AU Base Implementation Guide
4.1.1-preview - Preview Australia flag

This page is part of the AU Base Implementation Guide 4.1.1-preview based on FHIR R4. For a full list of available versions, see the Directory of published versions

Resource Profile: AUBaseMedicationDispense - Detailed Descriptions

Page standards status: Trial-use Maturity Level: 2

Definitions for the au-medicationdispense resource profile.

Guidance on how to interpret the contents of this table can be found here.

1. MedicationDispense
2. MedicationDispense.extension
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
3. MedicationDispense.extension:subsidisedConcurrentSupply
SliceNamesubsidisedConcurrentSupply
Control0..1
TypeExtension(GroundsForConcurrentSupplyOfMedication) (Extension Type: Coding)
4. MedicationDispense.extension:dispenseNumber
SliceNamedispenseNumber
Control0..1
TypeExtension(DispenseNumber) (Extension Type: integer)
5. MedicationDispense.identifier
NoteThis is a business identifier, not a resource identifier (see discussion)
TypeIdentifier(Identifier, AULocalDispenseIdentifier)
6. MedicationDispense.medication[x]
[x] NoteSee Choice of Data Types for further information about how to use [x]
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
7. MedicationDispense.medication[x]:medicationCodeableConcept
SliceNamemedicationCodeableConcept
Control0..?
TypeCodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
8. MedicationDispense.medication[x]:medicationCodeableConcept.coding
Control0..?
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
9. MedicationDispense.medication[x]:medicationCodeableConcept.coding:pbs
SliceNamepbs
Control0..?
BindingThe codes SHOULD be taken from PBS Item Codes
Comments

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. )

10. MedicationDispense.medication[x]:medicationCodeableConcept.coding:pbs.system
Control1..?
Fixed Valuehttp://pbs.gov.au/code/item
11. MedicationDispense.medication[x]:medicationCodeableConcept.coding:gtin
SliceNamegtin
Control0..?
BindingThe codes SHOULD be taken from GTIN
Comments

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

12. MedicationDispense.medication[x]:medicationCodeableConcept.coding:gtin.system
Control1..?
Fixed Valuehttp://www.gs1.org/gtin
13. MedicationDispense.medication[x]:medicationCodeableConcept.coding:amt
SliceNameamt
Control0..?
BindingThe codes SHOULD be taken from https://healthterminologies.gov.au/fhir/ValueSet/australian-medication-1
14. MedicationDispense.medication[x]:medicationCodeableConcept.coding:amt.extension
Control0..?
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
15. MedicationDispense.medication[x]:medicationCodeableConcept.coding:amt.extension:medicationClass
SliceNamemedicationClass
Control0..1
TypeExtension(MedicationType) (Extension Type: Coding)
16. MedicationDispense.medication[x]:medicationCodeableConcept.coding:amt.system
Control1..?
Fixed Valuehttp://snomed.info/sct
17. MedicationDispense.medication[x]:medicationCodeableConcept.coding:mimsPackage
SliceNamemimsPackage
Control0..1
BindingThe codes SHOULD be taken from MIMS
18. MedicationDispense.medication[x]:medicationCodeableConcept.coding:mimsPackage.system
Control1..?
Fixed Valuehttp://www.mims.com.au/codes
19. 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..?
20. MedicationDispense.medication[x]:medicationReference
SliceNamemedicationReference
Control0..?
TypeReference(Medication)
[x] NoteSee Choice of Data Types for further information about how to use [x]
21. MedicationDispense.authorizingPrescription
TypeReference(AUBaseMedicationRequest|MedicationRequest)
22. MedicationDispense.dosageInstruction
TypeDosage(AUBaseDosage)
23. MedicationDispense.substitution
24. MedicationDispense.substitution.reason
Control0..1*
BindingThe codes SHOULD be taken from https://healthterminologies.gov.au/fhir/ValueSet/medicine-substitution-reason-1For example codes, see SubstanceAdminSubstitutionReason

Guidance on how to interpret the contents of this table can be found here.

1. MedicationDispense
Definition

Indicates that a medication product is to be or has been dispensed for a named person/patient. This includes a description of the medication product (supply) provided and the instructions for administering the medication. The medication dispense is the result of a pharmacy system responding to a medication order.

Control0..*
Summaryfalse
InvariantsDefined on this element
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 or SHALL refer to the containing resource (: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).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())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (: contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (: text.`div`.exists())
mdd-1: whenHandedOver cannot be before whenPrepared (: whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared)
2. 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. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Control0..1
Typeuri
Is Modifiertrue
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
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. 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.

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

An Extension

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.

Control0..*
TypeExtension
Summaryfalse
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.

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

The grounds which authorise a PBS or RPBS subsidy for the concurrent supply of a medication item specified in a prescription and all of its repeats.

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() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
5. MedicationDispense.extension:dispenseNumber
SliceNamedispenseNumber
Definition

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

The value of this extension is 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() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
6. 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 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).

Control0..*
TypeExtension
Is Modifiertrue
Summaryfalse
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

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.

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

Identifiers associated with this Medication Dispense that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..* This element is affected by the following invariants: ele-1
TypeIdentifier(Identifier, AULocalDispenseIdentifier)
Comments

This is a business identifier, not a resource identifier.

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

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

Control1..1
BindingThe codes SHALL be taken from MedicationDispense Status Codes

A coded concept specifying the state of the dispense event.

Typecode
Is Modifiertrue
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Comments

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

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
9. 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
BindingFor example codes, see SNOMEDCTMedicationCodes

A coded concept identifying which substance or product can be dispensed.

TypeChoice of: CodeableConcept, Reference(Medication)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
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
10. 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.

Control01..1
BindingFor example codes, see SNOMEDCTMedicationCodes

A coded concept identifying which substance or product can be dispensed.

TypeChoice of: CodeableConcept, Reference(Medication)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
11. MedicationDispense.medication[x]:medicationCodeableConcept.coding
Definition

A reference to a code defined by a terminology system.

Control0..*
TypeCoding
Summarytrue
Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
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
12. MedicationDispense.medication[x]:medicationCodeableConcept.coding:pbs
SliceNamepbs
Definition

A reference to a code defined by a terminology system.

Control0..*
BindingThe codes SHOULD be taken from PBS Item CodesFor codes, see (unbound)
TypeCoding
Summarytrue
Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

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. )

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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
13. MedicationDispense.medication[x]:medicationCodeableConcept.coding:pbs.system
Definition

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

Control10..1
Typeuri
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
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 reference to some definition that establishes the system clearly and unambiguously.

Fixed Valuehttp://pbs.gov.au/code/item
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
14. MedicationDispense.medication[x]:medicationCodeableConcept.coding:gtin
SliceNamegtin
Definition

A reference to a code defined by a terminology system.

Control0..*
BindingThe codes SHOULD be taken from GTINFor codes, see (unbound)
TypeCoding
Summarytrue
Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

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

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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
15. MedicationDispense.medication[x]:medicationCodeableConcept.coding:gtin.system
Definition

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

Control10..1
Typeuri
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
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 reference to some definition that establishes the system clearly and unambiguously.

Fixed Valuehttp://www.gs1.org/gtin
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
16. 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-1For codes, see (unbound)
TypeCoding
Summarytrue
Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
17. MedicationDispense.medication[x]:medicationCodeableConcept.coding:amt.extension
Definition

An Extension

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.

Control0..*
TypeExtension
Summaryfalse
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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
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
18. MedicationDispense.medication[x]:medicationCodeableConcept.coding:amt.extension:medicationClass
SliceNamemedicationClass
Definition

The type of information covered by the medication coding, e.g. branded product with no strength or form.

Control0..1
TypeExtension(MedicationType) (Extension Type: Coding)
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
19. MedicationDispense.medication[x]:medicationCodeableConcept.coding:amt.system
Definition

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

Control10..1
Typeuri
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
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 reference to some definition that establishes the system clearly and unambiguously.

Fixed Valuehttp://snomed.info/sct
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
20. 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 MIMSFor codes, see (unbound)
TypeCoding
Summarytrue
Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
21. MedicationDispense.medication[x]:medicationCodeableConcept.coding:mimsPackage.system
Definition

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

Control10..1
Typeuri
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
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 reference to some definition that establishes the system clearly and unambiguously.

Fixed Valuehttp://www.mims.com.au/codes
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
22. 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
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
23. 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.

Control01..1
TypeChoice of: Reference(Medication), CodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
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.

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

Indicates the medication order that is being dispensed against.

Control0..*
TypeReference(AUBaseMedicationRequest|MedicationRequest)
Summaryfalse
Comments

Maps to basedOn in Event logical model.

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

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

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

Control0..*
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() or (children().count() > id.count()))
26. 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
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
27. 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 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).

Control0..*
TypeExtension
Is Modifiertrue
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

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.

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

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

Control1..1
Typeboolean
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
29. MedicationDispense.substitution.reason
Definition

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

Control0..1*
BindingThe codes SHOULD be taken from https://healthterminologies.gov.au/fhir/ValueSet/medicine-substitution-reason-1For example codes, see SubstanceAdminSubstitutionReason
TypeCodeableConcept
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))

Guidance on how to interpret the contents of this table can be found here.

1. MedicationDispense
Definition

Indicates that a medication product is to be or has been dispensed for a named person/patient. This includes a description of the medication product (supply) provided and the instructions for administering the medication. The medication dispense is the result of a pharmacy system responding to a medication order.

Control0..*
Summaryfalse
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
Summarytrue
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 might not always be associated with version changes to the resource.

Control0..1
TypeMeta
Summarytrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
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. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Control0..1
Typeuri
Is Modifiertrue
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
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. 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.

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

The base language in which the resource is written.

Control0..1
BindingThe codes SHOULD be taken from CommonLanguages A human language
Additional BindingsPurpose
AllLanguagesMax Binding
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
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).

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

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.

Control0..1
TypeNarrative
Summaryfalse
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 information is added later.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
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
Summaryfalse
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

8. MedicationDispense.extension
Definition

An Extension

Control0..*
TypeExtension
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
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:subsidisedConcurrentSupply
SliceNamesubsidisedConcurrentSupply
Definition

The grounds which authorise a PBS or RPBS subsidy for the concurrent supply of a medication item specified in a prescription and all of its repeats.

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() or (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

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

The value of this extension is 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() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
11. MedicationDispense.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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).

Control0..*
TypeExtension
Is Modifiertrue
Summaryfalse
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

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.

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

Identifiers associated with this Medication Dispense that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..* This element is affected by the following invariants: ele-1
TypeIdentifier(Identifier, AULocalDispenseIdentifier)
Comments

This is a business identifier, not a resource identifier.

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

The procedure that trigger the dispense.

Control0..*
TypeReference(Procedure)
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
14. MedicationDispense.status
Definition

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

Control1..1
BindingThe codes SHALL be taken from MedicationDispense Status Codes A coded concept specifying the state of the dispense event
Typecode
Is Modifiertrue
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Comments

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

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
15. MedicationDispense.statusReason[x]
Definition

Indicates the reason why a dispense was not performed.

Control0..1
BindingFor example codes, see MedicationDispense Status Reason Codes A code describing why a dispense was not performed
TypeChoice of: CodeableConcept, Reference(DetectedIssue)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
16. MedicationDispense.category
Definition

Indicates the type of medication dispense (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)).

Control0..1
BindingThe codes SHOULD be taken from MedicationDispense Category Codes A code describing where the dispensed medication is expected to be consumed or administered
TypeCodeableConcept
Summaryfalse
Comments

The category can be used to include where the medication is expected to be consumed or other types of dispenses. Invariants can be used to bind to different value sets when profiling to bind.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
17. 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
BindingFor example codes, see SNOMEDCTMedicationCodes A coded concept identifying which substance or product can be dispensed
TypeChoice of: CodeableConcept, Reference(Medication)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
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
18. 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
BindingFor example codes, see SNOMEDCTMedicationCodes A coded concept identifying which substance or product can be dispensed
TypeCodeableConcept
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
19. 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
XML RepresentationIn the XML format, this property is represented as an attribute.
Summaryfalse
20. MedicationDispense.medication[x]:medicationCodeableConcept.extension
Definition

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.

Control0..*
TypeExtension
Summaryfalse
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.

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

A reference to a code defined by a terminology system.

Control0..*
TypeCoding
Summarytrue
Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
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
22. MedicationDispense.medication[x]:medicationCodeableConcept.coding:pbs
SliceNamepbs
Definition

A reference to a code defined by a terminology system.

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

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

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. )

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
23. 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
XML RepresentationIn the XML format, this property is represented as an attribute.
Summaryfalse
24. 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. 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.

Control0..*
TypeExtension
Summaryfalse
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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
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
25. 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
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
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 reference to some definition that establishes the system clearly and unambiguously.

Fixed Valuehttp://pbs.gov.au/code/item
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
26. 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
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
27. 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
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Need to refer to a particular code in the system.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
28. 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
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

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

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
29. MedicationDispense.medication[x]:medicationCodeableConcept.coding:pbs.userSelected
Definition

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

Control0..1
Typeboolean
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
30. MedicationDispense.medication[x]:medicationCodeableConcept.coding:gtin
SliceNamegtin
Definition

A reference to a code defined by a terminology system.

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

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

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

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
31. 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
XML RepresentationIn the XML format, this property is represented as an attribute.
Summaryfalse
32. 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. 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.

Control0..*
TypeExtension
Summaryfalse
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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
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
33. 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
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
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 reference to some definition that establishes the system clearly and unambiguously.

Fixed Valuehttp://www.gs1.org/gtin
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
34. 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
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
35. 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
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Need to refer to a particular code in the system.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
36. 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
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

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

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
37. MedicationDispense.medication[x]:medicationCodeableConcept.coding:gtin.userSelected
Definition

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

Control0..1
Typeboolean
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
38. 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
Summarytrue
Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
39. 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
XML RepresentationIn the XML format, this property is represented as an attribute.
Summaryfalse
40. MedicationDispense.medication[x]:medicationCodeableConcept.coding:amt.extension
Definition

An Extension

Control0..*
TypeExtension
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
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
41. MedicationDispense.medication[x]:medicationCodeableConcept.coding:amt.extension:medicationClass
SliceNamemedicationClass
Definition

The type of information covered by the medication coding, e.g. branded product with no strength or form.

Control0..1
TypeExtension(MedicationType) (Extension Type: Coding)
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
42. 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
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
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 reference to some definition that establishes the system clearly and unambiguously.

Fixed Valuehttp://snomed.info/sct
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
43. 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
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
44. 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
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Need to refer to a particular code in the system.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
45. 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
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

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

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
46. MedicationDispense.medication[x]:medicationCodeableConcept.coding:amt.userSelected
Definition

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

Control0..1
Typeboolean
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
47. 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
TypeCoding
Summarytrue
Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
48. 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
XML RepresentationIn the XML format, this property is represented as an attribute.
Summaryfalse
49. 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. 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.

Control0..*
TypeExtension
Summaryfalse
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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
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
50. 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
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
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 reference to some definition that establishes the system clearly and unambiguously.

Fixed Valuehttp://www.mims.com.au/codes
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
51. 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
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
52. 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
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Need to refer to a particular code in the system.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
53. 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
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

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

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
54. MedicationDispense.medication[x]:medicationCodeableConcept.coding:mimsPackage.userSelected
Definition

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

Control0..1
Typeboolean
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
55. 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
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
56. 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(Medication)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summarytrue
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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
57. 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)
Summarytrue
Comments

SubstanceAdministration->subject->Patient.

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

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

Control0..1
TypeReference(Encounter|EpisodeOfCare)
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
59. MedicationDispense.supportingInformation
Definition

Additional information that supports the medication being dispensed.

Control0..*
TypeReference(Resource)
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
60. MedicationDispense.performer
Definition

Indicates who or what performed the event.

Control0..*
TypeBackboneElement
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
61. 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
XML RepresentationIn the XML format, this property is represented as an attribute.
Summaryfalse
62. MedicationDispense.performer.extension
Definition

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.

Control0..*
TypeExtension
Summaryfalse
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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
63. 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 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).

Control0..*
TypeExtension
Is Modifiertrue
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

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.

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

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

Control0..1
BindingFor example codes, see MedicationDispense Performer Function Codes A code describing the role an individual played in dispensing a medication
TypeCodeableConcept
Summaryfalse
Requirements

Allows disambiguation of the types of involvement of different performers.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
65. 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|PractitionerRole|Organization|Patient|Device|RelatedPerson)
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
66. MedicationDispense.location
Definition

The principal physical location where the dispense was performed.

Control0..1
TypeReference(Location)
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
67. MedicationDispense.authorizingPrescription
Definition

Indicates the medication order that is being dispensed against.

Control0..*
TypeReference(AUBaseMedicationRequest)
Summaryfalse
Comments

Maps to basedOn in Event logical model.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
68. 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
BindingFor example codes, see ActPharmacySupplyType Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc
TypeCodeableConcept
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
69. MedicationDispense.quantity
Definition

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

Control0..1
TypeQuantity(SimpleQuantity)
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
70. MedicationDispense.daysSupply
Definition

The amount of medication expressed as a timing amount.

Control0..1
TypeQuantity(SimpleQuantity)
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
71. MedicationDispense.whenPrepared
Definition

The time when the dispensed product was packaged and reviewed.

Control0..1
TypedateTime
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
72. MedicationDispense.whenHandedOver
Definition

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

Control0..1
TypedateTime
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
73. MedicationDispense.destination
Definition

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

Control0..1
TypeReference(Location)
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
74. 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)
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
75. MedicationDispense.note
Definition

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

Control0..*
TypeAnnotation
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
76. MedicationDispense.dosageInstruction
Definition

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

Control0..*
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() or (children().count() > id.count()))
77. 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
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
78. 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
XML RepresentationIn the XML format, this property is represented as an attribute.
Summaryfalse
79. MedicationDispense.substitution.extension
Definition

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.

Control0..*
TypeExtension
Summaryfalse
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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
80. 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 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).

Control0..*
TypeExtension
Is Modifiertrue
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

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.

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

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

Control1..1
Typeboolean
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
82. MedicationDispense.substitution.type
Definition

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

Control0..1
BindingFor example codes, see ActSubstanceAdminSubstitutionCode A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription
TypeCodeableConcept
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
83. MedicationDispense.substitution.reason
Definition

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

Control0..1
BindingThe codes SHOULD be taken from https://healthterminologies.gov.au/fhir/ValueSet/medicine-substitution-reason-1
TypeCodeableConcept
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
84. MedicationDispense.substitution.responsibleParty
Definition

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

Control0..*
TypeReference(Practitioner|PractitionerRole)
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
85. 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)
Summaryfalse
Alternate NamesContraindication, Drug Utilization Review (DUR), Alert
Comments

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.

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

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

Control0..*
TypeReference(Provenance)
Summaryfalse
Comments

This might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.).

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