Australian Base Implementation Guide (AU Base 1.1.1)

This page is part of the Australian Base IG (v1.1.1: AU Base 1.1 on STU3 Draft) based on FHIR R3. The current version which supercedes this version is 1.0.2. For a full list of available versions, see the Directory of published versions

D.4.1.4 StructureDefinition: - Detailed Descriptions

Definitions for the StructureDefinition-au-medicationdispense Profile.

1. MedicationDispense
Definition

Dispensing of a medication to patient in an Australian healthcare contex

Control0..*
Comments

The WG will be updating the MedicationDispense resource to adjust each affected resource to align with the workflow pattern (see workflow.html).

InvariantsDefined on this element
dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (: contained.text.empty())
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (: contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (: contained.where(('#'+id in %resource.descendants().reference).not()).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
mdd-1: whenHandedOver cannot be before whenPrepared (: whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared)
2. MedicationDispense.id
Definition

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

Control0..1
Typeid
Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

3. MedicationDispense.meta
Definition

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

Control0..1
TypeMeta
4. MedicationDispense.implicitRules
Definition

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

Control0..1
Typeuri
Is Modifiertrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

5. MedicationDispense.language
Definition

The base language in which the resource is written.

Control0..1
BindingA human language.
The codes SHALL be taken from Common Languages; other codes may be used where these codes are not suitable
Max Binding: All Languages
Typecode
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

6. MedicationDispense.text
Definition

A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

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

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. 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 in formation is added later.

7. MedicationDispense.contained
Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

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

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.

8. MedicationDispense.extension
Definition

An Extension

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

Coded Grounds for Concurrent Supply of Medication

Control0..1 This element is affected by the following invariants: ele-1
TypeExtension(GroundsForConcurrentSupplyOfMedication) (Extension Type: Coding)
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
10. MedicationDispense.extension:dispenseNumber
SliceNamedispenseNumber
Definition

This extension applies to the MedicationDispense resource and the value indicates the dispense number or sequence number that has been reached for a therapeutic good prescribed with repeats.

Control0..1 This element is affected by the following invariants: ele-1
TypeExtension(DispenseNumber) (Extension Type: integer)
Comments

It has the value 1 when there are no repeats. The value increments by one each time a dispense act is successfully completed.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
11. MedicationDispense.extension:brandName
SliceNamebrandName
Definition

The brand medication text name for an associated medication, this may be supplied if a coded brand name is not available for medicationCodeableConcept but the brand name is needed.

Control0..1 This element is affected by the following invariants: ele-1
TypeExtension(MedicationBrandName) (Extension Type: string)
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
12. MedicationDispense.extension:genericName
SliceNamegenericName
Definition

The generic medication text name for an associated medication, this may not be the same as the medicationCodeableConcept medication (prescribed, dispensed or stated) but may be used to provide an additional or equivalent drug name that is a generic medication concept.

Control0..1 This element is affected by the following invariants: ele-1
TypeExtension(MedicationGenericName) (Extension Type: string)
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
13. MedicationDispense.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

14. MedicationDispense.identifier
Definition

Identifier assigned by the dispensing facility - this is an identifier assigned outside FHIR.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
SlicingThis element introduces a set of slices on MedicationDispense.identifier. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ system
  • ,
  • value @ type
15. MedicationDispense.identifier:localDispenseIdentifier
SliceNamelocalDispenseIdentifier
Definition

Identifier assigned by the dispensing system this allows linking of this dispensing record to a local system identfier.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
16. MedicationDispense.identifier:localDispenseIdentifier.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
17. MedicationDispense.identifier:localDispenseIdentifier.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on MedicationDispense.identifier.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
18. MedicationDispense.identifier:localDispenseIdentifier.use
Definition

The purpose of this identifier.

Control0..1
BindingIdentifies the purpose for this identifier, if known .
The codes SHALL be taken from IdentifierUse
Typecode
Is Modifiertrue
Requirements

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

Comments

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

19. MedicationDispense.identifier:localDispenseIdentifier.type
Definition

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

Control1..1
BindingLocal identifier type
The codes SHALL be taken from v2 Identifier Type - AU Extended
TypeCodeableConcept
Requirements

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

Comments

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage.

Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

20. MedicationDispense.identifier:localDispenseIdentifier.type.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
21. MedicationDispense.identifier:localDispenseIdentifier.type.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on MedicationDispense.identifier.type.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
22. MedicationDispense.identifier:localDispenseIdentifier.type.coding
Definition

A reference to a code defined by a terminology system.

Control1..1
TypeCoding
Requirements

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

Comments

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

23. MedicationDispense.identifier:localDispenseIdentifier.type.coding.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
24. MedicationDispense.identifier:localDispenseIdentifier.type.coding.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on MedicationDispense.identifier.type.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
25. MedicationDispense.identifier:localDispenseIdentifier.type.coding.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control1..1
Typeuri
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

Fixed Valuehttp://hl7.org.au/fhir/v2/0203
26. MedicationDispense.identifier:localDispenseIdentifier.type.coding.version
Definition

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

27. MedicationDispense.identifier:localDispenseIdentifier.type.coding.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control1..1
Typecode
Requirements

Need to refer to a particular code in the system.

Fixed ValueLDI
28. MedicationDispense.identifier:localDispenseIdentifier.type.coding.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control0..1
Typestring
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

29. MedicationDispense.identifier:localDispenseIdentifier.type.coding.userSelected
Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Control0..1
Typeboolean
Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

30. MedicationDispense.identifier:localDispenseIdentifier.type.text
Definition

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

Control1..1
Typestring
Requirements

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

Comments

Very often the text is the same as a displayName of one of the codings.

Fixed ValueLocal Dispense Identifier
31. MedicationDispense.identifier:localDispenseIdentifier.system
Definition

URL assigned by the local dispensing system.

Control1..1
Typeuri
Requirements

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

Example
General:http://www.acme.com/identifiers/patient
32. MedicationDispense.identifier:localDispenseIdentifier.value
Definition

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

Control1..1
Typestring
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.

Example
General:123456
33. MedicationDispense.identifier:localDispenseIdentifier.period
Definition

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

Control0..1
TypePeriod
34. MedicationDispense.identifier:localDispenseIdentifier.assigner
Definition

Organization that issued/manages the identifier.

Control1..1
TypeReference(Organization)
Comments

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

35. MedicationDispense.identifier:localDispenseIdentifier.assigner.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
36. MedicationDispense.identifier:localDispenseIdentifier.assigner.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on MedicationDispense.identifier.assigner.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
37. MedicationDispense.identifier:localDispenseIdentifier.assigner.reference
Definition

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

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

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

38. MedicationDispense.identifier:localDispenseIdentifier.assigner.identifier
Definition

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..1
TypeIdentifier
Comments

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

39. MedicationDispense.identifier:localDispenseIdentifier.assigner.display
Definition

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

Control1..1
Typestring
Comments

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

40. MedicationDispense.partOf
Definition

The procedure that the dispense is done because of.

Control0..*
TypeReference(Procedure)
41. MedicationDispense.status
Definition

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

Control0..1
BindingA coded concept specifying the state of the dispense event.
The codes SHALL be taken from MedicationDispenseStatus
Typecode
Is Modifiertrue
Comments

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

42. MedicationDispense.category
Definition

Indicates type of medication dispense and where the medication is expected to be consumed or administered.

Control0..1
BindingA code describing where the dispensed medication is expected to be consumed or administered
The codes SHOULD be taken from MedicationDispenseCategory
TypeCodeableConcept
43. MedicationDispense.medication[x]
Definition

Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.

Control1..1
BindingA coded concept identifying which substance or product can be dispensed
For example codes, see SNOMED CT Medication Codes
TypeChoice of: CodeableConcept, Reference(Medication)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Comments

If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended.  For example if you require form or lot number, then you must reference the Medication resource. .

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

Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.

Control0..1
BindingA coded concept identifying which substance or product can be dispensed
For example codes, see SNOMED CT Medication Codes
TypeCodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Comments

If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended.  For example if you require form or lot number, then you must reference the Medication resource. .

45. MedicationDispense.medication[x]:medicationCodeableConcept.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
46. MedicationDispense.medication[x]:medicationCodeableConcept.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on MedicationDispense.medication[x].extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
47. MedicationDispense.medication[x]:medicationCodeableConcept.coding
Definition

A reference to a code defined by a terminology system.

Control0..*
TypeCoding
Requirements

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

Comments

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

SlicingThis element introduces a set of slices on MedicationDispense.medication[x].coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ system
48. MedicationDispense.medication[x]:medicationCodeableConcept.coding:pbs
SliceNamepbs
Definition

PBS code from http://pbs.gov.au/code/item. Use of PBS as a code to refer to a type of medication, this excludes implication of context based on the PBS code. Where context is to be implied or stated PBS code needs to be associated with recording a prescription (MedicationRequest) or dispense record(MedicationDispense)

Control0..*
BindingThe codes SHOULD be taken from PBS Medicines Item Codes
TypeCoding
Requirements

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

Comments

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

49. MedicationDispense.medication[x]:medicationCodeableConcept.coding:pbs.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
50. MedicationDispense.medication[x]:medicationCodeableConcept.coding:pbs.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on MedicationDispense.medication[x].coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
51. MedicationDispense.medication[x]:medicationCodeableConcept.coding:pbs.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control1..1
Typeuri
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

Fixed Valuehttp://pbs.gov.au/code/item
52. MedicationDispense.medication[x]:medicationCodeableConcept.coding:pbs.version
Definition

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

53. MedicationDispense.medication[x]:medicationCodeableConcept.coding:pbs.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control0..1
Typecode
Requirements

Need to refer to a particular code in the system.

54. MedicationDispense.medication[x]:medicationCodeableConcept.coding:pbs.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control0..1
Typestring
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

55. MedicationDispense.medication[x]:medicationCodeableConcept.coding:pbs.userSelected
Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Control0..1
Typeboolean
Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

56. MedicationDispense.medication[x]:medicationCodeableConcept.coding:gtin
SliceNamegtin
Definition

GTIN value from http://www.gs1.org/gtin.

Control0..*
BindingThe codes SHOULD be taken from GTIN for Medicines
TypeCoding
Requirements

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

Comments

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

57. MedicationDispense.medication[x]:medicationCodeableConcept.coding:gtin.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
58. MedicationDispense.medication[x]:medicationCodeableConcept.coding:gtin.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on MedicationDispense.medication[x].coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
59. MedicationDispense.medication[x]:medicationCodeableConcept.coding:gtin.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control1..1
Typeuri
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

Fixed Valuehttp://www.gs1.org/gtin
60. MedicationDispense.medication[x]:medicationCodeableConcept.coding:gtin.version
Definition

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

61. MedicationDispense.medication[x]:medicationCodeableConcept.coding:gtin.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control0..1
Typecode
Requirements

Need to refer to a particular code in the system.

62. MedicationDispense.medication[x]:medicationCodeableConcept.coding:gtin.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control0..1
Typestring
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

63. MedicationDispense.medication[x]:medicationCodeableConcept.coding:gtin.userSelected
Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Control0..1
Typeboolean
Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

64. MedicationDispense.medication[x]:medicationCodeableConcept.coding:amt
SliceNameamt
Definition

A reference to a code defined by a terminology system.

Control0..*
BindingThe codes SHOULD be taken from https://healthterminologies.gov.au/fhir/ValueSet/australian-medication-1
TypeCoding
Requirements

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

Comments

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

65. MedicationDispense.medication[x]:medicationCodeableConcept.coding:amt.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
66. MedicationDispense.medication[x]:medicationCodeableConcept.coding:amt.extension
Definition

An Extension

Control0..*
TypeExtension
SlicingThis element introduces a set of slices on MedicationDispense.medication[x].coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
67. MedicationDispense.medication[x]:medicationCodeableConcept.coding:amt.extension:medicationClass
SliceNamemedicationClass
Definition

General category of coding to allow usage of codes to be distinguished from the same CodeSystem

Control0..1
TypeExtension(MedicationType) (Extension Type: Coding)
68. MedicationDispense.medication[x]:medicationCodeableConcept.coding:amt.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control1..1
Typeuri
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

Fixed Valuehttp://snomed.info/sct
69. MedicationDispense.medication[x]:medicationCodeableConcept.coding:amt.version
Definition

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

70. MedicationDispense.medication[x]:medicationCodeableConcept.coding:amt.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control0..1
Typecode
Requirements

Need to refer to a particular code in the system.

71. MedicationDispense.medication[x]:medicationCodeableConcept.coding:amt.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control0..1
Typestring
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

72. MedicationDispense.medication[x]:medicationCodeableConcept.coding:amt.userSelected
Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Control0..1
Typeboolean
Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

73. MedicationDispense.medication[x]:medicationCodeableConcept.coding:mimsPackage
SliceNamemimsPackage
Definition

A reference to a code defined by a terminology system.

Control0..1
BindingThe codes SHOULD be taken from MIMS Terminology
TypeCoding
Requirements

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

Comments

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

74. MedicationDispense.medication[x]:medicationCodeableConcept.coding:mimsPackage.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
75. MedicationDispense.medication[x]:medicationCodeableConcept.coding:mimsPackage.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on MedicationDispense.medication[x].coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
76. MedicationDispense.medication[x]:medicationCodeableConcept.coding:mimsPackage.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control1..1
Typeuri
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

Fixed Valuehttp://www.mims.com.au/codes
77. MedicationDispense.medication[x]:medicationCodeableConcept.coding:mimsPackage.version
Definition

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Comments

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

78. MedicationDispense.medication[x]:medicationCodeableConcept.coding:mimsPackage.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control0..1
Typecode
Requirements

Need to refer to a particular code in the system.

79. MedicationDispense.medication[x]:medicationCodeableConcept.coding:mimsPackage.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control0..1
Typestring
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

80. MedicationDispense.medication[x]:medicationCodeableConcept.coding:mimsPackage.userSelected
Definition

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

Control0..1
Typeboolean
Requirements

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Comments

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

81. MedicationDispense.medication[x]:medicationCodeableConcept.text
Definition

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

This may be a brand or generic name as suitable for the intent of the entry.

Control0..1
Typestring
Requirements

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

Comments

Very often the text is the same as a displayName of one of the codings.

82. MedicationDispense.medication[x]:medicationReference
SliceNamemedicationReference
Definition

Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.

Control0..1
TypeReference(AUBaseMedication)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Comments

If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended.  For example if you require form or lot number, then you must reference the Medication resource. .

83. MedicationDispense.subject
Definition

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

Control0..1
TypeReference(Patient | Group)
Comments

SubstanceAdministration->subject->Patient.

84. MedicationDispense.context
Definition

The encounter or episode of care that establishes the context for this event.

Control0..1
TypeReference(Encounter | EpisodeOfCare)
85. MedicationDispense.supportingInformation
Definition

Additional information that supports the medication being dispensed.

Control0..*
TypeReference(Resource)
86. MedicationDispense.performer
Definition

Indicates who or what performed the event. It should be assumed that the performer is the dispenser of the medication.

Control0..*
TypeBackboneElement
Comments

The performer will be reviewed as part of STU4.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
87. MedicationDispense.performer.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
88. MedicationDispense.performer.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

89. MedicationDispense.performer.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

90. MedicationDispense.performer.actor
Definition

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

Control1..1
TypeReference(Practitioner | Organization | Patient | Device | RelatedPerson)
91. MedicationDispense.performer.onBehalfOf
Definition

The organization the device or practitioner was acting on behalf of.

Control0..1
TypeReference(Organization)
92. MedicationDispense.authorizingPrescription
Definition

Indicates the medication order that is being dispensed against.

Control0..*
TypeReference(AUBaseMedicationRequest)
Comments

Maps to basedOn in Event logical model.

93. MedicationDispense.type
Definition

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

Control0..1
BindingIndicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc.
For example codes, see ActPharmacySupplyType
TypeCodeableConcept
94. MedicationDispense.quantity
Definition

The amount of medication that has been dispensed. Includes unit of measure.

Control0..1
TypeQuantity(SimpleQuantity)
95. MedicationDispense.daysSupply
Definition

The amount of medication expressed as a timing amount.

Control0..1
TypeQuantity(SimpleQuantity)
96. MedicationDispense.whenPrepared
Definition

The time when the dispensed product was packaged and reviewed.

Control0..1
TypedateTime
97. MedicationDispense.whenHandedOver
Definition

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

Control0..1
TypedateTime
98. MedicationDispense.destination
Definition

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

Control0..1
TypeReference(Location)
99. MedicationDispense.receiver
Definition

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

Control0..*
TypeReference(Patient | Practitioner)
100. MedicationDispense.note
Definition

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

Control0..*
TypeAnnotation
101. MedicationDispense.dosageInstruction
Definition

Indicates how the medication is/was taken or should be taken by the patient.

Control0..* This element is affected by the following invariants: ele-1
TypeDosage(AUBaseDosage)
Comments

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

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
102. MedicationDispense.dosageInstruction.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
103. MedicationDispense.dosageInstruction.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on MedicationDispense.dosageInstruction.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
104. MedicationDispense.dosageInstruction.sequence
Definition

Indicates the order in which the dosage instructions should be applied or interpreted.

Control0..1
Typeinteger
Requirements

If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. If the sequence number is different, then the Dosages are intended to be sequential.

105. MedicationDispense.dosageInstruction.text
Definition

Free text dosage instructions e.g. SIG.

Control0..1
Typestring
Requirements

Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing.

106. MedicationDispense.dosageInstruction.additionalInstruction
Definition

Supplemental instruction - e.g. "with meals".

Control0..*
BindingThe codes SHOULD be taken from SNOMED CT Additional Dosage Instructions
TypeCodeableConcept
Requirements

Additional instruction such as "Swallow with plenty of water" which may or may not be coded.

107. MedicationDispense.dosageInstruction.patientInstruction
Definition

Instructions in terms that are understood by the patient or consumer.

Control0..1
Typestring
108. MedicationDispense.dosageInstruction.timing
Definition

When medication should be administered.

Control0..1
TypeTiming
Requirements

The timing schedule for giving the medication to the patient. The Schedule data type allows many different expressions. For example: "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

Comments

This attribute may not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.

109. MedicationDispense.dosageInstruction.asNeeded[x]
Definition

Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept).

Control0..1
BindingThe codes SHOULD be taken from https://healthterminologies.gov.au/fhir/ValueSet/clinical-finding-1
TypeChoice of: boolean, CodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Comments

Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not "prn" or "as needed".

110. MedicationDispense.dosageInstruction.site
Definition

Body site to administer to.

Control0..1
BindingThe codes SHOULD be taken from https://healthterminologies.gov.au/fhir/ValueSet/body-site-1
TypeCodeableConcept
Requirements

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

Comments

If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension body-site-instance. May be a summary code, or a reference to a very precise definition of the location, or both.

111. MedicationDispense.dosageInstruction.route
Definition

How drug should enter body.

Control0..1
BindingThe codes SHOULD be taken from https://healthterminologies.gov.au/fhir/ValueSet/route-of-administration-1
TypeCodeableConcept
Requirements

A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.

112. MedicationDispense.dosageInstruction.method
Definition

Technique for administering medication.

Control0..1
BindingThe codes SHOULD be taken from SNOMED CT Administration Method Codes
TypeCodeableConcept
Requirements

A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV.

Comments

Terminologies used often pre-coordinate this term with the route and or form of administration.

113. MedicationDispense.dosageInstruction.method.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
114. MedicationDispense.dosageInstruction.method.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingThis element introduces a set of slices on MedicationDispense.dosageInstruction.method.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
115. MedicationDispense.dosageInstruction.method.coding
Definition

A reference to a code defined by a terminology system.

Control0..*
TypeCoding
Requirements

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

Comments

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

SlicingThis element introduces a set of slices on MedicationDispense.dosageInstruction.method.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ system
116. MedicationDispense.dosageInstruction.method.text
Definition

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

Control0..1
Typestring
Requirements

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

Comments

Very often the text is the same as a displayName of one of the codings.

117. MedicationDispense.dosageInstruction.dose[x]
Definition

Amount of medication per dose.

Control0..1
TypeChoice of: Range, Quantity(SimpleQuantity)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Requirements

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

Comments

Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.

118. MedicationDispense.dosageInstruction.maxDosePerPeriod
Definition

Upper limit on medication per unit of time.

Control0..1
TypeRatio
Requirements

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

Comments

This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".

119. MedicationDispense.dosageInstruction.maxDosePerAdministration
Definition

Upper limit on medication per administration.

Control0..1
TypeQuantity(SimpleQuantity)
Requirements

The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.

Comments

This is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg.

120. MedicationDispense.dosageInstruction.maxDosePerLifetime
Definition

Upper limit on medication per lifetime of the patient.

Control0..1
TypeQuantity(SimpleQuantity)
Requirements

The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.

121. MedicationDispense.dosageInstruction.rate[x]
Definition

Amount of medication per unit of time.

Control0..1
TypeChoice of: Ratio, Range, Quantity(SimpleQuantity)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Requirements

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. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

Comments

It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate.

122. MedicationDispense.substitution
Definition

Indicates whether or not substitution was made as part of the dispense. In some cases substitution will be expected but does not happen, in other cases substitution is not expected but does happen. This block explains what substitution did or did not happen and why. If nothing is specified, substitution was not done.

Control0..1
TypeBackboneElement
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() | (children().count() > id.count()))
123. MedicationDispense.substitution.id
Definition

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
124. MedicationDispense.substitution.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Control0..*
TypeExtension
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

125. MedicationDispense.substitution.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

126. MedicationDispense.substitution.wasSubstituted
Definition

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

Control1..1
Typeboolean
127. MedicationDispense.substitution.type
Definition

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

Control0..1
BindingA coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription
For example codes, see ActSubstanceAdminSubstitutionCode
TypeCodeableConcept
128. MedicationDispense.substitution.reason
Definition

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

Control0..*
BindingThe codes SHOULD be taken from https://healthterminologies.gov.au/fhir/ValueSet/medicine-substitution-reason-1
TypeCodeableConcept
129. MedicationDispense.substitution.responsibleParty
Definition

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

Control0..*
TypeReference(Practitioner)
130. MedicationDispense.detectedIssue
Definition

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.

Control0..*
TypeReference(DetectedIssue)
Alternate NamesContraindication, Drug Utilization Review (DUR), Alert
131. MedicationDispense.notDone
Definition

True if the dispense was not performed for some reason.

Control0..1
Typeboolean
132. MedicationDispense.notDoneReason[x]
Definition

Indicates the reason why a dispense was not performed.

Control0..1
TypeChoice of: CodeableConcept, Reference(DetectedIssue)
[x] NoteSee Choice of Data Types for further information about how to use [x]
133. MedicationDispense.eventHistory
Definition

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

Control0..*
TypeReference(Provenance)
Comments

This may 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.).