MedicationDispense

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.

Schema

Elements

Name	Required	Type	Description
identifier		Identifier[]	External identifier Details Identifiers associated with this Medication Dispense that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server. This is a business identifier, not a resource identifier.
partOf		Reference<Procedure>[]	Event that dispense is part of Details The procedure that trigger the dispense.
status	✓	code	preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown Details A code specifying the state of the set of dispense events. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
statusReason[x]		CodeableConcept, Reference<DetectedIssue>	Why a dispense was not performed Details Indicates the reason why a dispense was not performed.
category		CodeableConcept	Type of medication dispense Details Indicates the type of medication dispense (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)). The category can be used to include where the medication is expected to be consumed or other types of dispenses. Invariants can be used to bind to different value sets when profiling to bind.
medication[x]	✓	CodeableConcept, Reference<Medication>	What medication was supplied Details 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. If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended. For example, if you require form or lot number, then you must reference the Medication resource.
subject		Reference<Patient | Group>	Who the dispense is for Details A link to a resource representing the person or the group to whom the medication will be given. SubstanceAdministration->subject->Patient.
context		Reference<Encounter | EpisodeOfCare>	Encounter / Episode associated with event Details The encounter or episode of care that establishes the context for this event.
supportingInformation		Reference<Resource>[]	Information that supports the dispensing of the medication Details Additional information that supports the medication being dispensed.
performer		MedicationDispensePerformer[]	Who performed event Details Indicates who or what performed the event.
id		string	Unique id for inter-element referencing Details Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
extension		Extension[]	Additional content defined by implementations Details May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. 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.
modifierExtension		Extension[]	Extensions that cannot be ignored even if unrecognized Details 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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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.
function		CodeableConcept	Who performed the dispense and what they did Details Distinguishes the type of performer in the dispense. For example, date enterer, packager, final checker.
actor	✓	Reference< Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson >	Individual who was performing Details The device, practitioner, etc. who performed the action. It should be assumed that the actor is the dispenser of the medication.
location		Reference<Location>	Where the dispense occurred Details The principal physical location where the dispense was performed.
authorizingPrescription		Reference<MedicationRequest>[]	Medication order that authorizes the dispense Details Indicates the medication order that is being dispensed against. Maps to basedOn in Event logical model.
type		CodeableConcept	Trial fill, partial fill, emergency fill, etc. Details Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc.
quantity		Quantity	Amount dispensed Details The amount of medication that has been dispensed. Includes unit of measure.
daysSupply		Quantity	Amount of medication expressed as a timing amount Details The amount of medication expressed as a timing amount.
whenPrepared		dateTime	When product was packaged and reviewed Details The time when the dispensed product was packaged and reviewed.
whenHandedOver		dateTime	When product was given out Details The time the dispensed product was provided to the patient or their representative.
destination		Reference<Location>	Where the medication was sent Details Identification of the facility/location where the medication was shipped to, as part of the dispense event.
receiver		Reference<Patient | Practitioner>[]	Who collected the medication Details 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.
note		Annotation[]	Information about the dispense Details Extra information about the dispense that could not be conveyed in the other attributes.
dosageInstruction		Dosage[]	How the medication is to be used by the patient or administered by the caregiver Details Indicates how the medication is to be used by the patient. When the dose or rate is intended to change over the entire administration period (e.g. Tapering dose prescriptions), multiple instances of dosage instructions will need to be supplied to convey the different doses/rates. The pharmacist reviews the medication order prior to dispense and updates the dosageInstruction based on the actual product being dispensed.
substitution		MedicationDispenseSubstitution	Whether a substitution was performed on the dispense Details Indicates whether or not substitution was made as part of the dispense. In some cases, substitution will be expected but does not happen, in other cases substitution is not expected but does happen. This block explains what substitution did or did not happen and why. If nothing is specified, substitution was not done.
id		string	Unique id for inter-element referencing Details Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
extension		Extension[]	Additional content defined by implementations Details May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. 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.
modifierExtension		Extension[]	Extensions that cannot be ignored even if unrecognized Details 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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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.
wasSubstituted	✓	boolean	Whether a substitution was or was not performed on the dispense Details True if the dispenser dispensed a different drug or product from what was prescribed.
type		CodeableConcept	Code signifying whether a different drug was dispensed from what was prescribed Details A code signifying whether a different drug was dispensed from what was prescribed.
reason		CodeableConcept[]	Why was substitution made Details Indicates the reason for the substitution (or lack of substitution) from what was prescribed.
responsibleParty		Reference<Practitioner | PractitionerRole>[]	Who is responsible for the substitution Details The person or organization that has primary responsibility for the substitution.
detectedIssue		Reference<DetectedIssue>[]	Clinical issue with action Details Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. drug-drug interaction, duplicate therapy, dosage alert etc. This element can include a detected issue that has been identified either by a decision support system or by a clinician and may include information on the steps that were taken to address the issue.
eventHistory		Reference<Provenance>[]	A list of relevant lifecycle events Details A summary of the events of interest that have occurred, such as when the dispense was verified. This might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.).

Search Parameters

Name	Type	Description	Expression
code	token	Returns dispenses of this medicine code	MedicationDispense.medication as CodeableConcept
identifier	token	Returns dispenses with this external identifier	MedicationDispense.identifier
patient	reference	The identity of a patient to list dispenses for	MedicationDispense.subject.where(resolve() is Patient)
medication	reference	Returns dispenses of this medicine resource	MedicationDispense.medication as Reference
status	token	Returns dispenses with a specified dispense status	MedicationDispense.status
context	reference	Returns dispenses with a specific context (episode or episode of care)	MedicationDispense.context
destination	reference	Returns dispenses that should be sent to a specific destination	MedicationDispense.destination
performer	reference	Returns dispenses performed by a specific individual	MedicationDispense.performer.actor
prescription	reference	The identity of a prescription to list dispenses from	MedicationDispense.authorizingPrescription
receiver	reference	The identity of a receiver to list dispenses for	MedicationDispense.receiver
responsibleparty	reference	Returns dispenses with the specified responsible party	MedicationDispense.substitution.responsibleParty
subject	reference	The identity of a patient for whom to list dispenses	MedicationDispense.subject
type	token	Returns dispenses of a specific type	MedicationDispense.type
whenhandedover	date	Returns dispenses handed over on this date	MedicationDispense.whenHandedOver
whenprepared	date	Returns dispenses prepared on this date	MedicationDispense.whenPrepared

Inherited Elements

Name	Required	Type	Description
id		string	Logical id of this artifact Details The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
meta		Meta	Metadata about the resource Details The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
implicitRules		uri	A set of rules under which this content was created Details A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. 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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
language		code	Language of the resource content Details The base language in which the resource is written. 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).
text		Narrative	Text summary of the resource, for human interpretation Details A human-readable narrative that contains a summary of the resource and can 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. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
contained		Resource[]	Contained, inline Resources Details 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. 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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
extension		Extension[]	Additional content defined by implementations Details May be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. 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.
modifierExtension		Extension[]	Extensions that cannot be ignored Details 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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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.

Usage

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

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

Relationships

The Medication domain includes a number of related resources

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

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

Background and Context

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

Referenced By

• ChargeItem
• MedicationStatement
• Observation