PrescribeIT® Dispense

3.62 StructureDefinition: PrescribeIT® Dispense

The official URL for this profile is:

http://prescribeit.ca/fhir/StructureDefinition/profile-medicationdispense

3.62.1 Scope and Usage

An Excel spreadsheet providing SIG guidance on how to populate dosage instructions can be found here.

3.62.2 Formal Views of Profile Content

Download Excel representation

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from MedicationDispense

Name	Card.	Type	Constraints and Usage
MedicationDispense	0..*	MedicationDispense	mdd-1: whenHandedOver cannot be before whenPrepared 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.
id	1..1	id	Definition: The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. 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.
extension	0..*	Extension	Slice: Unordered, Open by value:url Definition: An Extension
extension (renderedDosageInstruction)	1..1	Medication Rendered Dosage Instruction	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) 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.
extension (quantityRemaining)	1..1	Medication Dispense Quantity Remaining	Definition: The total authorized quantity outstanding after the fill issued as part of this dispense record Comments: Should be specified even if 0.
identifier	1..1	Shared Health Identifier	Definition: A technical identifier - identifies some entity uniquely and unambiguously. 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.
system	1..1	uri	dispenseIdentifier-branch-4: This must be an OID ending in .4 Example' General': http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri Definition: Establishes the namespace in which set of possible id values is unique. 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.
value	1..1	string	Example' General': 123456 Definition: The portion of the identifier typically relevant to the user and which is unique within the context of the system. 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.
status	1..1	code	Binding: MedicationDispenseStatus (required): A code specifying the state of the dispense event. Fixed Value: completed Definition: A code specifying the state of the set of dispense events. Comments: Fixed value: completed
medication[x] (medicationCodeableConcept)	1..1	Shared Health CodeableConcept Required Text with optional code	Binding: PrescriptionMedicinalProduct (extensible) Definition: A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. 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.
patient	1..1	Reference(Shared Health Patient) {b }	Definition: A link to a resource representing the person to whom the medication will be given. Comments: SubstanceAdministration->subject->Patient.
reference	1..1	string	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. Comments: This must point to the patient associated with the message
dispenser	1..1	Reference(Practitioner) {b }	Definition: The individual responsible for dispensing the medication. Comments: Only organization (conveyed by the extension) is needed. No need to send the actual dispensing practitioner
extension	0..*	Extension	Slice: Unordered, Open by value:url Definition: An Extension
extension (organization)	1..1	Reference Practitioner Organization	Definition: Allows capturing the organization responsible for an action instead of or in addition to identifying the responsible practitioner 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.
authorizingPrescription	1..1	Reference(PrescribeIT® Prescription) {b r }	Definition: Indicates the medication order that is being dispensed against. Comments: Usage Note: This segment provides the medication order that the dispense is associated with.
extension	0..*	Extension	Slice: Unordered, Open by value:url Definition: An Extension
extension (identifier)	1..1	Referenced Business identifier	Definition: Allows a reference to identify the target prescription, dispense or task by business identifier rather than URL 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.
url	1..1	uri	"http://hl7.org/fhir/StructureDefinition/extension-Reference.identifier"
value[x]	1..1	PrescribeIT® Prescriber Prescription Identifier	Slice: Unordered, Closed by type:$this Definition: A technical identifier - identifies some entity uniquely and unambiguously. 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.
reference	0..1	string	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. 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.
type	0..1	Shared Health CodeableConcept Code	Binding: ActPharmacySupplyType (20210501) (required) Definition: A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Comments: Usage note: For future use
quantity	1..1	PrescribeIT® Drug Quantity	Binding: PrescribedQuantityUnit (20210308) (extensible) qty-3: If a code for the unit is present, the system SHALL also be present sqty-1: The comparator is not used on a SimpleQuantity 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 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.
daysSupply	1..1	SimpleQuantity	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. 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)
value	1..1	decimal	Definition: The value of the measured amount. The value includes an implicit precision in the presentation of the value. Comments: The implicit precision in the value should always be honored.
system	1..1	uri	Definition: The identification of the system that provides the coded form of the unit.
code	1..1	code	Fixed Value: d Definition: A computer processable form of the unit in some unit representation system. Comments: Fixed value: d
whenPrepared	1..1	dateTime	Definition: The time when the dispensed product was packaged and reviewed. Comments: This represents the date the medication was dispensed.
dosageInstruction	0..*	BackboneElement	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. 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
extension	0..*	Extension	Slice: Unordered, Open by value:url Definition: An Extension
extension (sequence)	1..1	Medication Dosage Line Sequence	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. 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.
extension (instructionRelationship)	0..1	Medication Order Dosage Instruction Relationship	Definition: Indicates how the timing of this dosage instruction relates to the preceding dosage instruction. Specifically, is it concurrent (AND) or sequential (THEN). 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 COMPLEX_ADMINISTRATION_PERIOD specified as well. These will be consecutive periods. Conformance Rule: ANDs and THENs should not be mixed due to ambiguity of meaning
text	0..1	string	Definition: A free form description of how the dispensed medication is to be administered to the patient. Comments: Conformance Rule: If supported by the PMS, multiple dosage lines can be expressed individually. However, they must be concatenated into the RENDERED_DOSAGE_INSTRUCTION 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).
additionalInstructions	0..1	Shared Health CodeableConcept Text Required	Binding: (unbound) (example): Codes identifying additional instructions such as "take with water" or "avoid operating heavy machinery" Definition: A free form textual description of extended instruction regarding the administration of the drug. 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 DOSAGE_TIMING_FREQUENCY = once a day and 'at bedtime' would be placed into this field. HL7 MAPPING - ADDITIONAL_DOSAGE_INSTRUCTION (Business Name Change).
text	1..1	string	Max Length: 2500 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. Comments: Conformance Rule: This is the text used to convey the exact word that was displayed to the practitioner
timing	0..1	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. Comments: Conformance Rule: For EMRs that can support it, this should be specified. Must also be part of the COMPLEX_DOSAGE_INSTRUCTION Conformance Rule: A start date may optionally be included. Refer to the Timing data type page for guidance on its use.
event	0..1	dateTime	Definition: Identifies specific times when the event occurs.
repeat	0..1	Element	tim-3: Either frequency or when can exist, not both tim-1: if there's a duration, there needs to be duration units tim-2: if there's a period, there needs to be period units tim-9: If there's an offset, there must be a when tim-6: If there's a periodMax, there must be a period tim-8: If there's a countMax, there must be a count tim-7: If there's a durationMax, there must be a duration tim-4: duration SHALL be a non-negative value Definition: A set of rules that describe when the event should occur.
bounds[x]	0..1	Period, Shared Health Duration, Range	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.
count	0..1	integer	Definition: A total count of the desired number of repetitions. Comments: If you have both bounds and count, then this should be understood as within the bounds period, until count times happens.
countMax	0..1	integer	Definition: A maximum value for the count of the desired repetitions (e.g. do something 6-8 times).
duration	0..1	decimal	Definition: How long this thing happens for when it happens. 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).
durationMax	0..1	decimal	Definition: The upper limit of how long this thing happens for when it happens. 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).
durationUnit	0..1	code	Binding: x_TimeUnitsOfMeasure (20210501) (required) Definition: The units of time for the duration, in UCUM units.
frequency	0..1	integer	Definition: The number of times to repeat the action within the specified period / period range (i.e. both period and periodMax provided).
frequencyMax	0..1	integer	Definition: If present, indicates that the frequency is a range - so repeat between [frequency] and [frequencyMax] times within the period or period range.
period	0..1	decimal	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.
periodMax	0..1	decimal	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.
periodUnit	0..1	code	Binding: x_TimeUnitsOfMeasure (20210501) (required) Definition: The units of time for the period in UCUM units.
asNeeded[x]	0..1	boolean, CodeableConcept	Binding: (unbound) (example): 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. 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. 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.
site[x] (siteCodeableConcept)	0..1	Shared Health CodeableConcept Required Text with optional code	Binding: PrescriptionAdministrationSite (20190430) (extensible) Definition: A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Comments: Conformance Rule: When providing a structured SIG, this should be populated when appropriate. If not structured, this should be part of the SIG (RENDERED_DOSAGE_INSTRUCTION). Also can be specified for COMPLEX
route	0..1	Shared Health CodeableConcept Required Text with optional code	Binding: PrescriptionRouteOfAdministration (20190415) (extensible) Definition: A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Comments: Conformance Rule: Coding should be populated if a code is available. However, text is always required.
dose[x]	0..1	PrescribeIT® Drug Quantity for Administration, PrescribeIT® Drug Range	Binding: PrescriptionDoseQuantityUnit (20210308) (extensible) Definition: The amount of therapeutic or other substance given at one administration event. Comments: Conformance Rule: Could be sent as part of the dosage instruction. OR for those EMRs that can support it, this should be specified.
rate[x] (rateRatio)	0..1	Ratio	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.
maxDosePerPeriod	0..1	Ratio	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. Comments: Conformance Rule: When providing a structured SIG, this should be populated when appropriate. Also can be specified for COMPLEX
numerator	1..1	PrescribeIT® Drug Quantity for Administration	Binding: PrescribedQuantityUnit (20210308) (extensible) qty-3: If a code for the unit is present, the system SHALL also be present sqty-1: The comparator is not used on a SimpleQuantity 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 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).
denominator	1..1	Shared Health Quantity	qty-3: If a code for the unit is present, the system SHALL also be present 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. 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.

This structure is derived from MedicationDispense

Summary

Mandatory: 19 elements (4 nested mandatory elements)
Must-Support: 54 elements
Fixed Value: 2 elements
Prohibited: 2 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

This structure is derived from MedicationDispense

Name	Flags	Card.	Type	Description & Constraints
MedicationDispense	S	0..*	MedicationDispense	Dispensing a medication to a named patient
id	S	1..1	id	Logical id of this artifact
extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
ext-medication-rendered-dosage	S	1..1	string	Rendered dosage URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage
ext-dispense-quantity-remaining	S	1..1	PrescribeIT® Drug Quantity	Total quantity remaining URL: http://prescribeit.ca/fhir/StructureDefinition/ext-dispense-quantity-remaining Binding: PrescribedQuantityUnit (20210308) (extensible)
identifier	S	1..1	Shared Health Identifier	An identifier intended for computation
system	SI	1..1	uri	The namespace for the identifier dispenseIdentifier-branch-4: This must be an OID ending in .4
status	S	1..1	code	in-progress \| on-hold \| completed \| entered-in-error \| stopped Fixed Value: completed
medicationCodeableConcept	S	1..1	Shared Health CodeableConcept Required Text with optional code	Concept - reference to a terminology or just text Binding: PrescriptionMedicinalProduct (extensible)
patient	S	1..1	Reference(Shared Health Patient) {b }	Who the dispense is for
reference	S	1..1	string	Relative, internal or absolute URL reference
dispenser	S	1..1	Reference(Practitioner) {b }	Practitioner responsible for dispensing medication
extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
ext-reference-practitioner-org	S	1..1	Reference(Shared Health - eRx Service Location) {b }	Responsible organization URL: http://sharedhealth.exchange/fhir/StructureDefinition/ext-reference-practitioner-org
authorizingPrescription	S	1..1	Reference(PrescribeIT® Prescription) {b r }	Medication order that authorizes the dispense
extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
ext-reference-identifier	S	1..1	Identifier	Referenced identifier URL: http://hl7.org/fhir/StructureDefinition/extension-Reference.identifier profiled by http://sharedhealth.exchange/fhir/StructureDefinition/ext-reference-identifier
value[x]	S	1..1	PrescribeIT® Prescriber Prescription Identifier	Prescriber's order number
reference	S	0..1	string	Relative, internal or absolute URL reference
type	S	0..1	Shared Health CodeableConcept Code	Concept - reference to a terminology or just text Binding: ActPharmacySupplyType (20210501) (required)
quantity	S	1..1	PrescribeIT® Drug Quantity	Quantity of a medication Binding: PrescribedQuantityUnit (20210308) (extensible)
daysSupply	S	1..1	SimpleQuantity	Amount of medication expressed as a timing amount
value	S	1..1	decimal	Numerical value (with implicit precision)
system	S	1..1	uri	System that defines coded unit form
code	S	1..1	code	Coded form of the unit Fixed Value: d
whenPrepared	S	1..1	dateTime	Dispense processing time
dosageInstruction	S	0..*	BackboneElement	Medicine administration instructions to the patient/caregiver
extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
ext-medication-dosageinstruction-sequence	S	1..1	integer	Dosage instruction sequence URL: http://hl7.org/fhir/StructureDefinition/extension-Dosage.sequence profiled by http://prescribeit.ca/fhir/StructureDefinition/ext-medication-dosageinstruction-sequence
ext-medicationorder-dosageinstruction-relationship	S	0..1	code	AND \| THEN URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship Binding: PrescriptionDosageInstructionLineRelationship (20170626) (required)
text	S	0..1	string	Free text dosage instructions e.g. SIG
additionalInstructions	S	0..1	Shared Health CodeableConcept Text Required	Concept - reference to a terminology or just text
text	S	1..1	string	Plain text representation of the concept
timing	S	0..1	Timing	When medication should be administered
event	S	0..1	dateTime	When the event occurs
repeat	S	0..1	Element	When the event is to occur
bounds[x]	S	0..1		Length/Range of lengths, or (Start and/or end) limits
boundsPeriod			Period
boundsQuantity			Quantity(Shared Health Duration)
boundsRange			Range
count	S	0..1	integer	Number of times to repeat
countMax	S	0..1	integer	Maximum number of times to repeat
duration	S	0..1	decimal	How long when it happens
durationMax	S	0..1	decimal	How long when it happens (Max)
durationUnit	S	0..1	code	s \| min \| h \| d \| wk \| mo \| a - unit of time (UCUM) Binding: x_TimeUnitsOfMeasure (20210501) (required)
frequency	S	0..1	integer	Event occurs frequency times per period
frequencyMax	S	0..1	integer	Event occurs up to frequencyMax times per period
period	S	0..1	decimal	Event occurs frequency times per period
periodMax	S	0..1	decimal	Upper limit of period (3-4 hours)
periodUnit	S	0..1	code	s \| min \| h \| d \| wk \| mo \| a - unit of time (UCUM) Binding: x_TimeUnitsOfMeasure (20210501) (required)
when		0..0
offset		0..0
asNeeded[x]	S	0..1	boolean, CodeableConcept	Take "as needed" f(or x)
siteCodeableConcept	S	0..1	Shared Health CodeableConcept Required Text with optional code	Concept - reference to a terminology or just text Binding: PrescriptionAdministrationSite (20190430) (extensible)
route	S	0..1	Shared Health CodeableConcept Required Text with optional code	Concept - reference to a terminology or just text Binding: PrescriptionRouteOfAdministration (20190415) (extensible)
dose[x]	S	0..1		Amount of medication per dose Binding: PrescriptionDoseQuantityUnit (20210308) (extensible)
doseQuantity			Quantity(PrescribeIT® Drug Quantity for Administration)
doseRange			Range(PrescribeIT® Drug Range)
rateRatio	S	0..1	Ratio	Amount of medication per unit of time
maxDosePerPeriod	S	0..1	Ratio	Upper limit on medication per unit of time
numerator	S	1..1	PrescribeIT® Drug Quantity for Administration	Quantity of a medication Binding: PrescribedQuantityUnit (20210308) (extensible)
denominator	S	1..1	Shared Health Quantity	A measured or measurable amount
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
MedicationDispense	SΣI	0..*	MedicationDispense	Dispensing a medication to a named patient
id	SΣ	1..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: http://tools.ietf.org/html/bcp47 (required): A human language.
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
ext-medication-rendered-dosage	S	1..1	string	Rendered dosage URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage
ext-dispense-quantity-remaining	S	1..1	PrescribeIT® Drug Quantity	Total quantity remaining URL: http://prescribeit.ca/fhir/StructureDefinition/ext-dispense-quantity-remaining Binding: PrescribedQuantityUnit (20210308) (extensible)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	S	1..1	Shared Health Identifier	An identifier intended for computation
id		0..1	id	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
use	?!Σ	0..1	code	usual \| official \| temp \| secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣI	1..1	uri	The namespace for the identifier dispenseIdentifier-branch-4: This must be an OID ending in .4 Example General: http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri
value	SΣ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	in-progress \| on-hold \| completed \| entered-in-error \| stopped Binding: MedicationDispenseStatus (required): A code specifying the state of the dispense event. Fixed Value: completed
medication[x]	Σ	1..1	(Slice Definition)	What medication was supplied Slice: Unordered, Closed by type:$this
medication[x]:medicationCodeableConcept	S	1..1	Shared Health CodeableConcept Required Text with optional code	Concept - reference to a terminology or just text Binding: PrescriptionMedicinalProduct (extensible)
patient	SΣ	1..1	Reference(Shared Health Patient) {b }	Who the dispense is for
id		0..1	id	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
reference	SΣI	1..1	string	Relative, internal or absolute URL reference
display	Σ	0..1	string	Text alternative for the resource
dispenser	SΣ	1..1	Reference(Practitioner) {b }	Practitioner responsible for dispensing medication
id		0..1	id	xml:id (or equivalent in JSON)
extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
ext-reference-practitioner-org	S	1..1	Reference(Shared Health - eRx Service Location) {b }	Responsible organization URL: http://sharedhealth.exchange/fhir/StructureDefinition/ext-reference-practitioner-org
reference	ΣI	0..1	string	Relative, internal or absolute URL reference
display	Σ	0..1	string	Text alternative for the resource
authorizingPrescription	SΣ	1..1	Reference(PrescribeIT® Prescription) {b r }	Medication order that authorizes the dispense
id		0..1	id	xml:id (or equivalent in JSON)
extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
ext-reference-identifier	S	1..1	Identifier	Referenced identifier URL: http://hl7.org/fhir/StructureDefinition/extension-Reference.identifier profiled by http://sharedhealth.exchange/fhir/StructureDefinition/ext-reference-identifier
id		0..1	id	xml:id (or equivalent in JSON)
url	S	1..1	uri	"http://hl7.org/fhir/StructureDefinition/extension-Reference.identifier"
value[x]	S	1..1	(Slice Definition)	Prescriber's order number Slice: Unordered, Closed by type:$this
value[x]:valueIdentifier		1..1	Identifier	Value of extension
reference	SΣI	0..1	string	Relative, internal or absolute URL reference
display	Σ	0..1	string	Text alternative for the resource
type	S	0..1	Shared Health CodeableConcept Code	Concept - reference to a terminology or just text Binding: ActPharmacySupplyType (20210501) (required)
quantity	SI	1..1	PrescribeIT® Drug Quantity	Quantity of a medication Binding: PrescribedQuantityUnit (20210308) (extensible)
daysSupply	SΣ	1..1	SimpleQuantity	Amount of medication expressed as a timing amount
id		0..1	id	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
unit	Σ	0..1	string	Unit representation
system	SΣI	1..1	uri	System that defines coded unit form
code	SΣ	1..1	code	Coded form of the unit Fixed Value: d
whenPrepared	SΣ	1..1	dateTime	Dispense processing time
whenHandedOver	Σ	0..1	dateTime	When product was given out
destination	Σ	0..1	Reference(Location)	Where the medication was sent
receiver	Σ	0..*	Reference(Patient \| Practitioner)	Who collected the medication
note	Σ	0..*	Annotation	Information about the dispense
dosageInstruction	SΣ	0..*	BackboneElement	Medicine administration instructions to the patient/caregiver
id		0..1	id	xml:id (or equivalent in JSON)
extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
ext-medication-dosageinstruction-sequence	S	1..1	integer	Dosage instruction sequence URL: http://hl7.org/fhir/StructureDefinition/extension-Dosage.sequence profiled by http://prescribeit.ca/fhir/StructureDefinition/ext-medication-dosageinstruction-sequence
ext-medicationorder-dosageinstruction-relationship	S	0..1	code	AND \| THEN URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship Binding: PrescriptionDosageInstructionLineRelationship (20170626) (required)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
text	SΣ	0..1	string	Free text dosage instructions e.g. SIG
additionalInstructions	S	0..1	Shared Health CodeableConcept Text Required	Concept - reference to a terminology or just text Binding: (unbound) (example): Codes identifying additional instructions such as "take with water" or "avoid operating heavy machinery"
id		0..1	id	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
coding	Σ	0..*	Coding	Code defined by a terminology system
text	SΣ	1..1	string	Plain text representation of the concept Max Length: 2500
timing	SΣ	0..1	Timing	When medication should be administered
id		0..1	id	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
event	SΣ	0..1	dateTime	When the event occurs
repeat	SΣI	0..1	Element	When the event is to occur
id		0..1	id	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
bounds[x]	SΣ	0..1		Length/Range of lengths, or (Start and/or end) limits
boundsPeriod			Period
boundsQuantity			Quantity(Shared Health Duration)
boundsRange			Range
count	SΣ	0..1	integer	Number of times to repeat
countMax	SΣ	0..1	integer	Maximum number of times to repeat
duration	SΣ	0..1	decimal	How long when it happens
durationMax	SΣ	0..1	decimal	How long when it happens (Max)
durationUnit	SΣ	0..1	code	s \| min \| h \| d \| wk \| mo \| a - unit of time (UCUM) Binding: x_TimeUnitsOfMeasure (20210501) (required)
frequency	SΣ	0..1	integer	Event occurs frequency times per period
frequencyMax	SΣ	0..1	integer	Event occurs up to frequencyMax times per period
period	SΣ	0..1	decimal	Event occurs frequency times per period
periodMax	SΣ	0..1	decimal	Upper limit of period (3-4 hours)
periodUnit	SΣ	0..1	code	s \| min \| h \| d \| wk \| mo \| a - unit of time (UCUM) Binding: x_TimeUnitsOfMeasure (20210501) (required)
code	Σ	0..1	CodeableConcept	QD \| QOD \| Q4H \| Q6H \| BID \| TID \| QID \| AM \| PM + Binding: TimingAbbreviation (preferred): Code for a known / defined timing pattern.
asNeeded[x]	SΣ	0..1		Take "as needed" f(or x) Binding: (unbound) (example): 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.
asNeededBoolean			boolean
asNeededCodeableConcept			CodeableConcept
site[x]	Σ	0..1	(Slice Definition)	Body site to administer to Slice: Unordered, Closed by type:$this Binding: SNOMED CT Anatomical Structure for Administration Site Codes (example): A coded concept describing the site location the medicine enters into or onto the body
site[x]:siteCodeableConcept	S	0..1	Shared Health CodeableConcept Required Text with optional code	Concept - reference to a terminology or just text Binding: PrescriptionAdministrationSite (20190430) (extensible)
route	S	0..1	Shared Health CodeableConcept Required Text with optional code	Concept - reference to a terminology or just text Binding: PrescriptionRouteOfAdministration (20190415) (extensible)
method	Σ	0..1	CodeableConcept	Technique for administering medication Binding: (unbound) (example): A coded concept describing the technique by which the medicine is administered
dose[x]	SΣ	0..1		Amount of medication per dose Binding: PrescriptionDoseQuantityUnit (20210308) (extensible)
doseQuantity			Quantity(PrescribeIT® Drug Quantity for Administration)
doseRange			Range(PrescribeIT® Drug Range)
rate[x]	Σ	0..1	(Slice Definition)	Amount of medication per unit of time Slice: Unordered, Closed by type:$this
rate[x]:rateRatio	SΣ	0..1	Ratio	Amount of medication per unit of time
maxDosePerPeriod	SΣ	0..1	Ratio	Upper limit on medication per unit of time
id		0..1	id	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
numerator	SI	1..1	PrescribeIT® Drug Quantity for Administration	Quantity of a medication Binding: PrescribedQuantityUnit (20210308) (extensible)
denominator	SI	1..1	Shared Health Quantity	A measured or measurable amount
substitution	Σ	0..1	BackboneElement	Deals with substitution of one medicine for another
id		0..1	id	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
type	Σ	1..1	CodeableConcept	Code signifying whether a different drug was dispensed from what was prescribed Binding: ActSubstanceAdminSubstitutionCode (example): A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription
reason	Σ	0..*	CodeableConcept	Why was substitution made Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed
responsibleParty	Σ	0..*	Reference(Practitioner)	Who is responsible for the substitution
Documentation for this format

Grid View

This structure is derived from MedicationDispense

Name	Card.	Type	Constraints and Usage
MedicationDispense	0..*	MedicationDispense	mdd-1: whenHandedOver cannot be before whenPrepared 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.
id	1..1	id	Definition: The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. 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.
extension	0..*	Extension	Slice: Unordered, Open by value:url Definition: An Extension
extension (renderedDosageInstruction)	1..1	Medication Rendered Dosage Instruction	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) 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.
extension (quantityRemaining)	1..1	Medication Dispense Quantity Remaining	Definition: The total authorized quantity outstanding after the fill issued as part of this dispense record Comments: Should be specified even if 0.
identifier	1..1	Shared Health Identifier	Definition: A technical identifier - identifies some entity uniquely and unambiguously. 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.
system	1..1	uri	dispenseIdentifier-branch-4: This must be an OID ending in .4 Example' General': http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri Definition: Establishes the namespace in which set of possible id values is unique. 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.
value	1..1	string	Example' General': 123456 Definition: The portion of the identifier typically relevant to the user and which is unique within the context of the system. 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.
status	1..1	code	Binding: MedicationDispenseStatus (required): A code specifying the state of the dispense event. Fixed Value: completed Definition: A code specifying the state of the set of dispense events. Comments: Fixed value: completed
medication[x] (medicationCodeableConcept)	1..1	Shared Health CodeableConcept Required Text with optional code	Binding: PrescriptionMedicinalProduct (extensible) Definition: A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. 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.
patient	1..1	Reference(Shared Health Patient) {b }	Definition: A link to a resource representing the person to whom the medication will be given. Comments: SubstanceAdministration->subject->Patient.
reference	1..1	string	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. Comments: This must point to the patient associated with the message
dispenser	1..1	Reference(Practitioner) {b }	Definition: The individual responsible for dispensing the medication. Comments: Only organization (conveyed by the extension) is needed. No need to send the actual dispensing practitioner
extension	0..*	Extension	Slice: Unordered, Open by value:url Definition: An Extension
extension (organization)	1..1	Reference Practitioner Organization	Definition: Allows capturing the organization responsible for an action instead of or in addition to identifying the responsible practitioner 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.
authorizingPrescription	1..1	Reference(PrescribeIT® Prescription) {b r }	Definition: Indicates the medication order that is being dispensed against. Comments: Usage Note: This segment provides the medication order that the dispense is associated with.
extension	0..*	Extension	Slice: Unordered, Open by value:url Definition: An Extension
extension (identifier)	1..1	Referenced Business identifier	Definition: Allows a reference to identify the target prescription, dispense or task by business identifier rather than URL 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.
url	1..1	uri	"http://hl7.org/fhir/StructureDefinition/extension-Reference.identifier"
value[x]	1..1	PrescribeIT® Prescriber Prescription Identifier	Slice: Unordered, Closed by type:$this Definition: A technical identifier - identifies some entity uniquely and unambiguously. 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.
reference	0..1	string	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. 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.
type	0..1	Shared Health CodeableConcept Code	Binding: ActPharmacySupplyType (20210501) (required) Definition: A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Comments: Usage note: For future use
quantity	1..1	PrescribeIT® Drug Quantity	Binding: PrescribedQuantityUnit (20210308) (extensible) qty-3: If a code for the unit is present, the system SHALL also be present sqty-1: The comparator is not used on a SimpleQuantity 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 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.
daysSupply	1..1	SimpleQuantity	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. 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)
value	1..1	decimal	Definition: The value of the measured amount. The value includes an implicit precision in the presentation of the value. Comments: The implicit precision in the value should always be honored.
system	1..1	uri	Definition: The identification of the system that provides the coded form of the unit.
code	1..1	code	Fixed Value: d Definition: A computer processable form of the unit in some unit representation system. Comments: Fixed value: d
whenPrepared	1..1	dateTime	Definition: The time when the dispensed product was packaged and reviewed. Comments: This represents the date the medication was dispensed.
dosageInstruction	0..*	BackboneElement	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. 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
extension	0..*	Extension	Slice: Unordered, Open by value:url Definition: An Extension
extension (sequence)	1..1	Medication Dosage Line Sequence	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. 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.
extension (instructionRelationship)	0..1	Medication Order Dosage Instruction Relationship	Definition: Indicates how the timing of this dosage instruction relates to the preceding dosage instruction. Specifically, is it concurrent (AND) or sequential (THEN). 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 COMPLEX_ADMINISTRATION_PERIOD specified as well. These will be consecutive periods. Conformance Rule: ANDs and THENs should not be mixed due to ambiguity of meaning
text	0..1	string	Definition: A free form description of how the dispensed medication is to be administered to the patient. Comments: Conformance Rule: If supported by the PMS, multiple dosage lines can be expressed individually. However, they must be concatenated into the RENDERED_DOSAGE_INSTRUCTION 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).
additionalInstructions	0..1	Shared Health CodeableConcept Text Required	Binding: (unbound) (example): Codes identifying additional instructions such as "take with water" or "avoid operating heavy machinery" Definition: A free form textual description of extended instruction regarding the administration of the drug. 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 DOSAGE_TIMING_FREQUENCY = once a day and 'at bedtime' would be placed into this field. HL7 MAPPING - ADDITIONAL_DOSAGE_INSTRUCTION (Business Name Change).
text	1..1	string	Max Length: 2500 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. Comments: Conformance Rule: This is the text used to convey the exact word that was displayed to the practitioner
timing	0..1	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. Comments: Conformance Rule: For EMRs that can support it, this should be specified. Must also be part of the COMPLEX_DOSAGE_INSTRUCTION Conformance Rule: A start date may optionally be included. Refer to the Timing data type page for guidance on its use.
event	0..1	dateTime	Definition: Identifies specific times when the event occurs.
repeat	0..1	Element	tim-3: Either frequency or when can exist, not both tim-1: if there's a duration, there needs to be duration units tim-2: if there's a period, there needs to be period units tim-9: If there's an offset, there must be a when tim-6: If there's a periodMax, there must be a period tim-8: If there's a countMax, there must be a count tim-7: If there's a durationMax, there must be a duration tim-4: duration SHALL be a non-negative value Definition: A set of rules that describe when the event should occur.
bounds[x]	0..1	Period, Shared Health Duration, Range	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.
count	0..1	integer	Definition: A total count of the desired number of repetitions. Comments: If you have both bounds and count, then this should be understood as within the bounds period, until count times happens.
countMax	0..1	integer	Definition: A maximum value for the count of the desired repetitions (e.g. do something 6-8 times).
duration	0..1	decimal	Definition: How long this thing happens for when it happens. 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).
durationMax	0..1	decimal	Definition: The upper limit of how long this thing happens for when it happens. 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).
durationUnit	0..1	code	Binding: x_TimeUnitsOfMeasure (20210501) (required) Definition: The units of time for the duration, in UCUM units.
frequency	0..1	integer	Definition: The number of times to repeat the action within the specified period / period range (i.e. both period and periodMax provided).
frequencyMax	0..1	integer	Definition: If present, indicates that the frequency is a range - so repeat between [frequency] and [frequencyMax] times within the period or period range.
period	0..1	decimal	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.
periodMax	0..1	decimal	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.
periodUnit	0..1	code	Binding: x_TimeUnitsOfMeasure (20210501) (required) Definition: The units of time for the period in UCUM units.
asNeeded[x]	0..1	boolean, CodeableConcept	Binding: (unbound) (example): 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. 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. 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.
site[x] (siteCodeableConcept)	0..1	Shared Health CodeableConcept Required Text with optional code	Binding: PrescriptionAdministrationSite (20190430) (extensible) Definition: A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Comments: Conformance Rule: When providing a structured SIG, this should be populated when appropriate. If not structured, this should be part of the SIG (RENDERED_DOSAGE_INSTRUCTION). Also can be specified for COMPLEX
route	0..1	Shared Health CodeableConcept Required Text with optional code	Binding: PrescriptionRouteOfAdministration (20190415) (extensible) Definition: A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. Comments: Conformance Rule: Coding should be populated if a code is available. However, text is always required.
dose[x]	0..1	PrescribeIT® Drug Quantity for Administration, PrescribeIT® Drug Range	Binding: PrescriptionDoseQuantityUnit (20210308) (extensible) Definition: The amount of therapeutic or other substance given at one administration event. Comments: Conformance Rule: Could be sent as part of the dosage instruction. OR for those EMRs that can support it, this should be specified.
rate[x] (rateRatio)	0..1	Ratio	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.
maxDosePerPeriod	0..1	Ratio	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. Comments: Conformance Rule: When providing a structured SIG, this should be populated when appropriate. Also can be specified for COMPLEX
numerator	1..1	PrescribeIT® Drug Quantity for Administration	Binding: PrescribedQuantityUnit (20210308) (extensible) qty-3: If a code for the unit is present, the system SHALL also be present sqty-1: The comparator is not used on a SimpleQuantity 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 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).
denominator	1..1	Shared Health Quantity	qty-3: If a code for the unit is present, the system SHALL also be present 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. 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.

This structure is derived from MedicationDispense

Summary

Mandatory: 19 elements (4 nested mandatory elements)
Must-Support: 54 elements
Fixed Value: 2 elements
Prohibited: 2 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Differential View

This structure is derived from MedicationDispense

Name	Flags	Card.	Type	Description & Constraints
MedicationDispense	S	0..*	MedicationDispense	Dispensing a medication to a named patient
id	S	1..1	id	Logical id of this artifact
extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
ext-medication-rendered-dosage	S	1..1	string	Rendered dosage URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage
ext-dispense-quantity-remaining	S	1..1	PrescribeIT® Drug Quantity	Total quantity remaining URL: http://prescribeit.ca/fhir/StructureDefinition/ext-dispense-quantity-remaining Binding: PrescribedQuantityUnit (20210308) (extensible)
identifier	S	1..1	Shared Health Identifier	An identifier intended for computation
system	SI	1..1	uri	The namespace for the identifier dispenseIdentifier-branch-4: This must be an OID ending in .4
status	S	1..1	code	in-progress \| on-hold \| completed \| entered-in-error \| stopped Fixed Value: completed
medicationCodeableConcept	S	1..1	Shared Health CodeableConcept Required Text with optional code	Concept - reference to a terminology or just text Binding: PrescriptionMedicinalProduct (extensible)
patient	S	1..1	Reference(Shared Health Patient) {b }	Who the dispense is for
reference	S	1..1	string	Relative, internal or absolute URL reference
dispenser	S	1..1	Reference(Practitioner) {b }	Practitioner responsible for dispensing medication
extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
ext-reference-practitioner-org	S	1..1	Reference(Shared Health - eRx Service Location) {b }	Responsible organization URL: http://sharedhealth.exchange/fhir/StructureDefinition/ext-reference-practitioner-org
authorizingPrescription	S	1..1	Reference(PrescribeIT® Prescription) {b r }	Medication order that authorizes the dispense
extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
ext-reference-identifier	S	1..1	Identifier	Referenced identifier URL: http://hl7.org/fhir/StructureDefinition/extension-Reference.identifier profiled by http://sharedhealth.exchange/fhir/StructureDefinition/ext-reference-identifier
value[x]	S	1..1	PrescribeIT® Prescriber Prescription Identifier	Prescriber's order number
reference	S	0..1	string	Relative, internal or absolute URL reference
type	S	0..1	Shared Health CodeableConcept Code	Concept - reference to a terminology or just text Binding: ActPharmacySupplyType (20210501) (required)
quantity	S	1..1	PrescribeIT® Drug Quantity	Quantity of a medication Binding: PrescribedQuantityUnit (20210308) (extensible)
daysSupply	S	1..1	SimpleQuantity	Amount of medication expressed as a timing amount
value	S	1..1	decimal	Numerical value (with implicit precision)
system	S	1..1	uri	System that defines coded unit form
code	S	1..1	code	Coded form of the unit Fixed Value: d
whenPrepared	S	1..1	dateTime	Dispense processing time
dosageInstruction	S	0..*	BackboneElement	Medicine administration instructions to the patient/caregiver
extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
ext-medication-dosageinstruction-sequence	S	1..1	integer	Dosage instruction sequence URL: http://hl7.org/fhir/StructureDefinition/extension-Dosage.sequence profiled by http://prescribeit.ca/fhir/StructureDefinition/ext-medication-dosageinstruction-sequence
ext-medicationorder-dosageinstruction-relationship	S	0..1	code	AND \| THEN URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship Binding: PrescriptionDosageInstructionLineRelationship (20170626) (required)
text	S	0..1	string	Free text dosage instructions e.g. SIG
additionalInstructions	S	0..1	Shared Health CodeableConcept Text Required	Concept - reference to a terminology or just text
text	S	1..1	string	Plain text representation of the concept
timing	S	0..1	Timing	When medication should be administered
event	S	0..1	dateTime	When the event occurs
repeat	S	0..1	Element	When the event is to occur
bounds[x]	S	0..1		Length/Range of lengths, or (Start and/or end) limits
boundsPeriod			Period
boundsQuantity			Quantity(Shared Health Duration)
boundsRange			Range
count	S	0..1	integer	Number of times to repeat
countMax	S	0..1	integer	Maximum number of times to repeat
duration	S	0..1	decimal	How long when it happens
durationMax	S	0..1	decimal	How long when it happens (Max)
durationUnit	S	0..1	code	s \| min \| h \| d \| wk \| mo \| a - unit of time (UCUM) Binding: x_TimeUnitsOfMeasure (20210501) (required)
frequency	S	0..1	integer	Event occurs frequency times per period
frequencyMax	S	0..1	integer	Event occurs up to frequencyMax times per period
period	S	0..1	decimal	Event occurs frequency times per period
periodMax	S	0..1	decimal	Upper limit of period (3-4 hours)
periodUnit	S	0..1	code	s \| min \| h \| d \| wk \| mo \| a - unit of time (UCUM) Binding: x_TimeUnitsOfMeasure (20210501) (required)
when		0..0
offset		0..0
asNeeded[x]	S	0..1	boolean, CodeableConcept	Take "as needed" f(or x)
siteCodeableConcept	S	0..1	Shared Health CodeableConcept Required Text with optional code	Concept - reference to a terminology or just text Binding: PrescriptionAdministrationSite (20190430) (extensible)
route	S	0..1	Shared Health CodeableConcept Required Text with optional code	Concept - reference to a terminology or just text Binding: PrescriptionRouteOfAdministration (20190415) (extensible)
dose[x]	S	0..1		Amount of medication per dose Binding: PrescriptionDoseQuantityUnit (20210308) (extensible)
doseQuantity			Quantity(PrescribeIT® Drug Quantity for Administration)
doseRange			Range(PrescribeIT® Drug Range)
rateRatio	S	0..1	Ratio	Amount of medication per unit of time
maxDosePerPeriod	S	0..1	Ratio	Upper limit on medication per unit of time
numerator	S	1..1	PrescribeIT® Drug Quantity for Administration	Quantity of a medication Binding: PrescribedQuantityUnit (20210308) (extensible)
denominator	S	1..1	Shared Health Quantity	A measured or measurable amount
Documentation for this format

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
MedicationDispense	SΣI	0..*	MedicationDispense	Dispensing a medication to a named patient
id	SΣ	1..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: http://tools.ietf.org/html/bcp47 (required): A human language.
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
ext-medication-rendered-dosage	S	1..1	string	Rendered dosage URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medication-rendered-dosage
ext-dispense-quantity-remaining	S	1..1	PrescribeIT® Drug Quantity	Total quantity remaining URL: http://prescribeit.ca/fhir/StructureDefinition/ext-dispense-quantity-remaining Binding: PrescribedQuantityUnit (20210308) (extensible)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	S	1..1	Shared Health Identifier	An identifier intended for computation
id		0..1	id	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
use	?!Σ	0..1	code	usual \| official \| temp \| secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣI	1..1	uri	The namespace for the identifier dispenseIdentifier-branch-4: This must be an OID ending in .4 Example General: http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri
value	SΣ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	in-progress \| on-hold \| completed \| entered-in-error \| stopped Binding: MedicationDispenseStatus (required): A code specifying the state of the dispense event. Fixed Value: completed
medication[x]	Σ	1..1	(Slice Definition)	What medication was supplied Slice: Unordered, Closed by type:$this
medication[x]:medicationCodeableConcept	S	1..1	Shared Health CodeableConcept Required Text with optional code	Concept - reference to a terminology or just text Binding: PrescriptionMedicinalProduct (extensible)
patient	SΣ	1..1	Reference(Shared Health Patient) {b }	Who the dispense is for
id		0..1	id	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
reference	SΣI	1..1	string	Relative, internal or absolute URL reference
display	Σ	0..1	string	Text alternative for the resource
dispenser	SΣ	1..1	Reference(Practitioner) {b }	Practitioner responsible for dispensing medication
id		0..1	id	xml:id (or equivalent in JSON)
extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
ext-reference-practitioner-org	S	1..1	Reference(Shared Health - eRx Service Location) {b }	Responsible organization URL: http://sharedhealth.exchange/fhir/StructureDefinition/ext-reference-practitioner-org
reference	ΣI	0..1	string	Relative, internal or absolute URL reference
display	Σ	0..1	string	Text alternative for the resource
authorizingPrescription	SΣ	1..1	Reference(PrescribeIT® Prescription) {b r }	Medication order that authorizes the dispense
id		0..1	id	xml:id (or equivalent in JSON)
extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
ext-reference-identifier	S	1..1	Identifier	Referenced identifier URL: http://hl7.org/fhir/StructureDefinition/extension-Reference.identifier profiled by http://sharedhealth.exchange/fhir/StructureDefinition/ext-reference-identifier
id		0..1	id	xml:id (or equivalent in JSON)
url	S	1..1	uri	"http://hl7.org/fhir/StructureDefinition/extension-Reference.identifier"
value[x]	S	1..1	(Slice Definition)	Prescriber's order number Slice: Unordered, Closed by type:$this
value[x]:valueIdentifier		1..1	Identifier	Value of extension
reference	SΣI	0..1	string	Relative, internal or absolute URL reference
display	Σ	0..1	string	Text alternative for the resource
type	S	0..1	Shared Health CodeableConcept Code	Concept - reference to a terminology or just text Binding: ActPharmacySupplyType (20210501) (required)
quantity	SI	1..1	PrescribeIT® Drug Quantity	Quantity of a medication Binding: PrescribedQuantityUnit (20210308) (extensible)
daysSupply	SΣ	1..1	SimpleQuantity	Amount of medication expressed as a timing amount
id		0..1	id	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
unit	Σ	0..1	string	Unit representation
system	SΣI	1..1	uri	System that defines coded unit form
code	SΣ	1..1	code	Coded form of the unit Fixed Value: d
whenPrepared	SΣ	1..1	dateTime	Dispense processing time
whenHandedOver	Σ	0..1	dateTime	When product was given out
destination	Σ	0..1	Reference(Location)	Where the medication was sent
receiver	Σ	0..*	Reference(Patient \| Practitioner)	Who collected the medication
note	Σ	0..*	Annotation	Information about the dispense
dosageInstruction	SΣ	0..*	BackboneElement	Medicine administration instructions to the patient/caregiver
id		0..1	id	xml:id (or equivalent in JSON)
extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
ext-medication-dosageinstruction-sequence	S	1..1	integer	Dosage instruction sequence URL: http://hl7.org/fhir/StructureDefinition/extension-Dosage.sequence profiled by http://prescribeit.ca/fhir/StructureDefinition/ext-medication-dosageinstruction-sequence
ext-medicationorder-dosageinstruction-relationship	S	0..1	code	AND \| THEN URL: http://prescribeit.ca/fhir/StructureDefinition/ext-medicationorder-dosageinstruction-relationship Binding: PrescriptionDosageInstructionLineRelationship (20170626) (required)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
text	SΣ	0..1	string	Free text dosage instructions e.g. SIG
additionalInstructions	S	0..1	Shared Health CodeableConcept Text Required	Concept - reference to a terminology or just text Binding: (unbound) (example): Codes identifying additional instructions such as "take with water" or "avoid operating heavy machinery"
id		0..1	id	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
coding	Σ	0..*	Coding	Code defined by a terminology system
text	SΣ	1..1	string	Plain text representation of the concept Max Length: 2500
timing	SΣ	0..1	Timing	When medication should be administered
id		0..1	id	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
event	SΣ	0..1	dateTime	When the event occurs
repeat	SΣI	0..1	Element	When the event is to occur
id		0..1	id	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
bounds[x]	SΣ	0..1		Length/Range of lengths, or (Start and/or end) limits
boundsPeriod			Period
boundsQuantity			Quantity(Shared Health Duration)
boundsRange			Range
count	SΣ	0..1	integer	Number of times to repeat
countMax	SΣ	0..1	integer	Maximum number of times to repeat
duration	SΣ	0..1	decimal	How long when it happens
durationMax	SΣ	0..1	decimal	How long when it happens (Max)
durationUnit	SΣ	0..1	code	s \| min \| h \| d \| wk \| mo \| a - unit of time (UCUM) Binding: x_TimeUnitsOfMeasure (20210501) (required)
frequency	SΣ	0..1	integer	Event occurs frequency times per period
frequencyMax	SΣ	0..1	integer	Event occurs up to frequencyMax times per period
period	SΣ	0..1	decimal	Event occurs frequency times per period
periodMax	SΣ	0..1	decimal	Upper limit of period (3-4 hours)
periodUnit	SΣ	0..1	code	s \| min \| h \| d \| wk \| mo \| a - unit of time (UCUM) Binding: x_TimeUnitsOfMeasure (20210501) (required)
code	Σ	0..1	CodeableConcept	QD \| QOD \| Q4H \| Q6H \| BID \| TID \| QID \| AM \| PM + Binding: TimingAbbreviation (preferred): Code for a known / defined timing pattern.
asNeeded[x]	SΣ	0..1		Take "as needed" f(or x) Binding: (unbound) (example): 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.
asNeededBoolean			boolean
asNeededCodeableConcept			CodeableConcept
site[x]	Σ	0..1	(Slice Definition)	Body site to administer to Slice: Unordered, Closed by type:$this Binding: SNOMED CT Anatomical Structure for Administration Site Codes (example): A coded concept describing the site location the medicine enters into or onto the body
site[x]:siteCodeableConcept	S	0..1	Shared Health CodeableConcept Required Text with optional code	Concept - reference to a terminology or just text Binding: PrescriptionAdministrationSite (20190430) (extensible)
route	S	0..1	Shared Health CodeableConcept Required Text with optional code	Concept - reference to a terminology or just text Binding: PrescriptionRouteOfAdministration (20190415) (extensible)
method	Σ	0..1	CodeableConcept	Technique for administering medication Binding: (unbound) (example): A coded concept describing the technique by which the medicine is administered
dose[x]	SΣ	0..1		Amount of medication per dose Binding: PrescriptionDoseQuantityUnit (20210308) (extensible)
doseQuantity			Quantity(PrescribeIT® Drug Quantity for Administration)
doseRange			Range(PrescribeIT® Drug Range)
rate[x]	Σ	0..1	(Slice Definition)	Amount of medication per unit of time Slice: Unordered, Closed by type:$this
rate[x]:rateRatio	SΣ	0..1	Ratio	Amount of medication per unit of time
maxDosePerPeriod	SΣ	0..1	Ratio	Upper limit on medication per unit of time
id		0..1	id	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
numerator	SI	1..1	PrescribeIT® Drug Quantity for Administration	Quantity of a medication Binding: PrescribedQuantityUnit (20210308) (extensible)
denominator	SI	1..1	Shared Health Quantity	A measured or measurable amount
substitution	Σ	0..1	BackboneElement	Deals with substitution of one medicine for another
id		0..1	id	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
type	Σ	1..1	CodeableConcept	Code signifying whether a different drug was dispensed from what was prescribed Binding: ActSubstanceAdminSubstitutionCode (example): A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription
reason	Σ	0..*	CodeableConcept	Why was substitution made Binding: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed
responsibleParty	Σ	0..*	Reference(Practitioner)	Who is responsible for the substitution
Documentation for this format

Other representations of profile: Schematron

3.62.3 Terminology Bindings

Terminology Bindings

Path	Conformance	ValueSet / Code
MedicationDispense.language	required	http://tools.ietf.org/html/bcp47
MedicationDispense.identifier.use	required	IdentifierUse
MedicationDispense.identifier.type	extensible	Identifier Type Codes
MedicationDispense.status	required	Fixed Value: completed
MedicationDispense.medication[x]:medicationCodeableConcept	extensible	PrescriptionMedicinalProduct
MedicationDispense.type	required	ActPharmacySupplyType
MedicationDispense.quantity	extensible	PrescribedQuantityUnit
MedicationDispense.dosageInstruction.additionalInstructions	example
MedicationDispense.dosageInstruction.timing.repeat.durationUnit	required	x_TimeUnitsOfMeasure
MedicationDispense.dosageInstruction.timing.repeat.periodUnit	required	x_TimeUnitsOfMeasure
MedicationDispense.dosageInstruction.timing.code	preferred	TimingAbbreviation
MedicationDispense.dosageInstruction.asNeeded[x]	example
MedicationDispense.dosageInstruction.site[x]	example	SNOMED CT Anatomical Structure for Administration Site Codes
MedicationDispense.dosageInstruction.site[x]:siteCodeableConcept	extensible	PrescriptionAdministrationSite
MedicationDispense.dosageInstruction.route	extensible	PrescriptionRouteOfAdministration
MedicationDispense.dosageInstruction.method	example
MedicationDispense.dosageInstruction.dose[x]	extensible	PrescriptionDoseQuantityUnit
MedicationDispense.dosageInstruction.maxDosePerPeriod.numerator	extensible	PrescribedQuantityUnit
MedicationDispense.substitution.type	example	ActSubstanceAdminSubstitutionCode
MedicationDispense.substitution.reason	example	SubstanceAdminSubstitutionReason

3.62.4 Constraints

Constraints

Id	Path	Details	Requirements
mdd-1	MedicationDispense	whenHandedOver cannot be before whenPrepared : whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared
dispenseIdentifier-branch-4	MedicationDispense.identifier.system	This must be an OID ending in .4 : $this.matches('^urn\\:oid\\:(\\d+\\.)+4$')
qty-3	MedicationDispense.quantity	If a code for the unit is present, the system SHALL also be present : code.empty() or system.exists()
sqty-1	MedicationDispense.quantity	The comparator is not used on a SimpleQuantity : comparator.empty()
tim-3	MedicationDispense.dosageInstruction.timing.repeat	Either frequency or when can exist, not both : ((period.exists() or frequency.exists()) and when.exists()).not()
tim-1	MedicationDispense.dosageInstruction.timing.repeat	if there's a duration, there needs to be duration units : duration.empty() or durationUnit.exists()
tim-2	MedicationDispense.dosageInstruction.timing.repeat	if there's a period, there needs to be period units : period.empty() or periodUnit.exists()
tim-9	MedicationDispense.dosageInstruction.timing.repeat	If there's an offset, there must be a when : offset.empty() or when.exists()
tim-6	MedicationDispense.dosageInstruction.timing.repeat	If there's a periodMax, there must be a period : periodMax.empty() or period.exists()
tim-8	MedicationDispense.dosageInstruction.timing.repeat	If there's a countMax, there must be a count : countMax.empty() or count.exists()
tim-7	MedicationDispense.dosageInstruction.timing.repeat	If there's a durationMax, there must be a duration : durationMax.empty() or duration.exists()
tim-4	MedicationDispense.dosageInstruction.timing.repeat	duration SHALL be a non-negative value : duration.exists() implies duration >= 0
qty-3	MedicationDispense.dosageInstruction.maxDosePerPeriod.numerator	If a code for the unit is present, the system SHALL also be present : code.empty() or system.exists()
sqty-1	MedicationDispense.dosageInstruction.maxDosePerPeriod.numerator	The comparator is not used on a SimpleQuantity : comparator.empty()
qty-3	MedicationDispense.dosageInstruction.maxDosePerPeriod.denominator	If a code for the unit is present, the system SHALL also be present : code.empty() or system.exists()