common Order Segment / Quantity/Timing / Duration component. This is a formatted string, first character for the time unit (e.g., D=days), followed by the value. For example, “D14” represents “14 days supply” From v2.5 on, TQ1.6 Timing/Quantity Segment / Service Duration. This is a CQ data type ([Quantity (NM)] ^ [Units (CWE)]), thus for days supply, assuming the unit of measure is “days”, the numeric value is TQ1.6.1 (…|14^ For backwards compatibility, ORC.7 was permitted through v2.6. Both forms (field and segment) may be present in v2.5, v2.5.1, and v2.6; rim=effectiveUseTime

MedicationDispense.fillNumber

A number that represents the known fill this dispense represents

Definition: Represents the known number of the fill over the entire lifetime of the prescription, i.e. if this is the first dispense by this pharmacy but the third fill overall, then the fillNumber will be 3. Each fill number represents one dispensation, even if that dispensation is not for the full quantity. Partial fills are not represented by decimal quantities, i.e., a partial fill of 40 tablets (full quantity is 100 tablets) adds 1 to the prior fill number, not 0.4. This means that the 'fillNumber' may sometimes be higher than the MedicationRequest.numberOfRepeatsAllowed, as the latter assumes full fills, while fillNumber does not.

Comments: This element may be inaccurate as it relies on the dispensing pharmacy to be aware of all fills that have occurred for the request.

Cardinality: 0..1

Type: positiveInt

MedicationDispense.recorded

When the recording of the dispense started

Definition: The date the occurrence of the MedicationDispense was first captured in the system.

Cardinality: 0..1

Type: dateTime

Mappings: rim=.MedicationDispense.dataEnterer..time

MedicationDispense.whenPrepared

When product was packaged and reviewed

Definition: The time when the dispensed product was packaged and reviewed.

Conditions: mdd-1

Cardinality: 0..1

Type: dateTime

Summary: true

Mappings: v2=RXD-3 Date/Time Dispensed; rim=.effectiveTime[xmi:type=IVL_TS].low; rx-dispense-rmim=CombinedMedicationDispense.SupplyEvent.effectiveTime

MedicationDispense.whenHandedOver

When product was given out

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

Conditions: mdd-1

Cardinality: 0..1

Type: dateTime

Mappings: workflow=Event.occurrence[x]; v2=RXD-3 Date/Time Dispensed; rim=.effectiveTime[xmi:type=IVL_TS].high; rx-dispense-rmim=CombinedMedicationDispense.SupplyEvent.effectiveTime

MedicationDispense.destination

Where the medication was/will be sent

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

Cardinality: 0..1

Type: Reference(Location)

Mappings: v2=RXD-13 Dispense-to Location; RXD-30 Dispense to Pharmacy; RXD-31 Dispense to Pharmacy Address; rim=.participation[typeCode=DST].role; rx-dispense-rmim=CombinedMedicationDispense.SupplyEvent.destination

MedicationDispense.receiver

Who collected the medication or where the medication was delivered

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

Cardinality: 0..*

Type: Reference(Patient, Practitioner, RelatedPerson, Location, PractitionerRole, Organization, Group)

Mappings: rim=.participation[typeCode=RCV].role; rx-dispense-rmim=CombinedMedicationDispense.SupplyEvent.receiver

MedicationDispense.note

Information about the dispense

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

Cardinality: 0..*

Type: Annotation

Mappings: workflow=Event.note; v2=RXD-9 Dispense Notes; rim=.inboundRelationship[typeCode=SUBJ]/source[classCode=ACT,moodCode=EVN]

MedicationDispense.dosageInstruction

How the medication is to be used by the patient or administered by the caregiver

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

Comments: When the dose or rate is intended to change over the entire administration period (e.g. Tapering dose prescriptions), multiple instances of dosage instructions will need to be supplied to convey the different doses/rates. The pharmacist reviews the medication order prior to dispense and updates the dosageInstruction based on the actual product being dispensed.

Cardinality: 0..1

Type: DosageDetails

Mappings: rim=.outboundRelationship[typeCode=COMP].target[classCode=SBADM, moodCode=INT]

MedicationDispense.doseAdministrationAid

Type of adherence packaging to use for the dispense

Definition: Provides information about the type of adherence packaging supplied for the medication dispense.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:medication-dose-aid

MedicationDispense.substitution

Whether a substitution was performed on the dispense

Definition: 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.

Cardinality: 0..1

Type: BackboneElement

Mappings: rim=.outboundRelationship[typeCode=COMP].target[classCode=SUBST, moodCode=EVN]; rx-dispense-rmim=CombinedMedicationDispense.substitutionMade

MedicationDispense.substitution.wasSubstituted

Whether a substitution was or was not performed on the dispense

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

Cardinality: 1..1

Type: boolean

Mappings: rim=.actionNegationInd

MedicationDispense.substitution.type

Code signifying whether a different drug was dispensed from what was prescribed

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

Cardinality: 0..1

Type: CodeableConcept

Binding: example:v3-ActSubstanceAdminSubstitutionCode

Mappings: v2=RXO-9 Allow Substitutions / RXE-9 Substitution Status; rim=.code; rx-dispense-rmim=CombinedMedicationDispense.substitutionMade.code

MedicationDispense.substitution.reason

Why was substitution made

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

Cardinality: 0..*

Type: CodeableConcept

Binding: example:v3-SubstanceAdminSubstitutionReason

Mappings: rim=.reasonCode; rx-dispense-rmim=CombinedMedicationDispense.substitutionMade.reasonCode

MedicationDispense.substitution.responsibleParty

Who is responsible for the substitution

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

Cardinality: 0..1

Type: Reference(Practitioner, PractitionerRole, Organization)

Mappings: rim=.participation[typeCode=PFM].role[classCode=ASSIGN]; rx-dispense-rmim=CombinedMedicationDispense.substitutionMade.ResponsibleParty

MedicationDispense.eventHistory

A list of relevant lifecycle events

Definition: A summary of the events of interest that have occurred, such as when the dispense was verified.

Comments: 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.).

Cardinality: 0..*

Type: Reference(Provenance)

Mappings: rim=.inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]