us-quality-core-medicationdispensedeclined
type: StructureDefinition
node role: treeRoot
id:
  v: us-quality-core-medicationdispensedeclined
text:
  status:
    v: extensions
  div:
    v: Generated Narrative: StructureDefinition us-quality-core-medicationdispensedeclined Name Flags Card. Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> MedicationDispense C 0..* USCoreMedicationDispenseProfile(6.1.0) Dispensing a medication to a named patient Constraints: mnd-1 #xD; Slices for extension Content/Rules for all slices #xD; extension:recorded 1..1 dateTime Extension URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded #xD; status 1..1 code (USCDI+ Quality) (USCDI) preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown Binding: MedicationDispense Status Codes (required) Fixed Value: declined #xD; statusReason[x] 1..1 CodeableConcept (USCDI+ Quality) Why a dispense was not performed Binding: USQualityCore Negation Reason Codes (extensible): The reason the event did not occur or was not performed #xD; medication[x] 1..1 CodeableConcept, Reference(US Core Medication Profile(7.0.0)) (USCDI) What medication was supplied Binding: Medication Clinical Drug (extensible): The set of RxNorm codes to represent medications #xD; Slices for extension Content/Rules for all slices #xD; extension:notDoneValueSet 0..1 canonical(ValueSet) Url of a value set of activities not requested or performed URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet #xD; subject 1..1 Reference(US Quality Core Patient) (USCDI) Who the dispense is for #xD; authorizingPrescription 0..* Reference(US Quality Core MedicationRequest) (USCDI) #xD; quantity 0..1 Quantity (USCDI) Amount dispensed #xD; daysSupply 0..1 SimpleQuantity Amount of medication expressed as a timing amount #xD; dosageInstruction 0..* Dosage (USCDI) #xD; text 0..1 string (USCDI) Free text dosage instructions e.g. SIG #xD; timing 0..1 Timing (USCDI) When medication should be administered #xD; route 0..1 CodeableConcept How drug should enter bo…
url:
  v: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-medicationdispensedeclined
  l: us-quality-core-medicationdispensedeclined
version:
  v: 0.5.0
name:
  v: USQualityCoreMedicationDispenseDeclined
title:
  v: US Quality Core MedicationDispense Declined
status:
  v: active
experimental:
  v: false
date:
  v: 2026-06-05
publisher:
  v: Office of the National Coordinator for Health Information Technology (ONC)
contact:
  name:
    v: Office of the National Coordinator for Health Information Technology (ONC)
  telecom:
    system:
      v: url
    value:
      v: https://www.healthit.gov/feedback
description:
  v: Negation profile of MedicationDispense for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.
jurisdiction:
  coding:
    system:
      v: urn:iso:std:iso:3166
      l: 3166
    code:
      v: US
    display:
      v: United States of America
  text:
    v: USA
fhir version:
  v: 4.0.1
mapping:
  identity:
    v: workflow
  uri:
    v: http://hl7.org/fhir/workflow
    l: workflow
  name:
    v: Workflow Pattern
mapping:
  identity:
    v: rim
  uri:
    v: http://hl7.org/v3
    l: v3
  name:
    v: RIM Mapping
mapping:
  identity:
    v: w5
  uri:
    v: http://hl7.org/fhir/fivews
    l: fivews
  name:
    v: FiveWs Pattern Mapping
mapping:
  identity:
    v: rx-dispense-rmim
  uri:
    v: http://www.hl7.org/v3/PORX_RM020070UV
    l: PORX RM020070UV
  name:
    v: V3 Pharmacy Dispense RMIM
mapping:
  identity:
    v: v2
  uri:
    v: http://hl7.org/v2
    l: v2
  name:
    v: HL7 v2 Mapping
kind:
  v: resource
abstract:
  v: false
type:
  v: MedicationDispense
  l: MedicationDispense
base definition:
  v: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationdispense|6.1.0
  l: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationdispense
derivation:
  v: constraint
snapshot:
  extension:
    url:
      v: http://hl7.org/fhir/tools/StructureDefinition/snapshot-base-version
      l: snapshot-base-version
    value: String
      v: 6.1.0
  element:
    id:
      v: MedicationDispense
    path:
      v: MedicationDispense
    short:
      v: Dispensing a medication to a named patient
    definition:
      v: 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.
    min:
      v: 0
    max:
      v: *
    base:
      path:
        v: MedicationDispense
      min:
        v: 0
      max:
        v: *
    constraint:
      key:
        v: dom-2
      severity:
        v: error
      human:
        v: If the resource is contained in another resource, it SHALL NOT contain nested Resources
      expression:
        v: contained.contained.empty()
      xpath:
        v: not(parent::f:contained and f:contained)
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        l: DomainResource
    constraint:
      key:
        v: dom-3
      severity:
        v: error
      human:
        v: 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
      expression:
        v: 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()
      xpath:
        v: not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        l: DomainResource
    constraint:
      key:
        v: dom-4
      severity:
        v: error
      human:
        v: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
      expression:
        v: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
      xpath:
        v: not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        l: DomainResource
    constraint:
      key:
        v: dom-5
      severity:
        v: error
      human:
        v: If a resource is contained in another resource, it SHALL NOT have a security label
      expression:
        v: contained.meta.security.empty()
      xpath:
        v: not(exists(f:contained/*/f:meta/f:security))
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        l: DomainResource
    constraint:
      extension:
        value: Boolean
      extension:
        value: Markdown
      key:
        v: dom-6
      severity:
        v: warning
      human:
        v: A resource should have narrative for robust management
      expression:
        v: text.`div`.exists()
      xpath:
        v: exists(f:text/h:div)
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        l: DomainResource

Boolean
v: true

Markdown
v: When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.

key:
  v: mdd-1
severity:
  v: error
human:
  v: whenHandedOver cannot be before whenPrepared
expression:
  v: whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared
xpath:
  v: not(exists(f:whenHandedOver/@value)) or not(exists(f:whenPrepared/@value)) or ( f:whenHandedOver/@value >= f:whenPrepared/@value)
source:
  v: http://hl7.org/fhir/StructureDefinition/MedicationDispense
  l: MedicationDispense

key:
  v: us-core-20
severity:
  v: error
human:
  v: whenHandedOver SHALL be present if the status is "completed"
expression:
  v: status='completed' implies whenHandedOver.exists()
source:
  v: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationdispense
  l: us-core-medicationdispense

key:
  v: mnd-1
severity:
  v: error
human:
  v: To indicate what medication was not dispensed, either at least one coding in the medication or a notDoneValueSet extension shall be provided
expression:
  v: medication.extension('http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor medication.coding.exists()
xpath:
  v: exists(f:extension)

v: false

v: false

identity:
  v: rim
map:
  v: Entity. Role, or Act

identity:
  v: workflow
map:
  v: Event

identity:
  v: rim
map:
  v: Supply[moodCode=EVN]

id:
  v: MedicationDispense.id
path:
  v: MedicationDispense.id
short:
  v: Logical id of this artifact
definition:
  v: The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
comment:
  v: The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: id
      l: id
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: true

id:
  v: MedicationDispense.meta
path:
  v: MedicationDispense.meta
short:
  v: Metadata about the resource
definition:
  v: 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.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.meta
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Meta
    l: Meta
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true

id:
  v: MedicationDispense.implicitRules
path:
  v: MedicationDispense.implicitRules
short:
  v: A set of rules under which this content was created
definition:
  v: 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.
comment:
  v: 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.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.implicitRules
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: uri
    l: uri
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: true
is modifier reason:
  v: This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
is summary:
  v: true

id:
  v: MedicationDispense.language
path:
  v: MedicationDispense.language
short:
  v: Language of the resource content
definition:
  v: The base language in which the resource is written.
comment:
  v: 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).
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.language
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: code
    l: code
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet
      l: elementdefinition-maxValueSet
    value: Canonical
      v: http://hl7.org/fhir/ValueSet/all-languages
      l: all-languages
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: Language
  strength:
    v: preferred
  description:
    v: A human language.
  value set:
    v: http://hl7.org/fhir/ValueSet/languages
    l: languages

id:
  v: MedicationDispense.text
path:
  v: MedicationDispense.text
short:
  v: Text summary of the resource, for human interpretation
definition:
  v: 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.
comment:
  v: 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.
alias:
  v: narrative
alias:
  v: html
alias:
  v: xhtml
alias:
  v: display
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.text
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Narrative
    l: Narrative
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: Act.text?

id:
  v: MedicationDispense.contained
path:
  v: MedicationDispense.contained
short:
  v: Contained, inline Resources
definition:
  v: 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.
comment:
  v: 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.
alias:
  v: inline resources
alias:
  v: anonymous resources
alias:
  v: contained resources
min:
  v: 0
max:
  v: *
base:
  path:
    v: DomainResource.contained
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Resource
    l: Resource
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: MedicationDispense.extension
path:
  v: MedicationDispense.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  ordered:
    v: false
  rules:
    v: open
short:
  v: Extension
definition:
  v: An Extension
min:
  v: 1
max:
  v: *
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: false
is summary:
  v: false

id:
  v: MedicationDispense.extension:recorded
path:
  v: MedicationDispense.extension
slice name:
  v: recorded
short:
  v: Extension
definition:
  v: Captures the recorded date of the event.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded
    l: us-quality-core-recorded
condition:
  v: ele-1
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: false
is summary:
  v: false

id:
  v: MedicationDispense.modifierExtension
path:
  v: MedicationDispense.modifierExtension
short:
  v: Extensions that cannot be ignored
definition:
  v: 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).
comment:
  v: 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.
requirements:
  v: 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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: DomainResource.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: MedicationDispense.identifier
path:
  v: MedicationDispense.identifier
short:
  v: External identifier
definition:
  v: 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.
comment:
  v: This is a business identifier, not a resource identifier.
min:
  v: 0
max:
  v: *
base:
  path:
    v: MedicationDispense.identifier
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Identifier
    l: Identifier
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: workflow
  map:
    v: Event.identifier
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.identifier
mapping:
  identity:
    v: rim
  map:
    v: .id
mapping:
  identity:
    v: rx-dispense-rmim
  map:
    v: CombinedMedicationDispense.id

id:
  v: MedicationDispense.partOf
path:
  v: MedicationDispense.partOf
short:
  v: Event that dispense is part of
definition:
  v: The procedure that trigger the dispense.
min:
  v: 0
max:
  v: *
base:
  path:
    v: MedicationDispense.partOf
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Procedure
    l: Procedure
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: workflow
  map:
    v: Event.partOf
mapping:
  identity:
    v: rim
  map:
    v: .outboundRelationship[typeCode=COMP]/target[classCode=PROC,moodCode=EVN]

id:
  v: MedicationDispense.status
extension:
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
    l: uscdi-requirement
  value: Boolean
    v: true
extension:
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
    l: uscdi-requirement
  value: Boolean
    v: true
extension:
  url:
    v: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/uscdiplusquality
    l: uscdiplusquality
  value: Boolean
    v: true
path:
  v: MedicationDispense.status
short:
  v: (USCDI+ Quality) (USCDI) preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
definition:
  v: A code specifying the state of the set of dispense events.
comment:
  v: This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: MedicationDispense.status
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: code
    l: code
fixed: Code
  v: declined
condition:
  v: us-core-20
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: true
is modifier reason:
  v: This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
is summary:
  v: true
binding:
  strength:
    v: required
  value set:
    v: http://hl7.org/fhir/ValueSet/medicationdispense-status
    l: medicationdispense-status
mapping:
  identity:
    v: workflow
  map:
    v: Event.status
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.status
mapping:
  identity:
    v: rim
  map:
    v: .statusCode
mapping:
  identity:
    v: rx-dispense-rmim
  map:
    v: CombinedMedicationDispense.SupplyEvent.statusCode

id:
  v: MedicationDispense.statusReason[x]
extension:
  url:
    v: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/uscdiplusquality
    l: uscdiplusquality
  value: Boolean
    v: true
path:
  v: MedicationDispense.statusReason[x]
short:
  v: (USCDI+ Quality) Why a dispense was not performed
definition:
  v: Indicates the reason why a dispense was not performed.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: MedicationDispense.statusReason[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  strength:
    v: extensible
  description:
    v: The reason the event did not occur or was not performed
  value set:
    v: http://fhir.org/guides/onc/us-quality-core/ValueSet/us-quality-core-negation-reason
    l: us-quality-core-negation-reason
mapping:
  identity:
    v: workflow
  map:
    v: Event.statusReason
mapping:
  identity:
    v: rim
  map:
    v: .outboundRelationship[typeCode=RSON]/target[classCode=OBS,moodCode=EVN, code="not done reason"].value

id:
  v: MedicationDispense.category
path:
  v: MedicationDispense.category
short:
  v: Type of medication dispense
definition:
  v: Indicates the type of medication dispense (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)).
comment:
  v: 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.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: MedicationDispense.category
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: MedicationDispenseCategory
  strength:
    v: preferred
  description:
    v: A code describing where the dispensed medication is expected to be consumed or administered.
  value set:
    v: http://hl7.org/fhir/ValueSet/medicationdispense-category
    l: medicationdispense-category
mapping:
  identity:
    v: rim
  map:
    v: .inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="type of medication dispense"].value

id:
  v: MedicationDispense.medication[x]
extension:
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
    l: uscdi-requirement
  value: Boolean
    v: true
extension:
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
    l: uscdi-requirement
  value: Boolean
    v: true
path:
  v: MedicationDispense.medication[x]
short:
  v: (USCDI) What medication was supplied
definition:
  v: 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.
comment:
  v: 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.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: MedicationDispense.medication[x]
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication
    l: us-core-medication
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: true
binding:
  strength:
    v: extensible
  description:
    v: The set of RxNorm codes to represent medications
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4
mapping:
  identity:
    v: workflow
  map:
    v: Event.code
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.what[x]
mapping:
  identity:
    v: v2
  map:
    v: RXD-2-Dispense/Give Code
mapping:
  identity:
    v: rim
  map:
    v: .participation[typeCode=PRD].role
mapping:
  identity:
    v: rx-dispense-rmim
  map:
    v: CombinedMedicationRequest.component1.AdministrationRequest.consumable

id:
  v: MedicationDispense.medication[x].id
path:
  v: MedicationDispense.medication[x].id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: string
      l: string
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: MedicationDispense.medication[x].extension
path:
  v: MedicationDispense.medication[x].extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) url
  rules:
    v: open
short:
  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: 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.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: MedicationDispense.medication[x].extension:notDoneValueSet
path:
  v: MedicationDispense.medication[x].extension
slice name:
  v: notDoneValueSet
short:
  v: Url of a value set of activities not requested or performed
definition:
  v: A logical reference (e.g. a reference to ValueSet.url) to a value set/version that identifies a set of possible coded values representing activities that were not requested, ordered, or performed.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
  profile:
    v: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet
    l: us-quality-core-notDoneValueSet
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: v2
  map:
    v: CWE.
mapping:
  identity:
    v: rim
  map:
    v: CD.valueSet/CD.valueSetVersion

id:
  v: MedicationDispense.subject
extension:
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
    l: uscdi-requirement
  value: Boolean
    v: true
extension:
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
    l: uscdi-requirement
  value: Boolean
    v: true
path:
  v: MedicationDispense.subject
short:
  v: (USCDI) Who the dispense is for
definition:
  v: A link to a resource representing the person or the group to whom the medication will be given.
comment:
  v: SubstanceAdministration->subject->Patient.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: MedicationDispense.subject
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient
    l: us-quality-core-patient
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: workflow
  map:
    v: Event.subject
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.subject[x]
mapping:
  identity:
    v: v2
  map:
    v: PID-3-Patient ID List
mapping:
  identity:
    v: rim
  map:
    v: .participation[typeCode=SBJ].role[classCode=PAT]
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.subject

id:
  v: MedicationDispense.context
path:
  v: MedicationDispense.context
short:
  v: Encounter / Episode associated with event
definition:
  v: The encounter or episode of care that establishes the context for this event.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: MedicationDispense.context
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Encounter
    l: Encounter
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/EpisodeOfCare
    l: EpisodeOfCare
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: workflow
  map:
    v: Event.context
mapping:
  identity:
    v: rim
  map:
    v: .inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code="type of encounter or episode"]

id:
  v: MedicationDispense.supportingInformation
path:
  v: MedicationDispense.supportingInformation
short:
  v: Information that supports the dispensing of the medication
definition:
  v: Additional information that supports the medication being dispensed.
min:
  v: 0
max:
  v: *
base:
  path:
    v: MedicationDispense.supportingInformation
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Resource
    l: Resource
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.context
mapping:
  identity:
    v: rim
  map:
    v: .outboundRelationship[typeCode=PERT].target[A_SupportingClinicalStatement CMET minimal with many different choices of classCodes(ORG, ENC, PROC, SPLY, SBADM, OBS) and each of the act class codes draws from one or more of the following moodCodes (EVN, DEF, INT PRMS, RQO, PRP, APT, ARQ, GOL)]

id:
  v: MedicationDispense.performer
extension:
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
    l: uscdi-requirement
  value: Boolean
    v: true
path:
  v: MedicationDispense.performer
short:
  v: (USCDI) Who performed event
definition:
  v: Indicates who or what performed the event.
min:
  v: 0
max:
  v: *
base:
  path:
    v: MedicationDispense.performer
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: workflow
  map:
    v: Event.performer
mapping:
  identity:
    v: rim
  map:
    v: .participation[typeCode=PRF]

id:
  v: MedicationDispense.performer.id
path:
  v: MedicationDispense.performer.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: string
      l: string
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: MedicationDispense.performer.extension
path:
  v: MedicationDispense.performer.extension
short:
  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: 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.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: MedicationDispense.performer.modifierExtension
path:
  v: MedicationDispense.performer.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: 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).
comment:
  v: 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.
requirements:
  v: 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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: MedicationDispense.performer.function
path:
  v: MedicationDispense.performer.function
short:
  v: Who performed the dispense and what they did
definition:
  v: Distinguishes the type of performer in the dispense. For example, date enterer, packager, final checker.
requirements:
  v: Allows disambiguation of the types of involvement of different performers.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: MedicationDispense.performer.function
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: MedicationDispensePerformerFunction
  strength:
    v: example
  description:
    v: A code describing the role an individual played in dispensing a medication.
  value set:
    v: http://hl7.org/fhir/ValueSet/medicationdispense-performer-function
    l: medicationdispense-performer-function
mapping:
  identity:
    v: rim
  map:
    v: participation[typeCode=PRF].functionCode

id:
  v: MedicationDispense.performer.actor
extension:
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
    l: uscdi-requirement
  value: Boolean
    v: true
path:
  v: MedicationDispense.performer.actor
short:
  v: (USCDI) Individual who was performing
definition:
  v: The device, practitioner, etc. who performed the action. It should be assumed that the actor is the dispenser of the medication.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: MedicationDispense.performer.actor
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner
    l: us-core-practitioner
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support
        l: elementdefinition-type-must-support
      value: Boolean
        v: true
  target profile:
    v: http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient
    l: us-core-patient
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support
        l: elementdefinition-type-must-support
      value: Boolean
        v: false
  target profile:
    v: http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization
    l: us-core-organization
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support
        l: elementdefinition-type-must-support
      value: Boolean
        v: true
  target profile:
    v: http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole
    l: us-core-practitionerrole
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support
        l: elementdefinition-type-must-support
      value: Boolean
        v: false
  target profile:
    v: http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson
    l: us-core-relatedperson
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support
        l: elementdefinition-type-must-support
      value: Boolean
        v: false
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Device
    l: Device
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support
        l: elementdefinition-type-must-support
      value: Boolean
        v: false
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: workflow
  map:
    v: Event.performer.actor
mapping:
  identity:
    v: rim
  map:
    v: .role

id:
  v: MedicationDispense.location
path:
  v: MedicationDispense.location
short:
  v: Where the dispense occurred
definition:
  v: The principal physical location where the dispense was performed.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: MedicationDispense.location
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Location
    l: Location
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: .participation[typeCode=LOC].role

id:
  v: MedicationDispense.authorizingPrescription
extension:
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
    l: uscdi-requirement
  value: Boolean
    v: true
extension:
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
    l: uscdi-requirement
  value: Boolean
    v: true
path:
  v: MedicationDispense.authorizingPrescription
short:
  v: (USCDI)
definition:
  v: Indicates the medication order that is being dispensed against.
comment:
  v: Maps to basedOn in Event logical model.
min:
  v: 0
max:
  v: *
base:
  path:
    v: MedicationDispense.authorizingPrescription
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-medicationrequest
    l: us-quality-core-medicationrequest
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: workflow
  map:
    v: Event.basedOn
mapping:
  identity:
    v: v2
  map:
    v: ORC-2 Placer Order Number
mapping:
  identity:
    v: rim
  map:
    v: .outboundRelationship[typeCode=FLFS].target[moodCode=RQO]
mapping:
  identity:
    v: rx-dispense-rmim
  map:
    v: CombinedMedicationDispense.inFulfillmentOf

id:
  v: MedicationDispense.type
extension:
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
    l: uscdi-requirement
  value: Boolean
    v: true
path:
  v: MedicationDispense.type
short:
  v: (USCDI) Trial fill, partial fill, emergency fill, etc.
definition:
  v: Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: MedicationDispense.type
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false
binding:
  strength:
    v: extensible
  value set:
    v: http://terminology.hl7.org/ValueSet/v3-ActPharmacySupplyType
    l: v3-ActPharmacySupplyType
mapping:
  identity:
    v: v2
  map:
    v: RXD-33-Dispense Type
mapping:
  identity:
    v: rim
  map:
    v: .code
mapping:
  identity:
    v: rx-dispense-rmim
  map:
    v: CombinedMedicationDispense.SupplyEvent.code

id:
  v: MedicationDispense.quantity
extension:
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
    l: uscdi-requirement
  value: Boolean
    v: true
extension:
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
    l: uscdi-requirement
  value: Boolean
    v: true
path:
  v: MedicationDispense.quantity
short:
  v: (USCDI) Amount dispensed
definition:
  v: The amount of medication that has been dispensed. Includes unit of measure.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: MedicationDispense.quantity
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Quantity
    l: Quantity
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet
      l: elementdefinition-maxValueSet
    value: Canonical
      v: http://hl7.org/fhir/ValueSet/ucum-units
      l: ucum-units
  strength:
    v: preferred
  value set:
    v: http://hl7.org/fhir/ValueSet/ucum-common
    l: ucum-common
mapping:
  identity:
    v: v2
  map:
    v: RXD-4-Actual Dispense Amount / RXD-5.1-Actual Dispense Units.code / RXD-5.3-Actual Dispense Units.name of coding system
mapping:
  identity:
    v: rim
  map:
    v: .quantity
mapping:
  identity:
    v: rx-dispense-rmim
  map:
    v: CombinedMedicationDispense.SupplyEvent.quantity

id:
  v: MedicationDispense.daysSupply
path:
  v: MedicationDispense.daysSupply
short:
  v: Amount of medication expressed as a timing amount
definition:
  v: The amount of medication expressed as a timing amount.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: MedicationDispense.daysSupply
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Quantity
    l: Quantity
  profile:
    v: http://hl7.org/fhir/StructureDefinition/SimpleQuantity
    l: SimpleQuantity
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: v2
  map:
    v: TQ1.6 Timing/Quantity Segment Service Duration. Prior to v2.5, ORC.7.3 Common Order Segment / Quantity/Timing / Duration component. This is a formatted string, first character for the time unit (e.g., D=days), followed by the value. For example, “D14” represents “14 days supply” From v2.5 on, TQ1.6 Timing/Quantity Segment / Service Duration. This is a CQ data type (<Quantity (NM)> ^ <Units (CWE)>), thus for days supply, assuming the unit of measure is “days”, the numeric value is TQ1.6.1 (…|14^ For backwards compatibility, ORC.7 was permitted through v2.6. Both forms (field and segment) may be present in v2.5, v2.5.1, and v2.6
mapping:
  identity:
    v: rim
  map:
    v: effectiveUseTime

id:
  v: MedicationDispense.whenPrepared
path:
  v: MedicationDispense.whenPrepared
short:
  v: When product was packaged and reviewed
definition:
  v: The time when the dispensed product was packaged and reviewed.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: MedicationDispense.whenPrepared
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: dateTime
    l: dateTime
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: RXD-3-Date/Time Dispensed
mapping:
  identity:
    v: rim
  map:
    v: .effectiveTime[xmi:type=IVL_TS].low
mapping:
  identity:
    v: rx-dispense-rmim
  map:
    v: CombinedMedicationDispense.SupplyEvent.effectiveTime

id:
  v: MedicationDispense.whenHandedOver
extension:
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
    l: uscdi-requirement
  value: Boolean
    v: true
path:
  v: MedicationDispense.whenHandedOver
short:
  v: (USCDI) When product was given out or mailed
definition:
  v: When the product was given out. For mailed prescriptions, when the label was printed
min:
  v: 0
max:
  v: 1
base:
  path:
    v: MedicationDispense.whenHandedOver
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: dateTime
    l: dateTime
condition:
  v: us-core-20
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: workflow
  map:
    v: Event.occurrence[x]
mapping:
  identity:
    v: v2
  map:
    v: RXD-3-Date/Time Dispensed
mapping:
  identity:
    v: rim
  map:
    v: .effectiveTime[xmi:type=IVL_TS].high
mapping:
  identity:
    v: rx-dispense-rmim
  map:
    v: CombinedMedicationDispense.SupplyEvent.effectiveTime

id:
  v: MedicationDispense.destination
path:
  v: MedicationDispense.destination
short:
  v: Where the medication was sent
definition:
  v: Identification of the facility/location where the medication was shipped to, as part of the dispense event.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: MedicationDispense.destination
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Location
    l: Location
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: v2
  map:
    v: RXD-13 Dispense-to Location; RXD-30 Dispense to Pharmacy; RXD-31 Dispense to Pharmacy Address
mapping:
  identity:
    v: rim
  map:
    v: .participation[typeCode=DST].role
mapping:
  identity:
    v: rx-dispense-rmim
  map:
    v: CombinedMedicationDispense.SupplyEvent.destination

id:
  v: MedicationDispense.receiver
path:
  v: MedicationDispense.receiver
short:
  v: Who collected the medication
definition:
  v: 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.
min:
  v: 0
max:
  v: *
base:
  path:
    v: MedicationDispense.receiver
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Patient
    l: Patient
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Practitioner
    l: Practitioner
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: .participation[typeCode=RCV].role
mapping:
  identity:
    v: rx-dispense-rmim
  map:
    v: CombinedMedicationDispense.SupplyEvent.receiver

id:
  v: MedicationDispense.note
path:
  v: MedicationDispense.note
short:
  v: Information about the dispense
definition:
  v: Extra information about the dispense that could not be conveyed in the other attributes.
min:
  v: 0
max:
  v: *
base:
  path:
    v: MedicationDispense.note
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Annotation
    l: Annotation
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: workflow
  map:
    v: Event.note
mapping:
  identity:
    v: v2
  map:
    v: RXD-9 Dispense Notes
mapping:
  identity:
    v: rim
  map:
    v: .inboundRelationship[typeCode=SUBJ]/source[classCode=ACT,moodCode=EVN]

id:
  v: MedicationDispense.dosageInstruction
extension:
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
    l: uscdi-requirement
  value: Boolean
    v: true
extension:
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
    l: uscdi-requirement
  value: Boolean
    v: true
path:
  v: MedicationDispense.dosageInstruction
short:
  v: (USCDI)
definition:
  v: Indicates how the medication is to be used by the patient.
comment:
  v: 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.
min:
  v: 0
max:
  v: *
base:
  path:
    v: MedicationDispense.dosageInstruction
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Dosage
    l: Dosage
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: .outboundRelationship[typeCode=COMP].target[classCode=SBADM, moodCode=INT]

id:
  v: MedicationDispense.dosageInstruction.id
path:
  v: MedicationDispense.dosageInstruction.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: string
      l: string
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: MedicationDispense.dosageInstruction.extension
path:
  v: MedicationDispense.dosageInstruction.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) url
  rules:
    v: open
short:
  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: 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.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: MedicationDispense.dosageInstruction.modifierExtension
path:
  v: MedicationDispense.dosageInstruction.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: 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).
comment:
  v: 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.
requirements:
  v: 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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: MedicationDispense.dosageInstruction.sequence
path:
  v: MedicationDispense.dosageInstruction.sequence
short:
  v: The order of the dosage instructions
definition:
  v: Indicates the order in which the dosage instructions should be applied or interpreted.
requirements:
  v: If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. If the sequence number is different, then the Dosages are intended to be sequential.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Dosage.sequence
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: integer
    l: integer
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: TQ1-1
mapping:
  identity:
    v: rim
  map:
    v: .text

id:
  v: MedicationDispense.dosageInstruction.text
extension:
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
    l: uscdi-requirement
  value: Boolean
    v: true
extension:
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
    l: uscdi-requirement
  value: Boolean
    v: true
path:
  v: MedicationDispense.dosageInstruction.text
short:
  v: (USCDI) Free text dosage instructions e.g. SIG
definition:
  v: Free text dosage instructions e.g. SIG.
requirements:
  v: Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing. Additional information about administration or preparation of the medication should be included as text.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Dosage.text
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
    l: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: RXO-6; RXE-21
mapping:
  identity:
    v: rim
  map:
    v: .text

id:
  v: MedicationDispense.dosageInstruction.additionalInstruction
path:
  v: MedicationDispense.dosageInstruction.additionalInstruction
short:
  v: Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
definition:
  v: Supplemental instructions to the patient on how to take the medication (e.g. "with meals" or"take half to one hour before food") or warnings for the patient about the medication (e.g. "may cause drowsiness" or "avoid exposure of skin to direct sunlight or sunlamps").
comment:
  v: Information about administration or preparation of the medication (e.g. "infuse as rapidly as possibly via intraperitoneal port" or "immediately following drug x") should be populated in dosage.text.
requirements:
  v: Additional instruction is intended to be coded, but where no code exists, the element could include text. For example, "Swallow with plenty of water" which might or might not be coded.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Dosage.additionalInstruction
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: AdditionalInstruction
  strength:
    v: example
  description:
    v: A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
  value set:
    v: http://hl7.org/fhir/ValueSet/additional-instruction-codes
    l: additional-instruction-codes
mapping:
  identity:
    v: v2
  map:
    v: RXO-7
mapping:
  identity:
    v: rim
  map:
    v: .text

id:
  v: MedicationDispense.dosageInstruction.patientInstruction
path:
  v: MedicationDispense.dosageInstruction.patientInstruction
short:
  v: Patient or consumer oriented instructions
definition:
  v: Instructions in terms that are understood by the patient or consumer.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Dosage.patientInstruction
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
    l: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: RXO-7
mapping:
  identity:
    v: rim
  map:
    v: .text

id:
  v: MedicationDispense.dosageInstruction.timing
extension:
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
    l: uscdi-requirement
  value: Boolean
    v: true
extension:
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
    l: uscdi-requirement
  value: Boolean
    v: true
path:
  v: MedicationDispense.dosageInstruction.timing
short:
  v: (USCDI) When medication should be administered
definition:
  v: When medication should be administered.
comment:
  v: This attribute might not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.
requirements:
  v: The timing schedule for giving the medication to the patient. This data type allows many different expressions. For example: "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Dosage.timing
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Timing
    l: Timing
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: .effectiveTime

id:
  v: MedicationDispense.dosageInstruction.asNeeded[x]
path:
  v: MedicationDispense.dosageInstruction.asNeeded[x]
short:
  v: Take "as needed" (for x)
definition:
  v: Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept).
comment:
  v: Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not "prn" or "as needed".
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Dosage.asNeeded[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: boolean
    l: boolean
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: MedicationAsNeededReason
  strength:
    v: example
  description:
    v: A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.
  value set:
    v: http://hl7.org/fhir/ValueSet/medication-as-needed-reason
    l: medication-as-needed-reason
mapping:
  identity:
    v: v2
  map:
    v: TQ1-9
mapping:
  identity:
    v: rim
  map:
    v: .outboundRelationship[typeCode=PRCN].target[classCode=OBS, moodCode=EVN, code="as needed"].value=boolean or codable concept

id:
  v: MedicationDispense.dosageInstruction.site
path:
  v: MedicationDispense.dosageInstruction.site
short:
  v: Body site to administer to
definition:
  v: Body site to administer to.
comment:
  v: If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [bodySite](http://hl7.org/fhir/R4/extension-bodysite.html). May be a summary code, or a reference to a very precise definition of the location, or both.
requirements:
  v: A coded specification of the anatomic site where the medication first enters the body.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Dosage.site
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: MedicationAdministrationSite
  strength:
    v: example
  description:
    v: A coded concept describing the site location the medicine enters into or onto the body.
  value set:
    v: http://hl7.org/fhir/ValueSet/approach-site-codes
    l: approach-site-codes
mapping:
  identity:
    v: v2
  map:
    v: RXR-2
mapping:
  identity:
    v: rim
  map:
    v: .approachSiteCode

id:
  v: MedicationDispense.dosageInstruction.route
path:
  v: MedicationDispense.dosageInstruction.route
short:
  v: How drug should enter body
definition:
  v: How drug should enter body.
requirements:
  v: A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Dosage.route
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: false
is modifier:
  v: false
is summary:
  v: true
binding:
  strength:
    v: preferred
  value set:
    v: http://hl7.org/fhir/ValueSet/route-codes
    l: route-codes
mapping:
  identity:
    v: v2
  map:
    v: RXR-1
mapping:
  identity:
    v: rim
  map:
    v: .routeCode

id:
  v: MedicationDispense.dosageInstruction.method
path:
  v: MedicationDispense.dosageInstruction.method
short:
  v: Technique for administering medication
definition:
  v: Technique for administering medication.
comment:
  v: Terminologies used often pre-coordinate this term with the route and or form of administration.
requirements:
  v: A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Dosage.method
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: MedicationAdministrationMethod
  strength:
    v: example
  description:
    v: A coded concept describing the technique by which the medicine is administered.
  value set:
    v: http://hl7.org/fhir/ValueSet/administration-method-codes
    l: administration-method-codes
mapping:
  identity:
    v: v2
  map:
    v: RXR-4
mapping:
  identity:
    v: rim
  map:
    v: .doseQuantity

id:
  v: MedicationDispense.dosageInstruction.doseAndRate
extension:
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
    l: uscdi-requirement
  value: Boolean
    v: true
extension:
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
    l: uscdi-requirement
  value: Boolean
    v: true
path:
  v: MedicationDispense.dosageInstruction.doseAndRate
short:
  v: (USCDI) Amount of medication administered
definition:
  v: The amount of medication administered.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Dosage.doseAndRate
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Element
    l: Element
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: TQ1-2

id:
  v: MedicationDispense.dosageInstruction.doseAndRate.id
path:
  v: MedicationDispense.dosageInstruction.doseAndRate.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: string
      l: string
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: MedicationDispense.dosageInstruction.doseAndRate.extension
path:
  v: MedicationDispense.dosageInstruction.doseAndRate.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) url
  rules:
    v: open
short:
  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: 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.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: MedicationDispense.dosageInstruction.doseAndRate.type
path:
  v: MedicationDispense.dosageInstruction.doseAndRate.type
short:
  v: The kind of dose or rate specified
definition:
  v: The kind of dose or rate specified, for example, ordered or calculated.
requirements:
  v: If the type is not populated, assume to be "ordered".
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Dosage.doseAndRate.type
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
binding:
  strength:
    v: preferred
  description:
    v: Medication dose types (e.g., loading, maintenance, etc.)
  value set:
    v: http://fhir.org/guides/onc/us-quality-core/ValueSet/us-quality-core-medication-dose-type
    l: us-quality-core-medication-dose-type
mapping:
  identity:
    v: v2
  map:
    v: RXO-21; RXE-23

id:
  v: MedicationDispense.dosageInstruction.doseAndRate.dose[x]
extension:
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
    l: uscdi-requirement
  value: Boolean
    v: true
extension:
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
    l: uscdi-requirement
  value: Boolean
    v: true
path:
  v: MedicationDispense.dosageInstruction.doseAndRate.dose[x]
short:
  v: (USCDI) Amount of medication per dose
definition:
  v: Amount of medication per dose.
comment:
  v: Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.
requirements:
  v: The amount of therapeutic or other substance given at one administration event.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Dosage.doseAndRate.dose[x]
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support
      l: elementdefinition-type-must-support
    value: Boolean
      v: true
  code:
    v: Quantity
    l: Quantity
type:
  code:
    v: Range
    l: Range
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet
      l: elementdefinition-maxValueSet
    value: Canonical
      v: http://hl7.org/fhir/ValueSet/ucum-units
      l: ucum-units
  strength:
    v: preferred
  value set:
    v: http://hl7.org/fhir/ValueSet/ucum-common
    l: ucum-common
mapping:
  identity:
    v: v2
  map:
    v: RXO-2, RXE-3
mapping:
  identity:
    v: rim
  map:
    v: .doseQuantity

id:
  v: MedicationDispense.dosageInstruction.doseAndRate.rate[x]
path:
  v: MedicationDispense.dosageInstruction.doseAndRate.rate[x]
short:
  v: Amount of medication per unit of time
definition:
  v: Amount of medication per unit of time.
comment:
  v: It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate. It is possible to specify a rate over time (for example, 100 ml/hour) using either the rateRatio and rateQuantity. The rateQuantity approach requires systems to have the capability to parse UCUM grammer where ml/hour is included rather than a specific ratio where the time is specified as the denominator. Where a rate such as 500ml over 2 hours is specified, the use of rateRatio may be more semantically correct than specifying using a rateQuantity of 250 mg/hour.
requirements:
  v: Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Dosage.doseAndRate.rate[x]
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Ratio
    l: Ratio
type:
  code:
    v: Range
    l: Range
type:
  code:
    v: Quantity
    l: Quantity
  profile:
    v: http://hl7.org/fhir/StructureDefinition/SimpleQuantity
    l: SimpleQuantity
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: RXE22, RXE23, RXE-24
mapping:
  identity:
    v: rim
  map:
    v: .rateQuantity

id:
  v: MedicationDispense.dosageInstruction.maxDosePerPeriod
path:
  v: MedicationDispense.dosageInstruction.maxDosePerPeriod
short:
  v: Upper limit on medication per unit of time
definition:
  v: Upper limit on medication per unit of time.
comment:
  v: This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".
requirements:
  v: The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Dosage.maxDosePerPeriod
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Ratio
    l: Ratio
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: RXO-23, RXE-19
mapping:
  identity:
    v: rim
  map:
    v: .maxDoseQuantity

id:
  v: MedicationDispense.dosageInstruction.maxDosePerAdministration
path:
  v: MedicationDispense.dosageInstruction.maxDosePerAdministration
short:
  v: Upper limit on medication per administration
definition:
  v: Upper limit on medication per administration.
comment:
  v: This is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg.
requirements:
  v: The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Dosage.maxDosePerAdministration
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Quantity
    l: Quantity
  profile:
    v: http://hl7.org/fhir/StructureDefinition/SimpleQuantity
    l: SimpleQuantity
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: not supported

id:
  v: MedicationDispense.dosageInstruction.maxDosePerLifetime
path:
  v: MedicationDispense.dosageInstruction.maxDosePerLifetime
short:
  v: Upper limit on medication per lifetime of the patient
definition:
  v: Upper limit on medication per lifetime of the patient.
requirements:
  v: The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Dosage.maxDosePerLifetime
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Quantity
    l: Quantity
  profile:
    v: http://hl7.org/fhir/StructureDefinition/SimpleQuantity
    l: SimpleQuantity
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: not supported

id:
  v: MedicationDispense.substitution
path:
  v: MedicationDispense.substitution
short:
  v: Whether a substitution was performed on the dispense
definition:
  v: 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.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: MedicationDispense.substitution
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: .outboundRelationship[typeCode=COMP].target[classCode=SUBST, moodCode=EVN]
mapping:
  identity:
    v: rx-dispense-rmim
  map:
    v: CombinedMedicationDispense.substitutionMade

id:
  v: MedicationDispense.substitution.id
path:
  v: MedicationDispense.substitution.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: string
      l: string
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: MedicationDispense.substitution.extension
path:
  v: MedicationDispense.substitution.extension
short:
  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: 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.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: MedicationDispense.substitution.modifierExtension
path:
  v: MedicationDispense.substitution.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: 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).
comment:
  v: 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.
requirements:
  v: 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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: MedicationDispense.substitution.wasSubstituted
path:
  v: MedicationDispense.substitution.wasSubstituted
short:
  v: Whether a substitution was or was not performed on the dispense
definition:
  v: True if the dispenser dispensed a different drug or product from what was prescribed.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: MedicationDispense.substitution.wasSubstituted
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: boolean
    l: boolean
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: .actionNegationInd

id:
  v: MedicationDispense.substitution.type
path:
  v: MedicationDispense.substitution.type
short:
  v: Code signifying whether a different drug was dispensed from what was prescribed
definition:
  v: A code signifying whether a different drug was dispensed from what was prescribed.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: MedicationDispense.substitution.type
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: MedicationIntendedSubstitutionType
  strength:
    v: example
  description:
    v: A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription.
  value set:
    v: http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode
    l: v3-ActSubstanceAdminSubstitutionCode
mapping:
  identity:
    v: v2
  map:
    v: RXO-9-Allow Substitutions / RXE-9-Substitution Status
mapping:
  identity:
    v: rim
  map:
    v: .code
mapping:
  identity:
    v: rx-dispense-rmim
  map:
    v: CombinedMedicationDispense.substitutionMade.code

id:
  v: MedicationDispense.substitution.reason
path:
  v: MedicationDispense.substitution.reason
short:
  v: Why was substitution made
definition:
  v: Indicates the reason for the substitution (or lack of substitution) from what was prescribed.
min:
  v: 0
max:
  v: *
base:
  path:
    v: MedicationDispense.substitution.reason
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: MedicationIntendedSubstitutionReason
  strength:
    v: example
  description:
    v: A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
  value set:
    v: http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason
    l: v3-SubstanceAdminSubstitutionReason
mapping:
  identity:
    v: rim
  map:
    v: .reasonCode
mapping:
  identity:
    v: rx-dispense-rmim
  map:
    v: CombinedMedicationDispense.substitutionMade.reasonCode

id:
  v: MedicationDispense.substitution.responsibleParty
path:
  v: MedicationDispense.substitution.responsibleParty
short:
  v: Who is responsible for the substitution
definition:
  v: The person or organization that has primary responsibility for the substitution.
min:
  v: 0
max:
  v: *
base:
  path:
    v: MedicationDispense.substitution.responsibleParty
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Practitioner
    l: Practitioner
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/PractitionerRole
    l: PractitionerRole
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: .participation[typeCode=PFM].role[classCode=ASSIGN]
mapping:
  identity:
    v: rx-dispense-rmim
  map:
    v: CombinedMedicationDispense.substitutionMade.ResponsibleParty

id:
  v: MedicationDispense.detectedIssue
path:
  v: MedicationDispense.detectedIssue
short:
  v: Clinical issue with action
definition:
  v: 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.
comment:
  v: 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.
alias:
  v: Contraindication
alias:
  v: Drug Utilization Review (DUR)
alias:
  v: Alert
min:
  v: 0
max:
  v: *
base:
  path:
    v: MedicationDispense.detectedIssue
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/DetectedIssue
    l: DetectedIssue
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: .inboundRelationship[typeCode=SUBJ]/source[classCode=ALRT,moodCode=EVN].value

id:
  v: MedicationDispense.eventHistory
path:
  v: MedicationDispense.eventHistory
short:
  v: A list of relevant lifecycle events
definition:
  v: A summary of the events of interest that have occurred, such as when the dispense was verified.
comment:
  v: 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.).
min:
  v: 0
max:
  v: *
base:
  path:
    v: MedicationDispense.eventHistory
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Provenance
    l: Provenance
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: .inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]

element:
  id:
    v: MedicationDispense
  path:
    v: MedicationDispense
  constraint:
    key:
      v: mnd-1
    severity:
      v: error
    human:
      v: To indicate what medication was not dispensed, either at least one coding in the medication or a notDoneValueSet extension shall be provided
    expression:
      v: medication.extension('http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor medication.coding.exists()
    xpath:
      v: exists(f:extension)
element:
  id:
    v: MedicationDispense.extension:recorded
  path:
    v: MedicationDispense.extension
  slice name:
    v: recorded
  short:
    v: Extension
  min:
    v: 1
  max:
    v: 1
  type:
    code:
      v: Extension
      l: Extension
    profile:
      v: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded
      l: us-quality-core-recorded
element:
  id:
    v: MedicationDispense.status
  extension:
    url:
      v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
      l: uscdi-requirement
    value: Boolean
      v: true
  extension:
    url:
      v: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/uscdiplusquality
      l: uscdiplusquality
    value: Boolean
      v: true
  path:
    v: MedicationDispense.status
  short:
    v: (USCDI+ Quality) (USCDI) preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
  type:
    code:
      v: code
      l: code
  fixed: Code
    v: declined
  binding:
    strength:
      v: required
    value set:
      v: http://hl7.org/fhir/ValueSet/medicationdispense-status
      l: medicationdispense-status
element:
  id:
    v: MedicationDispense.statusReason[x]
  extension:
    url:
      v: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/uscdiplusquality
      l: uscdiplusquality
    value: Boolean
      v: true
  path:
    v: MedicationDispense.statusReason[x]
  short:
    v: (USCDI+ Quality) Why a dispense was not performed
  min:
    v: 1
  max:
    v: 1
  type:
    code:
      v: CodeableConcept
      l: CodeableConcept
  binding:
    strength:
      v: extensible
    description:
      v: The reason the event did not occur or was not performed
    value set:
      v: http://fhir.org/guides/onc/us-quality-core/ValueSet/us-quality-core-negation-reason
      l: us-quality-core-negation-reason
element:
  id:
    v: MedicationDispense.medication[x]
  extension:
    url:
      v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
      l: uscdi-requirement
    value: Boolean
      v: true
  path:
    v: MedicationDispense.medication[x]
  short:
    v: (USCDI) What medication was supplied
  binding:
    strength:
      v: extensible
    description:
      v: The set of RxNorm codes to represent medications
    value set:
      v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4
      l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1010.4
element:
  id:
    v: MedicationDispense.medication[x].extension:notDoneValueSet
  path:
    v: MedicationDispense.medication[x].extension
  slice name:
    v: notDoneValueSet
  short:
    v: Url of a value set of activities not requested or performed
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: Extension
      l: Extension
    profile:
      v: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet
      l: us-quality-core-notDoneValueSet
element:
  id:
    v: MedicationDispense.subject
  extension:
    url:
      v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
      l: uscdi-requirement
    value: Boolean
      v: true
  path:
    v: MedicationDispense.subject
  short:
    v: (USCDI) Who the dispense is for
  type:
    code:
      v: Reference
      l: Reference
    target profile:
      v: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient
      l: us-quality-core-patient
element:
  id:
    v: MedicationDispense.authorizingPrescription
  extension:
    url:
      v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
      l: uscdi-requirement
    value: Boolean
      v: true
  path:
    v: MedicationDispense.authorizingPrescription
  short:
    v: (USCDI)
  type:
    code:
      v: Reference
      l: Reference
    target profile:
      v: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-medicationrequest
      l: us-quality-core-medicationrequest
element:
  id:
    v: MedicationDispense.quantity
  extension:
    url:
      v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
      l: uscdi-requirement
    value: Boolean
      v: true
  path:
    v: MedicationDispense.quantity
  short:
    v: (USCDI) Amount dispensed
element:
  id:
    v: MedicationDispense.daysSupply
  path:
    v: MedicationDispense.daysSupply
  short:
    v: Amount of medication expressed as a timing amount
element:
  id:
    v: MedicationDispense.dosageInstruction
  extension:
    url:
      v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
      l: uscdi-requirement
    value: Boolean

Boolean
v: true

v: MedicationDispense.dosageInstruction

v: (USCDI)

id:
  v: MedicationDispense.dosageInstruction.text
extension:
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
    l: uscdi-requirement
  value: Boolean
    v: true
path:
  v: MedicationDispense.dosageInstruction.text
short:
  v: (USCDI) Free text dosage instructions e.g. SIG

id:
  v: MedicationDispense.dosageInstruction.timing
extension:
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
    l: uscdi-requirement
  value: Boolean
    v: true
path:
  v: MedicationDispense.dosageInstruction.timing
short:
  v: (USCDI) When medication should be administered

id:
  v: MedicationDispense.dosageInstruction.route
path:
  v: MedicationDispense.dosageInstruction.route
must support:
  v: false
binding:
  strength:
    v: preferred
  value set:
    v: http://hl7.org/fhir/ValueSet/route-codes
    l: route-codes

id:
  v: MedicationDispense.dosageInstruction.doseAndRate
extension:
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
    l: uscdi-requirement
  value: Boolean
    v: true
path:
  v: MedicationDispense.dosageInstruction.doseAndRate
short:
  v: (USCDI) Amount of medication administered

id:
  v: MedicationDispense.dosageInstruction.doseAndRate.type
path:
  v: MedicationDispense.dosageInstruction.doseAndRate.type
short:
  v: The kind of dose or rate specified
min:
  v: 1
max:
  v: 1
binding:
  strength:
    v: preferred
  description:
    v: Medication dose types (e.g., loading, maintenance, etc.)
  value set:
    v: http://fhir.org/guides/onc/us-quality-core/ValueSet/us-quality-core-medication-dose-type
    l: us-quality-core-medication-dose-type

id:
  v: MedicationDispense.dosageInstruction.doseAndRate.dose[x]
extension:
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement
    l: uscdi-requirement
  value: Boolean
    v: true
path:
  v: MedicationDispense.dosageInstruction.doseAndRate.dose[x]
short:
  v: (USCDI) Amount of medication per dose