PrescribeIT® Specification and Guide Version 5.0


v5.0 of this specification has been superseded by v5.3. v5.3 is compatible but adds additional features for Quebec.

The version (Bundle.meta.tag:version) that is sent in the message will remain PrescribeIT5.0

 

Definitions for the profile-medicationdispense Profile.

1. MedicationDispense
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.

Control0..*
Must Supporttrue
Max Length0
InvariantsDefined on this element
mdd-1: whenHandedOver cannot be before whenPrepared (: whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared)
2. MedicationDispense.id
Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Control1..1
Typeid
Must Supporttrue
Comments

Usage Note: This will usually be a GUID and is assigned by the sending application. Ideally it should be consistent for all messages referencing this same set of coverage information.

Max Length0
3. MedicationDispense.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

Control0..1
TypeMeta
Max Length0
4. MedicationDispense.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

Control0..1
Typeuri
Is Modifiertrue
Comments

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 as much as possible.

Max Length0
5. MedicationDispense.language
Definition

The base language in which the resource is written.

Control0..1
BindingThe codes SHALL be taken from http://tools.ietf.org/html/bcp47 A human language.

Typecode
Comments

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).

Max Length0
6. MedicationDispense.text
Definition

A human-readable narrative that contains a summary of the resource, and may 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.

Control0..1 This element is affected by the following invariants: dom-1
TypeNarrative
Alternate Namesnarrative, html, xhtml, display
Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative.

Max Length0
7. MedicationDispense.contained
Definition

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.

Control0..*
TypeResource
Alternate Namesinline resources, anonymous resources, contained resources
Comments

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.

Max Length0
8. MedicationDispense.extension
Definition

An Extension

Control0..*
TypeExtension
Must Supporttrue
Max Length0
SlicingThis element introduces a set of slices on MedicationDispense.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
9. MedicationDispense.extension:renderedDosageInstruction
SliceNamerenderedDosageInstruction
Definition

Provides a complete text rendering of the dosage instruction lines for an order or dispense (separate from the rendering of the overall resource instance)

Control1..1
TypeExtension(Medication Rendered Dosage Instruction) (Extension Type: string)
Must Supporttrue
Comments

Conformance Rule: In the context of a dispense notification, this will be populated by the PMS and will reflect the directions as presented to the patient on the label. The rendered dosage instruction must contain all dosage instructions and must be able to stand on its own.

Conformance Rule: This field is made up of structured dosage information as well as patient instructions, assembled into one field and formatted as human-readable, meaning that codes should not be used (e.g. 'days' should be used instead of 'd').

Conformance Rule: Dosage quantity, dosage unit, dosage frequency, form, strength, max quantity per period,minimal interval between dispense, route of administration and where applicable, the administration site.

Note: Any additional patient instructions that are specified at the dosage line level (e.g. take with food, starting one day before dental appointment) should be included.

Conformance Rule: If a PMS sends discrete data elements they must also populate this with a textual view of the SIG. E.g. PO value for RouteofAdministration will be conveyed as 'oral' in this field.

Max Length0
10. MedicationDispense.extension:quantityRemaining
SliceNamequantityRemaining
Definition

The total authorized quantity outstanding after the fill issued as part of this dispense record

Control1..1
TypeExtension(Medication Dispense Quantity Remaining) (Extension Type: Quantity(PrescribeIT® Drug Quantity))
Must Supporttrue
Comments

Should be specified even if 0.

Max Length0
11. MedicationDispense.modifierExtension
Definition

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. Usually modifier elements provide negation or qualification. In order 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.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content
Comments

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.

Max Length0
12. MedicationDispense.identifier
Definition

A technical identifier - identifies some entity uniquely and unambiguously.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control1..1
TypeIdentifier(Shared Health Identifier)
Must Supporttrue
Comments

This is the identifier assigned by the pharmacy to a specific dispense. The system element will be an OID of the form [Vendor root].[Application instance node].4 expressed as a uri (e.g. urn:oid:1.2.3.4). The value element will be the pharmacy-assigned dispense identifier.

Max Length0
13. MedicationDispense.identifier.id
Definition

unique id for the element within a resource (for internal references).

Control0..1
Typeid
Max Length0
14. MedicationDispense.identifier.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Max Length0
15. MedicationDispense.identifier.use
Definition

The purpose of this identifier.

Control0..1
BindingThe codes SHALL be taken from IdentifierUse Identifies the purpose for this identifier, if known .

Typecode
Is Modifiertrue
Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Max Length0
16. MedicationDispense.identifier.type
Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Control0..1
BindingThe codes SHALL be taken from Identifier Type Codes; other codes may be used where these codes are not suitable A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

TypeCodeableConcept
Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

Max Length0
17. MedicationDispense.identifier.system
Definition

Establishes the namespace in which set of possible id values is unique.

Control1..1
Typeuri
Must Supporttrue
Requirements

There are many sequences of identifiers. To perform matching, we need to know what sequence we're dealing with. The system identifies a particular sequence or set of unique identifiers.

Comments

Conformance Rule: This must be an OID of the URI form [Vendor root].[Application instance node].2 (e.g. urn:oid:1.2.3.4). The branch, “.4” is appended to create a unique namespace for the Pharmacy-assigned dispense identifier.

Max Length0
Example
General:http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri
InvariantsDefined on this element
dispenseIdentifier-branch-4: This must be an OID ending in .4 (: $this.matches('^urn\\:oid\\:(\\d+\\.)+4$'))
18. MedicationDispense.identifier.value
Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Control1..1
Typestring
Must Supporttrue
Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension.

Max Length0
Example
General:123456
19. MedicationDispense.identifier.period
Definition

Time period during which identifier is/was valid for use.

Control0..1
TypePeriod
Max Length0
20. MedicationDispense.identifier.assigner
Definition

Organization that issued/manages the identifier.

Control0..1
TypeReference(Organization)
Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Max Length0
21. MedicationDispense.status
Definition

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

Control1..1
BindingThe codes SHALL be taken from MedicationDispenseStatus A code specifying the state of the dispense event.

Typecode
Is Modifiertrue
Must Supporttrue
Comments

Fixed value: completed

Max Length0
Fixed Valuecompleted
22. MedicationDispense.medication[x]
Definition

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.

Control1..1
TypeCodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
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. Note: do not use Medication.name to describe the dispensed medication. When the only available information is a text description of the medication, Medication.code.text should be used.

Max Length0
SlicingThis element introduces a set of slices on MedicationDispense.medication[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
  • type @ $this
23. MedicationDispense.medication[x]:medicationCodeableConcept
SliceNamemedicationCodeableConcept
Definition

A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.

Control1..1
BindingThe codes SHALL be taken from PrescriptionMedicinalProduct; other codes may be used where these codes are not suitable
TypeCodeableConcept(Shared Health CodeableConcept Required Text with optional code)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
Comments

Conformance Rule: This element is used to represent the medication dispensed A 'code' (Canadian Clinical Drug Data Set, or DIN or NPN) must be accompanied by 'text' when dispensing. For compounds, a code is not used and the description will be sent as 'text'. A DIN or an NPN may also be used if an appropriate CCDD code is not yet available. This has an extensible binding meaning that the CCDD code system should be used but if a code is not available, vendors may also submit a code from the DIN or NPN code system. (Eventually CCDD will encompass all DINs and NPNs.)

     Code systems that are acceptable in the message are:
     CCDD - https://fhir.infoway-inforoute.ca/CodeSystem/canadianclinicaldrugdataset
     DIN - http://hl7.org/fhir/NamingSystem/ca-hc-din
     NPN - http://hl7.org/fhir/NamingSystem/ca-hc-npn

      When sending CCDD codes, only the Manufactured Product (MP) or Device NTP codes should be used. In cases where a Canadian Clinical Drug Data Set value is not available within the PMS, the PMS can send a DIN or Natural Product Number (NPN).

     If no drug code (TM, NTP, MP, or DIN) is available in the EMR, only then should the EMR send the drug name as text without a code.

     The pharmacy system may use the drug coding (TM, NTP, MP, DIN, NPN or representative DIN) to display to the user the list of products that can be dispensed.
Max Length0
24. MedicationDispense.patient
Definition

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

Control1..1
TypeReference(Shared Health Patient)
Must Supporttrue
Comments

SubstanceAdministration->subject->Patient.

Max Length0
25. MedicationDispense.patient.id
Definition

unique id for the element within a resource (for internal references).

Control0..1
Typeid
Max Length0
26. MedicationDispense.patient.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Max Length0
27. MedicationDispense.patient.reference
Definition

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Control1..1 This element is affected by the following invariants: ref-1
Typestring
Must Supporttrue
Comments

This must point to the patient associated with the message

Max Length0
28. MedicationDispense.patient.display
Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Control0..1
Typestring
Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Max Length0
29. MedicationDispense.dispenser
Definition

The individual responsible for dispensing the medication.

Control1..1
TypeReference(Practitioner)
Must Supporttrue
Comments

Only organization (conveyed by the extension) is needed. No need to send the actual dispensing practitioner

Max Length0
30. MedicationDispense.dispenser.id
Definition

unique id for the element within a resource (for internal references).

Control0..1
Typeid
Max Length0
31. MedicationDispense.dispenser.extension
Definition

An Extension

Control0..*
TypeExtension
Must Supporttrue
Max Length0
SlicingThis element introduces a set of slices on MedicationDispense.dispenser.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
32. MedicationDispense.dispenser.extension:organization
SliceNameorganization
Definition

Allows capturing the organization responsible for an action instead of or in addition to identifying the responsible practitioner

Control1..1
TypeExtension(Reference Practitioner Organization) (Extension Type: Reference(Shared Health Reference)(Shared Health - eRx Service Location))
Must Supporttrue
Comments

For Shared Health purposes, only the pharmacy is relevant, not the dispensing pharmacist or technician. In the future, this should be supported directly by the resource.

Max Length0
33. MedicationDispense.dispenser.reference
Definition

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Control0..1 This element is affected by the following invariants: ref-1
Typestring
Comments

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

Max Length0
34. MedicationDispense.dispenser.display
Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Control0..1
Typestring
Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Max Length0
35. MedicationDispense.authorizingPrescription
Definition

Indicates the medication order that is being dispensed against.

Control1..1
TypeReference(PrescribeIT® Prescription)
Must Supporttrue
Comments

Usage Note: This segment provides the medication order that the dispense is associated with.

Max Length0
36. MedicationDispense.authorizingPrescription.id
Definition

unique id for the element within a resource (for internal references).

Control0..1
Typeid
Max Length0
37. MedicationDispense.authorizingPrescription.extension
Definition

An Extension

Control0..*
TypeExtension
Must Supporttrue
Max Length0
SlicingThis element introduces a set of slices on MedicationDispense.authorizingPrescription.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
38. MedicationDispense.authorizingPrescription.extension:identifier
SliceNameidentifier
Definition

Allows a reference to identify the target prescription, dispense or task by business identifier rather than URL

Control1..1
TypeExtension(Referenced Business identifier) (Extension Type: Identifier(Shared Health Identifier))
Must Supporttrue
Comments

This provides the medication order identifier that the dispense is associated with.

Usage: In the context of p160 and p200, PMS's will populate this identifier value with the appropriate value.

Usage: In the context of p200, EMR's need to use this value to find the corresponding medication order in their local system in order to associate the incoming dispense it to.

Usage in the context of p160, EMR's can use either this value or the medicationOrder.identifier (emr-id) to find the corresponding medication order in their local system which is related to the medication order which is asking to be renewed.

Max Length0
39. MedicationDispense.authorizingPrescription.extension:identifier.id
Definition

unique id for the element within a resource (for internal references).

Control0..1
Typeid
40. MedicationDispense.authorizingPrescription.extension:identifier.extension
Definition

An Extension

Control0..0
TypeExtension
41. MedicationDispense.authorizingPrescription.extension:identifier.url
Definition

Source of the definition for the extension code - a logical name or a URL.

Control1..1
Typeuri
Must Supporttrue
Comments

Fixed value: http://hl7.org/fhir/StructureDefinition/extension-Reference.identifier

Fixed Valuehttp://hl7.org/fhir/StructureDefinition/extension-Reference.identifier
42. MedicationDispense.authorizingPrescription.extension:identifier.value[x]
Definition

A technical identifier - identifies some entity uniquely and unambiguously.

Control1..1
TypeIdentifier(PrescribeIT® Prescriber Prescription Identifier)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
Comments

In the context of a p200 this will represent the mediation order identifier of the original electronic prescription (e110, e120, e162, e163, e180) which the dispense is associated with.

In the context of a p160 this will represent either the mediation order identifier of the original electronic prescription (e110, e120, e162, e163, e180) which is the dispense is associated with or it will be the pharmacies own medication order identifier when the dispense is associated with a previous non-electronic order (i.e. paper or fax).

Usage: EMR's should use the identifier.system and identifier.value to determine whether medication order relates to an order within the local application. The identifier.system value represents the application (application instance id) that assigned the identifier and identifier.value represents the actual medication order value. When the system value does NOT match the local application then this identifier was assigned by another application and should be treated like a non-electronic (i.e. paper or fax) order. When the system value matches the local application then this identifier was assigned by this application and the system should then proceed to find the value. If the value cannot be found it should be treated like a non-electronic (i.e. paper or fax) order. Only when both the system and value match a local medication order can the application treat it as a electronic medication order.

Max Length0
SlicingThis element introduces a set of slices on MedicationDispense.authorizingPrescription.extension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
  • type @ $this
43. MedicationDispense.authorizingPrescription.extension:identifier.value[x]:valueIdentifier
SliceNamevalueIdentifier
Definition

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

Control1..1
TypeIdentifier
[x] NoteSee Choice of Data Types for further information about how to use [x]
44. MedicationDispense.authorizingPrescription.reference
Definition

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Control0..1 This element is affected by the following invariants: ref-1
Typestring
Must Supporttrue
Comments

If the MedicationOrder is included in the bundle (e.g. p160 Renewal Request when sending the most recent dispense), this reference can be provide which points to the medication order resource found in the same bundle. This reference is optional and can be omitted.

Conformance Rule: When providing this reference it must be the same as the Task.subject reference value.

Max Length0
45. MedicationDispense.authorizingPrescription.display
Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Control0..1
Typestring
Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Max Length0
46. MedicationDispense.type
Definition

A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.

Control0..1
BindingThe codes SHALL be taken from ActPharmacySupplyType (20210501)
TypeCodeableConcept(Shared Health CodeableConcept Code)
Must Supporttrue
Comments

Usage note: For future use

Max Length0
47. MedicationDispense.quantity
Definition

A measured or counted amount of a medication expressed as a value and human-readable string with optional coded units expressed in a local coding system

Control1..1
BindingThe codes SHALL be taken from PrescribedQuantityUnit (20210308); other codes may be used where these codes are not suitable
TypeQuantity(PrescribeIT® Drug Quantity)
Must Supporttrue
Comments

Conformance Rule: Quantity is used throughout the messages. It may be a drug form (e.g. TAB) an administrable drug (e.g. PUFF) form or a unit of measure (e.g. mg). You must send the coding system and code.

Max Length0
InvariantsDefined on this element
qty-3: If a code for the unit is present, the system SHALL also be present (: code.empty() or system.exists())
sqty-1: The comparator is not used on a SimpleQuantity (: comparator.empty())
48. MedicationDispense.daysSupply
Definition

The number of days that the dispensed quantity is expected to last. Cannot be mandatory as there are some situations where 'as needed' cannot be used to determine days supply.

Control1..1
TypeQuantity(SimpleQuantity)
Must Supporttrue
Requirements

Useful in monitoring patient compliance. May also be useful in determining and managing certain contraindications ('Fill-Too-Soon', 'Fill-Too-Late', and 'Duration of Therapy'). Because 'Days Supply' may be necessary to compute total dispensed quantity, it is made a"populated field.

Comments

Usage Note: There are some situations where this cannot be calculated, an estimated value will be used as drug plans will require this.(e.g. warfarin 1mg with take as directed dosing instructions)

Max Length0
49. MedicationDispense.daysSupply.id
Definition

unique id for the element within a resource (for internal references).

Control0..1
Typeid
Max Length0
50. MedicationDispense.daysSupply.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Max Length0
51. MedicationDispense.daysSupply.value
Definition

The value of the measured amount. The value includes an implicit precision in the presentation of the value.

Control1..1
Typedecimal
Must Supporttrue
Requirements

Precision is handled implicitly in almost all cases of measurement.

Comments

The implicit precision in the value should always be honored.

Max Length0
52. MedicationDispense.daysSupply.comparator
Definition

Not allowed to be used in this context

Control0..0
BindingThe codes SHALL be taken from QuantityComparator How the Quantity should be understood and represented.

Typecode
Is Modifiertrue
Requirements

Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

Comments

This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value.

Max Length0
Meaning if MissingIf there is no comparator, then there is no modification of the value
53. MedicationDispense.daysSupply.unit
Definition

A human-readable form of the unit.

Control0..1
Typestring
Requirements

There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

Max Length0
54. MedicationDispense.daysSupply.system
Definition

The identification of the system that provides the coded form of the unit.

Control1..1 This element is affected by the following invariants: qty-3
Typeuri
Must Supporttrue
Requirements

Need to know the system that defines the coded form of the unit.

Max Length0
55. MedicationDispense.daysSupply.code
Definition

A computer processable form of the unit in some unit representation system.

Control1..1
Typecode
Must Supporttrue
Requirements

Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

Comments

Fixed value: d

Max Length0
Fixed Valued
56. MedicationDispense.whenPrepared
Definition

The time when the dispensed product was packaged and reviewed.

Control1..1
TypedateTime
Must Supporttrue
Comments

This represents the date the medication was dispensed.

Max Length0
57. MedicationDispense.whenHandedOver
Definition

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

Control0..1
TypedateTime
Max Length0
58. MedicationDispense.destination
Definition

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

Control0..1
TypeReference(Location)
Max Length0
59. MedicationDispense.receiver
Definition

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.

Control0..*
TypeReference(Patient | Practitioner)
Max Length0
60. MedicationDispense.note
Definition

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

Control0..*
TypeAnnotation
Max Length0
61. MedicationDispense.dosageInstruction
Definition

Indicates how the medication is to be used by the patient. The pharmacist reviews the medication order prior to dispense and updates the dosageInstruction based on the actual product being dispensed.

Control0..*
TypeBackboneElement
Must Supporttrue
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.  Conformance Rule:  If PMS is able to support the structured dosage, they may do so but this is not mandatory

Max Length0
62. MedicationDispense.dosageInstruction.id
Definition

unique id for the element within a resource (for internal references).

Control0..1
Typeid
Max Length0
63. MedicationDispense.dosageInstruction.extension
Definition

An Extension

Control0..*
TypeExtension
Must Supporttrue
Max Length0
SlicingThis element introduces a set of slices on MedicationDispense.dosageInstruction.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
64. MedicationDispense.dosageInstruction.extension:sequence
SliceNamesequence
Definition

Indicates the sequence of a particular dosage line within all dosage lines - equivalent to the repetition number of the dosage instruction element this extension is on.

Control1..1
TypeExtension(Medication Dosage Line Sequence) (Extension Type: integer(positiveInt))
Must Supporttrue
Comments

Conformance Rule: This must match the positional sequence of the dosageInstruction repetition. I.e. The first dosageInstruction repetition must have a 'sequence' value of 1, the second a 'sequence' value of 2, etc.

Max Length0
65. MedicationDispense.dosageInstruction.extension:instructionRelationship
SliceNameinstructionRelationship
Definition

Indicates how the timing of this dosage instruction relates to the preceding dosage instruction. Specifically, is it concurrent (AND) or sequential (THEN).

Control0..1
TypeExtension(Medication Order Dosage Instruction Relationship) (Extension Type: code)
Must Supporttrue
Comments

Conformance Rule: As this will establish the relationship to the previous dosage lines (example: first and second dosage line, the second and thrid dosage line, etc.) this must be present for all dosage lines except for the FIRST dosage line.

Usage Note: If THEN; is specified, there is typically a COMPLEXADMINISTRATIONPERIOD specified as well. These will be consecutive periods.

Conformance Rule: ANDs and THENs should not be mixed due to ambiguity of meaning

Max Length0
66. MedicationDispense.dosageInstruction.modifierExtension
Definition

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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content, modifiers
Comments

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.

Max Length0
67. MedicationDispense.dosageInstruction.text
Definition

A free form description of how the dispensed medication is to be administered to the patient.

Control0..1
Typestring
Must Supporttrue
Comments

Conformance Rule: If supported by the PMS, multiple dosage lines can be expressed individually. However, they must be concatenated into the RENDEREDDOSAGEINSTRUCTION as PMS will not be forced to support the receipt of individual lines.

Usage Note: This is a string that is typically composed of the route, duration, dose, frequency, per line.

Examples are: Prednisone, variable dosage instruction, or concurrent instructions (1 pill morning and 1 pill before bed) or sequential dosages (1 pill for 2 days, then 2 pills).

Max Length0
68. MedicationDispense.dosageInstruction.additionalInstructions
Definition

A free form textual description of extended instruction regarding the administration of the drug.

Control0..1
Binding

Codes identifying additional instructions such as "take with water" or "avoid operating heavy machinery"

TypeCodeableConcept(Shared Health CodeableConcept Text Required)
Must Supporttrue
Comments

Conformance Rule: When providing an additional instruction at the dosage line level (complex), this should be populated when appropriate.

Usage Note: It may be necessary for the EMR to parse instructions such as QHS (take at bedtime), into two data elements DOSAGETIMINGFREQUENCY = once a day and 'at bedtime' would be placed into this field.

HL7 MAPPING - ADDITIONALDOSAGEINSTRUCTION (Business Name Change).

Max Length0
69. MedicationDispense.dosageInstruction.additionalInstructions.id
Definition

unique id for the element within a resource (for internal references).

Control0..1
Typeid
Max Length0
70. MedicationDispense.dosageInstruction.additionalInstructions.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Max Length0
71. MedicationDispense.dosageInstruction.additionalInstructions.coding
Definition

A reference to a code defined by a terminology system.

Control0..*
TypeCoding
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labelled as UserSelected = true.

Max Length0
72. MedicationDispense.dosageInstruction.additionalInstructions.text
Definition

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

Control1..1
Typestring
Must Supporttrue
Requirements

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

Comments

Conformance Rule: This is the text used to convey the exact word that was displayed to the practitioner

Max Length2500
73. MedicationDispense.dosageInstruction.timing
Definition

A structure describing the frequency (how often the drug is to be administered), offset (elapse time between administrations) represented by one line of dosage administration instruction. Includes the overall time-period the dosage instruction applies.

Control0..1
TypeTiming
Must Supporttrue
Comments

Conformance Rule: For EMRs that can support it, this should be specified. Must also be part of the COMPLEXDOSAGEINSTRUCTION

Conformance Rule: A start date may optionally be included. Refer to the Timing data type page for guidance on its use.

Max Length0
74. MedicationDispense.dosageInstruction.timing.id
Definition

unique id for the element within a resource (for internal references).

Control0..1
Typeid
Max Length0
75. MedicationDispense.dosageInstruction.timing.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Max Length0
76. MedicationDispense.dosageInstruction.timing.event
Definition

Identifies specific times when the event occurs.

Control0..1
TypedateTime
Must Supporttrue
Requirements

In an MAR, for instance, you need to take a general specification, and turn it into a precise specification.

Max Length0
77. MedicationDispense.dosageInstruction.timing.repeat
Definition

A set of rules that describe when the event should occur.

Control0..1
TypeElement
Must Supporttrue
Requirements

Many timing schedules are determined by regular repetitions.

Max Length0
InvariantsDefined on this element
tim-1: if there's a duration, there needs to be duration units (: duration.empty() or durationUnit.exists())
tim-2: if there's a period, there needs to be period units (: period.empty() or periodUnit.exists())
tim-3: Either frequency or when can exist, not both (: ((period.exists() or frequency.exists()) and when.exists()).not())
tim-4: duration SHALL be a non-negative value (: duration.exists() implies duration >= 0)
tim-6: If there's a periodMax, there must be a period (: periodMax.empty() or period.exists())
tim-7: If there's a durationMax, there must be a duration (: durationMax.empty() or duration.exists())
tim-8: If there's a countMax, there must be a count (: countMax.empty() or count.exists())
tim-9: If there's an offset, there must be a when (: offset.empty() or when.exists())
78. MedicationDispense.dosageInstruction.timing.repeat.id
Definition

unique id for the element within a resource (for internal references).

Control0..1
Typeid
Max Length0
79. MedicationDispense.dosageInstruction.timing.repeat.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Max Length0
80. MedicationDispense.dosageInstruction.timing.repeat.bounds[x]
Definition

boundsPeriod defines the start and/or end date of the period over which the specified instruction should take place for a given dosage line. For example, if the prescriber wants a patient to start taking the medication starting the day before surgery, and the surgery is scheduled for Feb 16th 2019, the start date within bounds period would be Feb 15 2019. The end date can be included if the prescriber wants the patient to stop medication after a certain number of days. In the example above lets say the prescriber wants to the patient to stop the medication after 10 days the end date would Feb 26 2019.

boundsQuantity defines the amount a time that the patient should be taking the specified instruction for a given dosage line. As an example, a prescription may call for taking 1-2 pills per day for 10 days. The boundsQuantity would be 10 days.

boundsRange defines a minimum and maximum amount of time that the patient should be taking the specified instruction for a given dosage line. As an example, a prescriber may indicate that a patient should apply a cream 2 times per day for a minimum of 10 days but if the rash persists, continue applying for up to 14 days. In this case the minimum for boundsRange would be 10 days and the maximum for boundsRange would be 14 days.

Control0..1
TypeChoice of: Period, Quantity(Shared Health Duration), Range
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Max Length0
81. MedicationDispense.dosageInstruction.timing.repeat.count
Definition

A total count of the desired number of repetitions.

Control0..1
Typeinteger
Must Supporttrue
Requirements

Repetitions may be limited by end time or total occurrences.

Comments

If you have both bounds and count, then this should be understood as within the bounds period, until count times happens.

Max Length0
82. MedicationDispense.dosageInstruction.timing.repeat.countMax
Definition

A maximum value for the count of the desired repetitions (e.g. do something 6-8 times).

Control0..1
Typeinteger
Must Supporttrue
Max Length0
83. MedicationDispense.dosageInstruction.timing.repeat.duration
Definition

How long this thing happens for when it happens.

Control0..1
Typedecimal
Must Supporttrue
Requirements

Some activities are not instantaneous and need to be maintained for a period of time.

Comments

For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).

Max Length0
84. MedicationDispense.dosageInstruction.timing.repeat.durationMax
Definition

The upper limit of how long this thing happens for when it happens.

Control0..1
Typedecimal
Must Supporttrue
Requirements

Some activities are not instantaneous and need to be maintained for a period of time.

Comments

For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).

Max Length0
85. MedicationDispense.dosageInstruction.timing.repeat.durationUnit
Definition

The units of time for the duration, in UCUM units.

Control0..1
BindingThe codes SHALL be taken from x_TimeUnitsOfMeasure (20210501)
Typecode
Must Supporttrue
Max Length0
86. MedicationDispense.dosageInstruction.timing.repeat.frequency
Definition

The number of times to repeat the action within the specified period / period range (i.e. both period and periodMax provided).

Control0..1
Typeinteger
Must Supporttrue
Max Length0
Default Value1
87. MedicationDispense.dosageInstruction.timing.repeat.frequencyMax
Definition

If present, indicates that the frequency is a range - so repeat between [frequency] and [frequencyMax] times within the period or period range.

Control0..1
Typeinteger
Must Supporttrue
Max Length0
88. MedicationDispense.dosageInstruction.timing.repeat.period
Definition

Indicates the duration of time over which repetitions are to occur; e.g. to express "3 times per day", 3 would be the frequency and "1 day" would be the period.

Control0..1
Typedecimal
Must Supporttrue
Max Length0
89. MedicationDispense.dosageInstruction.timing.repeat.periodMax
Definition

If present, indicates that the period is a range from [period] to [periodMax], allowing expressing concepts such as "do this once every 3-5 days.

Control0..1
Typedecimal
Must Supporttrue
Max Length0
90. MedicationDispense.dosageInstruction.timing.repeat.periodUnit
Definition

The units of time for the period in UCUM units.

Control0..1
BindingThe codes SHALL be taken from x_TimeUnitsOfMeasure (20210501)
Typecode
Must Supporttrue
Max Length0
91. MedicationDispense.dosageInstruction.timing.repeat.when
Definition

A real world event that the occurrence of the event should be tied to.

Control0..0
BindingThe codes SHALL be taken from EventTiming Real world event that the relating to the schedule.

Typecode
Requirements

Timings are frequently determined by occurrences such as waking, eating and sleep.

Comments

Use "additionalInstructions" instead

Max Length0
92. MedicationDispense.dosageInstruction.timing.repeat.offset
Definition

The number of minutes from the event. If the event code does not indicate whether the minutes is before or after the event, then the offset is assumed to be after the event.

Control0..0
TypeunsignedInt
Comments

Use "additionalInstructions" instead

Max Length0
93. MedicationDispense.dosageInstruction.timing.code
Definition

A code for the timing pattern. Some codes such as BID are ubiquitous, but many institutions define their own additional codes. If a code is provided, the code is understood to be a complete statement of whatever is specified in the structured timing data, and either the code or the data may be used to interpret the Timing.

Control0..1
BindingThe codes SHOULD be taken from TimingAbbreviation Code for a known / defined timing pattern.

TypeCodeableConcept
Comments

BID etc are defined as 'at institutionally specified times'. For example, an institution may choose that BID is "always at 7am and 6pm". If it is inappropriate for this choice to be made, the code BID should not be used. Instead, a distinct organization-specific code should be used in place of the HL7-defined BID code and/or the a structured representation should be used (in this case, specifying the two event times).

Max Length0
94. MedicationDispense.dosageInstruction.asNeeded[x]
Definition

Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept). Specifically if 'boolean' datatype is selected, then the following logic applies: If set to True, this indicates that the medication is only taken when needed, within the specified schedule.

Control0..1
Binding

A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.

TypeChoice of: boolean, CodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Comments

Conformance Rule: Set value = true.

Conformance Rule: When this is specified, it is not acceptable to express the quantity exclusively as a duration/DAYSSUPPLY. The DOSAGEQUANTITY must be set.

Max Length0
95. MedicationDispense.dosageInstruction.site[x]
Definition

A coded specification of the anatomic site where the medication first enters the body.

Control0..1
BindingFor example codes, see SNOMED CT Anatomical Structure for Administration Site Codes A coded concept describing the site location the medicine enters into or onto the body

TypeCodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Max Length0
SlicingThis element introduces a set of slices on MedicationDispense.dosageInstruction.site[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
  • type @ $this
96. MedicationDispense.dosageInstruction.site[x]:siteCodeableConcept
SliceNamesiteCodeableConcept
Definition

A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.

Control0..1
BindingThe codes SHALL be taken from PrescriptionAdministrationSite (20190430); other codes may be used where these codes are not suitable
TypeCodeableConcept(Shared Health CodeableConcept Required Text with optional code)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
Comments

Conformance Rule: When providing a structured SIG, this should be populated when appropriate. If not structured, this should be part of the SIG (RENDEREDDOSAGEINSTRUCTION).

Also can be specified for COMPLEX

Max Length0
97. MedicationDispense.dosageInstruction.route
Definition

A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.

Control0..1
BindingThe codes SHALL be taken from PrescriptionRouteOfAdministration (20190415); other codes may be used where these codes are not suitable
TypeCodeableConcept(Shared Health CodeableConcept Required Text with optional code)
Must Supporttrue
Comments

Conformance Rule: Coding should be populated if a code is available. However, text is always required.

Max Length0
98. MedicationDispense.dosageInstruction.method
Definition

A coded value indicating the method by which the medication is intended to be or was introduced into or on the body.

Control0..1
Binding

A coded concept describing the technique by which the medicine is administered

TypeCodeableConcept
Comments

This attribute will most often NOT be populated. It is most commonly used for injections. For example, Slow Push, Deep IV. One of the reasons this attribute is not used often, is that the method is often pre-coordinated with the route and/or form of administration. This means the codes used in route or form may pre-coordinate the method in the route code or the form code. The implementation decision about what coding system to use for route or form code will determine how frequently the method code will be populated e.g. if route or form code pre-coordinate method code, then this attribute will not be populated often; if there is no pre-coordination then method code may be used frequently.

Max Length0
99. MedicationDispense.dosageInstruction.dose[x]
Definition

The amount of therapeutic or other substance given at one administration event.

Control0..1
BindingThe codes SHALL be taken from PrescriptionDoseQuantityUnit (20210308); other codes may be used where these codes are not suitable
TypeChoice of: Quantity(PrescribeIT® Drug Quantity for Administration), Range(PrescribeIT® Drug Range)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Comments

Conformance Rule: Could be sent as part of the dosage instruction. OR for those EMRs that can support it, this should be specified.

Max Length0
100. MedicationDispense.dosageInstruction.rate[x]
Definition

Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Currently we do not specify a default of '1' in the denominator, but this is being discussed. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours.

Control0..1
TypeRatio
[x] NoteSee Choice of Data Types for further information about how to use [x]
Max Length0
SlicingThis element introduces a set of slices on MedicationDispense.dosageInstruction.rate[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
  • type @ $this
101. MedicationDispense.dosageInstruction.rate[x]:rateRatio
SliceNamerateRatio
Definition

Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Currently we do not specify a default of '1' in the denominator, but this is being discussed. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours.

Control0..1
TypeRatio
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
Max Length0
102. MedicationDispense.dosageInstruction.maxDosePerPeriod
Definition

The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time, e.g. 1000mg in 24 hours.

Control0..1
TypeRatio
Must Supporttrue
Requirements

Needed when the dosage unit is not expressed as part of the dose quantity (mg, mL) or implicit as part of the drug form (capsules, tablets). Examples are Puffs, Actuations, etc.

Comments

Conformance Rule: When providing a structured SIG, this should be populated when appropriate.

Also can be specified for COMPLEX

Max Length0
103. MedicationDispense.dosageInstruction.maxDosePerPeriod.id
Definition

unique id for the element within a resource (for internal references).

Control0..1
Typeid
Max Length0
104. MedicationDispense.dosageInstruction.maxDosePerPeriod.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Max Length0
105. MedicationDispense.dosageInstruction.maxDosePerPeriod.numerator
Definition

A measured or counted amount of a medication expressed as a value and human-readable string with optional coded units expressed in a local coding system

Control1..1
BindingThe codes SHALL be taken from PrescribedQuantityUnit (20210308); other codes may be used where these codes are not suitable
TypeQuantity(PrescribeIT® Drug Quantity for Administration)
Must Supporttrue
Comments

Usage Note: Quantity is used throughout the messages. It may be a drug form (e.g. TAB) an administrable drug (e.g. PUFF) form or a unit of measure (e.g. mg).

Max Length0
InvariantsDefined on this element
qty-3: If a code for the unit is present, the system SHALL also be present (: code.empty() or system.exists())
sqty-1: The comparator is not used on a SimpleQuantity (: comparator.empty())
106. MedicationDispense.dosageInstruction.maxDosePerPeriod.denominator
Definition

A measured amount (or an amount that can potentially be measured). Note that measured amounts include amounts that are not precisely quantified, including amounts involving arbitrary units and floating currencies.

Control1..1
TypeQuantity(Shared Health Quantity)
Must Supporttrue
Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Max Length0
InvariantsDefined on this element
qty-3: If a code for the unit is present, the system SHALL also be present (: code.empty() or system.exists())
107. MedicationDispense.substitution
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.

Control0..1
TypeBackboneElement
Max Length0
108. MedicationDispense.substitution.id
Definition

unique id for the element within a resource (for internal references).

Control0..1
Typeid
Max Length0
109. MedicationDispense.substitution.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

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.

Max Length0
110. MedicationDispense.substitution.modifierExtension
Definition

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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

Control0..*
TypeExtension
Is Modifiertrue
Alternate Namesextensions, user content, modifiers
Comments

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.

Max Length0
111. MedicationDispense.substitution.type
Definition

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

Control1..1
BindingFor example codes, see ActSubstanceAdminSubstitutionCode A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription

TypeCodeableConcept
Max Length0
112. MedicationDispense.substitution.reason
Definition

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

Control0..*
BindingFor example codes, see SubstanceAdminSubstitutionReason A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed

TypeCodeableConcept
Max Length0
113. MedicationDispense.substitution.responsibleParty
Definition

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

Control0..*
TypeReference(Practitioner)
Max Length0