2026 US Quality Core Implementation Guide
0.5.0 - release United States of America flag

This page is part of the US Quality Core (v0.5.0: Release) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Resource Profile: US Quality Core MedicationDispense Declined

Official URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-medicationdispensedeclined Version: 0.5.0
Active as of 2026-06-05 Computable Name: USQualityCoreMedicationDispenseDeclined

Negation profile of MedicationDispense for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.

USCDI+ Quality Element Support Expectations

Systems are expected to support this profile as part of implementing USCDI+ Quality V1 in FHIR and meeting the conformance requirements of this guide.

The following elements are specifically relevant to USCDI+ Quality V1 data classes and elements. Systems are expected to support these elements as applicable to their role in US Quality Core data exchange. See the Must Support section of this guide for more information. These elements are tagged as (USCDI+ Quality) in the formal profile views.

USCDI+ Quality Elements:

  • status: (USCDI+ Quality) (USCDI) preparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
  • statusReason[x]: (USCDI+ Quality) Why a dispense was not performed

Because this profile is derived from US Core, systems are also expected to support Must Support requirements and (USCDI) tagged elements inherited from US Core. The Formal Views section also provides the formal summary, definitions, terminology requirements, and mandatory element requirements.

Profile Specific Implementation Guidance

This profile represents a medication dispense that was declined for a medical, patient, or system reason. To represent medication dispenses that were not declined, use the US Quality Core MedicationDispense profile.

Additional informational guidance for authoring CQL using this profile is provided in the CQL Authoring Usage (Informational) section of this page.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. MedicationDispense C 0..* USCoreMedicationDispenseProfile(6.1.0) Dispensing a medication to a named patient
Constraints: mdd-1, us-core-20, mnd-1
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:recorded 1..1 dateTime Extension
URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... 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
... medication[x] SΣ 1..1 (USCDI) What medication was supplied
Binding: Medication Clinical Drug . (extensible): The set of RxNorm codes to represent medications
.... medication[x]All Types Content/Rules for all Types
..... Slices for extension Content/Rules for all slices
...... 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
.... medicationCodeableConcept CodeableConcept
.... medicationReference Reference(US Core Medication Profile(7.0.0))
... subject SΣ 1..1 Reference(US Quality Core Patient) (USCDI) Who the dispense is for
... performer S 0..* BackboneElement (USCDI) Who performed event
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... actor S 1..1 Reference(US Core Practitioner Profile(7.0.0) S | US Core Patient Profile(7.0.0) | US Core Organization Profile(7.0.0) S | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0) | Device) (USCDI) Individual who was performing
... authorizingPrescription S 0..* Reference(US Quality Core MedicationRequest) (USCDI)
... type S 0..1 CodeableConcept (USCDI) Trial fill, partial fill, emergency fill, etc.
Binding: V3 Value SetActPharmacySupplyType (extensible)
... quantity S 0..1 Quantity (USCDI) Amount dispensed
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodes Max Binding
... daysSupply 0..1 SimpleQuantity Amount of medication expressed as a timing amount
... whenHandedOver SC 0..1 dateTime (USCDI) When product was given out or mailed
... dosageInstruction S 0..* Dosage (USCDI)
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... text SΣ 0..1 string (USCDI) Free text dosage instructions e.g. SIG
.... timing SΣ 0..1 Timing (USCDI) When medication should be administered
.... route Σ 0..1 CodeableConcept How drug should enter body
Binding: SNOMEDCTRouteCodes (preferred)
.... doseAndRate SΣ 0..* Element (USCDI) Amount of medication administered
..... type Σ 1..1 CodeableConcept The kind of dose or rate specified
Binding: USQualityCore SNOMED CT Dosage Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)
..... dose[x] SΣ 0..1 (USCDI) Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodes Max Binding
...... doseQuantity Quantity S
...... doseRange Range

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
MedicationDispense.status Base required Medication dispense status codes 📦4.0.1 FHIR Std.
MedicationDispense.statusReason[x] Base extensible USQualityCore Negation Reason Codes 📦0.5.0 This IG
MedicationDispense.medication[x] Base extensible Medication Clinical Drug . 📦20170601 VSAC v0.18
MedicationDispense.type Base extensible V3 Value SetActPharmacySupplyType 📦2014-03-26 FHIR Std.
MedicationDispense.quantity Base preferred Common UCUM units 📦4.0.1 FHIR Std.
MedicationDispense.dosageInstruction.​route Base preferred SNOMED CT Route Codes 📦4.0.1 FHIR Std.
MedicationDispense.dosageInstruction.​doseAndRate.type Base preferred USQualityCore SNOMED CT Dosage Codes 📦0.5.0 This IG
MedicationDispense.dosageInstruction.​doseAndRate.dose[x] Base preferred Common UCUM units 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error MedicationDispense If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error MedicationDispense If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error MedicationDispense If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error MedicationDispense If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice MedicationDispense A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
mdd-1 error MedicationDispense whenHandedOver cannot be before whenPrepared whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared
mnd-1 error MedicationDispense To indicate what medication was not dispensed, either at least one coding in the medication or a notDoneValueSet extension shall be provided medication.extension('http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor medication.coding.exists()
us-core-20 error MedicationDispense whenHandedOver SHALL be present if the status is "completed" status='completed' implies whenHandedOver.exists()

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. MedicationDispense C 0..* USCoreMedicationDispenseProfile(6.1.0) Dispensing a medication to a named patient
Constraints: mnd-1
... Slices for extension Content/Rules for all slices
.... extension:recorded 1..1 dateTime Extension
URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded
... 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
... 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
.... Slices for extension Content/Rules for all slices
..... 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
... subject 1..1 Reference(US Quality Core Patient) (USCDI) Who the dispense is for
... authorizingPrescription 0..* Reference(US Quality Core MedicationRequest) (USCDI)
... quantity 0..1 Quantity (USCDI) Amount dispensed
... daysSupply 0..1 SimpleQuantity Amount of medication expressed as a timing amount
... dosageInstruction 0..* Dosage (USCDI)
.... text 0..1 string (USCDI) Free text dosage instructions e.g. SIG
.... timing 0..1 Timing (USCDI) When medication should be administered
.... route 0..1 CodeableConcept How drug should enter body
Binding: SNOMEDCTRouteCodes (preferred)
.... doseAndRate 0..* Element (USCDI) Amount of medication administered
..... type 1..1 CodeableConcept The kind of dose or rate specified
Binding: USQualityCore SNOMED CT Dosage Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)
..... dose[x] 0..1 Quantity, Range (USCDI) Amount of medication per dose

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
MedicationDispense.status Base required Medication dispense status codes 📦4.0.1 FHIR Std.
MedicationDispense.statusReason[x] Base extensible USQualityCore Negation Reason Codes 📦0.5.0 This IG
MedicationDispense.medication[x] Base extensible Medication Clinical Drug . 📦20170601 VSAC v0.18
MedicationDispense.dosageInstruction.​route Base preferred SNOMED CT Route Codes 📦4.0.1 FHIR Std.
MedicationDispense.dosageInstruction.​doseAndRate.type Base preferred USQualityCore SNOMED CT Dosage Codes 📦0.5.0 This IG

Constraints

Id Grade Path(s) Description Expression
mnd-1 error MedicationDispense To indicate what medication was not dispensed, either at least one coding in the medication or a notDoneValueSet extension shall be provided medication.extension('http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor medication.coding.exists()
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. MedicationDispense C 0..* USCoreMedicationDispenseProfile(6.1.0) Dispensing a medication to a named patient
Constraints: mdd-1, us-core-20, mnd-1
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:recorded 1..1 dateTime Extension
URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier 0..* Identifier External identifier
... partOf 0..* Reference(Procedure) Event that dispense is part of
... status ?!SΣC 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
... 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
... category 0..1 CodeableConcept Type of medication dispense
Binding: MedicationDispense Category Codes (preferred): A code describing where the dispensed medication is expected to be consumed or administered.
... medication[x] SΣ 1..1 (USCDI) What medication was supplied
Binding: Medication Clinical Drug . (extensible): The set of RxNorm codes to represent medications
.... medication[x]All Types Content/Rules for all Types
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... 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
.... medicationCodeableConcept CodeableConcept
.... medicationReference Reference(US Core Medication Profile(7.0.0))
... subject SΣ 1..1 Reference(US Quality Core Patient) (USCDI) Who the dispense is for
... context 0..1 Reference(Encounter | EpisodeOfCare) Encounter / Episode associated with event
... supportingInformation 0..* Reference(Resource) Information that supports the dispensing of the medication
... performer S 0..* BackboneElement (USCDI) Who performed event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... function 0..1 CodeableConcept Who performed the dispense and what they did
Binding: MedicationDispense Performer Function Codes (example): A code describing the role an individual played in dispensing a medication.
.... actor S 1..1 Reference(US Core Practitioner Profile(7.0.0) S | US Core Patient Profile(7.0.0) | US Core Organization Profile(7.0.0) S | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0) | Device) (USCDI) Individual who was performing
... location 0..1 Reference(Location) Where the dispense occurred
... authorizingPrescription S 0..* Reference(US Quality Core MedicationRequest) (USCDI)
... type S 0..1 CodeableConcept (USCDI) Trial fill, partial fill, emergency fill, etc.
Binding: V3 Value SetActPharmacySupplyType (extensible)
... quantity S 0..1 Quantity (USCDI) Amount dispensed
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodes Max Binding
... daysSupply 0..1 SimpleQuantity Amount of medication expressed as a timing amount
... whenPrepared Σ 0..1 dateTime When product was packaged and reviewed
... whenHandedOver SC 0..1 dateTime (USCDI) When product was given out or mailed
... destination 0..1 Reference(Location) Where the medication was sent
... receiver 0..* Reference(Patient | Practitioner) Who collected the medication
... note 0..* Annotation Information about the dispense
... dosageInstruction S 0..* Dosage (USCDI)
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 0..1 integer The order of the dosage instructions
.... text SΣ 0..1 string (USCDI) Free text dosage instructions e.g. SIG
.... additionalInstruction Σ 0..* CodeableConcept Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
.... patientInstruction Σ 0..1 string Patient or consumer oriented instructions
.... timing SΣ 0..1 Timing (USCDI) When medication should be administered
.... asNeeded[x] Σ 0..1 Take "as needed" (for x)
Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.
..... asNeededBoolean boolean
..... asNeededCodeableConcept CodeableConcept
.... site Σ 0..1 CodeableConcept Body site to administer to
Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.
.... route Σ 0..1 CodeableConcept How drug should enter body
Binding: SNOMEDCTRouteCodes (preferred)
.... method Σ 0..1 CodeableConcept Technique for administering medication
Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.
.... doseAndRate SΣ 0..* Element (USCDI) Amount of medication administered
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... type Σ 1..1 CodeableConcept The kind of dose or rate specified
Binding: USQualityCore SNOMED CT Dosage Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)
..... dose[x] SΣ 0..1 (USCDI) Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodes Max Binding
...... doseQuantity Quantity S
...... doseRange Range
..... rate[x] Σ 0..1 Amount of medication per unit of time
...... rateRatio Ratio
...... rateRange Range
...... rateQuantity Quantity(SimpleQuantity)
.... maxDosePerPeriod Σ 0..1 Ratio Upper limit on medication per unit of time
.... maxDosePerAdministration Σ 0..1 SimpleQuantity Upper limit on medication per administration
.... maxDosePerLifetime Σ 0..1 SimpleQuantity Upper limit on medication per lifetime of the patient
... substitution 0..1 BackboneElement Whether a substitution was performed on the dispense
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... wasSubstituted 1..1 boolean Whether a substitution was or was not performed on the dispense
.... type 0..1 CodeableConcept Code signifying whether a different drug was dispensed from what was prescribed
Binding: V3 Value SetActSubstanceAdminSubstitutionCode (example): A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription.
.... reason 0..* CodeableConcept Why was substitution made
Binding: V3 Value SetSubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
.... responsibleParty 0..* Reference(Practitioner | PractitionerRole) Who is responsible for the substitution
... detectedIssue 0..* Reference(DetectedIssue) Clinical issue with action
... eventHistory 0..* Reference(Provenance) A list of relevant lifecycle events

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
MedicationDispense.language Base preferred Common Languages 📦4.0.1 FHIR Std.
MedicationDispense.status Base required Medication dispense status codes 📦4.0.1 FHIR Std.
MedicationDispense.statusReason[x] Base extensible USQualityCore Negation Reason Codes 📦0.5.0 This IG
MedicationDispense.category Base preferred Medication dispense category codes 📦4.0.1 FHIR Std.
MedicationDispense.medication[x] Base extensible Medication Clinical Drug . 📦20170601 VSAC v0.18
MedicationDispense.performer.​function Base example Medication dispense performer function codes 📦4.0.1 FHIR Std.
MedicationDispense.type Base extensible V3 Value SetActPharmacySupplyType 📦2014-03-26 FHIR Std.
MedicationDispense.quantity Base preferred Common UCUM units 📦4.0.1 FHIR Std.
MedicationDispense.dosageInstruction.​additionalInstruction Base example SNOMED CT Additional Dosage Instructions 📦4.0.1 FHIR Std.
MedicationDispense.dosageInstruction.​asNeeded[x] Base example SNOMED CT Medication As Needed Reason Codes 📦4.0.1 FHIR Std.
MedicationDispense.dosageInstruction.​site Base example SNOMED CT Anatomical Structure for Administration Site Codes 📦4.0.1 FHIR Std.
MedicationDispense.dosageInstruction.​route Base preferred SNOMED CT Route Codes 📦4.0.1 FHIR Std.
MedicationDispense.dosageInstruction.​method Base example SNOMED CT Administration Method Codes 📦4.0.1 FHIR Std.
MedicationDispense.dosageInstruction.​doseAndRate.type Base preferred USQualityCore SNOMED CT Dosage Codes 📦0.5.0 This IG
MedicationDispense.dosageInstruction.​doseAndRate.dose[x] Base preferred Common UCUM units 📦4.0.1 FHIR Std.
MedicationDispense.substitution.​type Base example V3 Value SetActSubstanceAdminSubstitutionCode 📦2014-03-26 FHIR Std.
MedicationDispense.substitution.​reason Base example V3 Value SetSubstanceAdminSubstitutionReason 📦2014-03-26 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error MedicationDispense If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error MedicationDispense If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error MedicationDispense If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error MedicationDispense If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice MedicationDispense A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
mdd-1 error MedicationDispense whenHandedOver cannot be before whenPrepared whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared
mnd-1 error MedicationDispense To indicate what medication was not dispensed, either at least one coding in the medication or a notDoneValueSet extension shall be provided medication.extension('http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor medication.coding.exists()
us-core-20 error MedicationDispense whenHandedOver SHALL be present if the status is "completed" status='completed' implies whenHandedOver.exists()

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. MedicationDispense C 0..* USCoreMedicationDispenseProfile(6.1.0) Dispensing a medication to a named patient
Constraints: mdd-1, us-core-20, mnd-1
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:recorded 1..1 dateTime Extension
URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... 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
... medication[x] SΣ 1..1 (USCDI) What medication was supplied
Binding: Medication Clinical Drug . (extensible): The set of RxNorm codes to represent medications
.... medication[x]All Types Content/Rules for all Types
..... Slices for extension Content/Rules for all slices
...... 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
.... medicationCodeableConcept CodeableConcept
.... medicationReference Reference(US Core Medication Profile(7.0.0))
... subject SΣ 1..1 Reference(US Quality Core Patient) (USCDI) Who the dispense is for
... performer S 0..* BackboneElement (USCDI) Who performed event
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... actor S 1..1 Reference(US Core Practitioner Profile(7.0.0) S | US Core Patient Profile(7.0.0) | US Core Organization Profile(7.0.0) S | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0) | Device) (USCDI) Individual who was performing
... authorizingPrescription S 0..* Reference(US Quality Core MedicationRequest) (USCDI)
... type S 0..1 CodeableConcept (USCDI) Trial fill, partial fill, emergency fill, etc.
Binding: V3 Value SetActPharmacySupplyType (extensible)
... quantity S 0..1 Quantity (USCDI) Amount dispensed
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodes Max Binding
... daysSupply 0..1 SimpleQuantity Amount of medication expressed as a timing amount
... whenHandedOver SC 0..1 dateTime (USCDI) When product was given out or mailed
... dosageInstruction S 0..* Dosage (USCDI)
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... text SΣ 0..1 string (USCDI) Free text dosage instructions e.g. SIG
.... timing SΣ 0..1 Timing (USCDI) When medication should be administered
.... route Σ 0..1 CodeableConcept How drug should enter body
Binding: SNOMEDCTRouteCodes (preferred)
.... doseAndRate SΣ 0..* Element (USCDI) Amount of medication administered
..... type Σ 1..1 CodeableConcept The kind of dose or rate specified
Binding: USQualityCore SNOMED CT Dosage Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)
..... dose[x] SΣ 0..1 (USCDI) Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodes Max Binding
...... doseQuantity Quantity S
...... doseRange Range

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
MedicationDispense.status Base required Medication dispense status codes 📦4.0.1 FHIR Std.
MedicationDispense.statusReason[x] Base extensible USQualityCore Negation Reason Codes 📦0.5.0 This IG
MedicationDispense.medication[x] Base extensible Medication Clinical Drug . 📦20170601 VSAC v0.18
MedicationDispense.type Base extensible V3 Value SetActPharmacySupplyType 📦2014-03-26 FHIR Std.
MedicationDispense.quantity Base preferred Common UCUM units 📦4.0.1 FHIR Std.
MedicationDispense.dosageInstruction.​route Base preferred SNOMED CT Route Codes 📦4.0.1 FHIR Std.
MedicationDispense.dosageInstruction.​doseAndRate.type Base preferred USQualityCore SNOMED CT Dosage Codes 📦0.5.0 This IG
MedicationDispense.dosageInstruction.​doseAndRate.dose[x] Base preferred Common UCUM units 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error MedicationDispense If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error MedicationDispense If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error MedicationDispense If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error MedicationDispense If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice MedicationDispense A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
mdd-1 error MedicationDispense whenHandedOver cannot be before whenPrepared whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared
mnd-1 error MedicationDispense To indicate what medication was not dispensed, either at least one coding in the medication or a notDoneValueSet extension shall be provided medication.extension('http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor medication.coding.exists()
us-core-20 error MedicationDispense whenHandedOver SHALL be present if the status is "completed" status='completed' implies whenHandedOver.exists()

Differential View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. MedicationDispense C 0..* USCoreMedicationDispenseProfile(6.1.0) Dispensing a medication to a named patient
Constraints: mnd-1
... Slices for extension Content/Rules for all slices
.... extension:recorded 1..1 dateTime Extension
URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded
... 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
... 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
.... Slices for extension Content/Rules for all slices
..... 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
... subject 1..1 Reference(US Quality Core Patient) (USCDI) Who the dispense is for
... authorizingPrescription 0..* Reference(US Quality Core MedicationRequest) (USCDI)
... quantity 0..1 Quantity (USCDI) Amount dispensed
... daysSupply 0..1 SimpleQuantity Amount of medication expressed as a timing amount
... dosageInstruction 0..* Dosage (USCDI)
.... text 0..1 string (USCDI) Free text dosage instructions e.g. SIG
.... timing 0..1 Timing (USCDI) When medication should be administered
.... route 0..1 CodeableConcept How drug should enter body
Binding: SNOMEDCTRouteCodes (preferred)
.... doseAndRate 0..* Element (USCDI) Amount of medication administered
..... type 1..1 CodeableConcept The kind of dose or rate specified
Binding: USQualityCore SNOMED CT Dosage Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)
..... dose[x] 0..1 Quantity, Range (USCDI) Amount of medication per dose

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
MedicationDispense.status Base required Medication dispense status codes 📦4.0.1 FHIR Std.
MedicationDispense.statusReason[x] Base extensible USQualityCore Negation Reason Codes 📦0.5.0 This IG
MedicationDispense.medication[x] Base extensible Medication Clinical Drug . 📦20170601 VSAC v0.18
MedicationDispense.dosageInstruction.​route Base preferred SNOMED CT Route Codes 📦4.0.1 FHIR Std.
MedicationDispense.dosageInstruction.​doseAndRate.type Base preferred USQualityCore SNOMED CT Dosage Codes 📦0.5.0 This IG

Constraints

Id Grade Path(s) Description Expression
mnd-1 error MedicationDispense To indicate what medication was not dispensed, either at least one coding in the medication or a notDoneValueSet extension shall be provided medication.extension('http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor medication.coding.exists()

Snapshot ViewView

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. MedicationDispense C 0..* USCoreMedicationDispenseProfile(6.1.0) Dispensing a medication to a named patient
Constraints: mdd-1, us-core-20, mnd-1
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:recorded 1..1 dateTime Extension
URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier 0..* Identifier External identifier
... partOf 0..* Reference(Procedure) Event that dispense is part of
... status ?!SΣC 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
... 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
... category 0..1 CodeableConcept Type of medication dispense
Binding: MedicationDispense Category Codes (preferred): A code describing where the dispensed medication is expected to be consumed or administered.
... medication[x] SΣ 1..1 (USCDI) What medication was supplied
Binding: Medication Clinical Drug . (extensible): The set of RxNorm codes to represent medications
.... medication[x]All Types Content/Rules for all Types
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... 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
.... medicationCodeableConcept CodeableConcept
.... medicationReference Reference(US Core Medication Profile(7.0.0))
... subject SΣ 1..1 Reference(US Quality Core Patient) (USCDI) Who the dispense is for
... context 0..1 Reference(Encounter | EpisodeOfCare) Encounter / Episode associated with event
... supportingInformation 0..* Reference(Resource) Information that supports the dispensing of the medication
... performer S 0..* BackboneElement (USCDI) Who performed event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... function 0..1 CodeableConcept Who performed the dispense and what they did
Binding: MedicationDispense Performer Function Codes (example): A code describing the role an individual played in dispensing a medication.
.... actor S 1..1 Reference(US Core Practitioner Profile(7.0.0) S | US Core Patient Profile(7.0.0) | US Core Organization Profile(7.0.0) S | US Core PractitionerRole Profile(7.0.0) | US Core RelatedPerson Profile(7.0.0) | Device) (USCDI) Individual who was performing
... location 0..1 Reference(Location) Where the dispense occurred
... authorizingPrescription S 0..* Reference(US Quality Core MedicationRequest) (USCDI)
... type S 0..1 CodeableConcept (USCDI) Trial fill, partial fill, emergency fill, etc.
Binding: V3 Value SetActPharmacySupplyType (extensible)
... quantity S 0..1 Quantity (USCDI) Amount dispensed
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodes Max Binding
... daysSupply 0..1 SimpleQuantity Amount of medication expressed as a timing amount
... whenPrepared Σ 0..1 dateTime When product was packaged and reviewed
... whenHandedOver SC 0..1 dateTime (USCDI) When product was given out or mailed
... destination 0..1 Reference(Location) Where the medication was sent
... receiver 0..* Reference(Patient | Practitioner) Who collected the medication
... note 0..* Annotation Information about the dispense
... dosageInstruction S 0..* Dosage (USCDI)
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 0..1 integer The order of the dosage instructions
.... text SΣ 0..1 string (USCDI) Free text dosage instructions e.g. SIG
.... additionalInstruction Σ 0..* CodeableConcept Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
Binding: SNOMEDCTAdditionalDosageInstructions (example): A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".
.... patientInstruction Σ 0..1 string Patient or consumer oriented instructions
.... timing SΣ 0..1 Timing (USCDI) When medication should be administered
.... asNeeded[x] Σ 0..1 Take "as needed" (for x)
Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.
..... asNeededBoolean boolean
..... asNeededCodeableConcept CodeableConcept
.... site Σ 0..1 CodeableConcept Body site to administer to
Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.
.... route Σ 0..1 CodeableConcept How drug should enter body
Binding: SNOMEDCTRouteCodes (preferred)
.... method Σ 0..1 CodeableConcept Technique for administering medication
Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.
.... doseAndRate SΣ 0..* Element (USCDI) Amount of medication administered
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... type Σ 1..1 CodeableConcept The kind of dose or rate specified
Binding: USQualityCore SNOMED CT Dosage Codes (preferred): Medication dose types (e.g., loading, maintenance, etc.)
..... dose[x] SΣ 0..1 (USCDI) Amount of medication per dose
Binding: Common UCUM units (preferred)
Additional BindingsPurpose
UCUMCodes Max Binding
...... doseQuantity Quantity S
...... doseRange Range
..... rate[x] Σ 0..1 Amount of medication per unit of time
...... rateRatio Ratio
...... rateRange Range
...... rateQuantity Quantity(SimpleQuantity)
.... maxDosePerPeriod Σ 0..1 Ratio Upper limit on medication per unit of time
.... maxDosePerAdministration Σ 0..1 SimpleQuantity Upper limit on medication per administration
.... maxDosePerLifetime Σ 0..1 SimpleQuantity Upper limit on medication per lifetime of the patient
... substitution 0..1 BackboneElement Whether a substitution was performed on the dispense
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... wasSubstituted 1..1 boolean Whether a substitution was or was not performed on the dispense
.... type 0..1 CodeableConcept Code signifying whether a different drug was dispensed from what was prescribed
Binding: V3 Value SetActSubstanceAdminSubstitutionCode (example): A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription.
.... reason 0..* CodeableConcept Why was substitution made
Binding: V3 Value SetSubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
.... responsibleParty 0..* Reference(Practitioner | PractitionerRole) Who is responsible for the substitution
... detectedIssue 0..* Reference(DetectedIssue) Clinical issue with action
... eventHistory 0..* Reference(Provenance) A list of relevant lifecycle events

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
MedicationDispense.language Base preferred Common Languages 📦4.0.1 FHIR Std.
MedicationDispense.status Base required Medication dispense status codes 📦4.0.1 FHIR Std.
MedicationDispense.statusReason[x] Base extensible USQualityCore Negation Reason Codes 📦0.5.0 This IG
MedicationDispense.category Base preferred Medication dispense category codes 📦4.0.1 FHIR Std.
MedicationDispense.medication[x] Base extensible Medication Clinical Drug . 📦20170601 VSAC v0.18
MedicationDispense.performer.​function Base example Medication dispense performer function codes 📦4.0.1 FHIR Std.
MedicationDispense.type Base extensible V3 Value SetActPharmacySupplyType 📦2014-03-26 FHIR Std.
MedicationDispense.quantity Base preferred Common UCUM units 📦4.0.1 FHIR Std.
MedicationDispense.dosageInstruction.​additionalInstruction Base example SNOMED CT Additional Dosage Instructions 📦4.0.1 FHIR Std.
MedicationDispense.dosageInstruction.​asNeeded[x] Base example SNOMED CT Medication As Needed Reason Codes 📦4.0.1 FHIR Std.
MedicationDispense.dosageInstruction.​site Base example SNOMED CT Anatomical Structure for Administration Site Codes 📦4.0.1 FHIR Std.
MedicationDispense.dosageInstruction.​route Base preferred SNOMED CT Route Codes 📦4.0.1 FHIR Std.
MedicationDispense.dosageInstruction.​method Base example SNOMED CT Administration Method Codes 📦4.0.1 FHIR Std.
MedicationDispense.dosageInstruction.​doseAndRate.type Base preferred USQualityCore SNOMED CT Dosage Codes 📦0.5.0 This IG
MedicationDispense.dosageInstruction.​doseAndRate.dose[x] Base preferred Common UCUM units 📦4.0.1 FHIR Std.
MedicationDispense.substitution.​type Base example V3 Value SetActSubstanceAdminSubstitutionCode 📦2014-03-26 FHIR Std.
MedicationDispense.substitution.​reason Base example V3 Value SetSubstanceAdminSubstitutionReason 📦2014-03-26 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error MedicationDispense If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error MedicationDispense If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error MedicationDispense If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error MedicationDispense If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice MedicationDispense A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
mdd-1 error MedicationDispense whenHandedOver cannot be before whenPrepared whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared
mnd-1 error MedicationDispense To indicate what medication was not dispensed, either at least one coding in the medication or a notDoneValueSet extension shall be provided medication.extension('http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor medication.coding.exists()
us-core-20 error MedicationDispense whenHandedOver SHALL be present if the status is "completed" status='completed' implies whenHandedOver.exists()

 

Other representations of profile: CSV, Excel, Schematron

Notes:

CQL Authoring Usage (Informational)

The following example illustrates the use of the MedicationDispenseDeclined profile:

define "Dementia Medication Not Dispensed":
    ["MedicationDispenseNotDone": "Dementia Medications"] MedicationDispense
      where MedicationDispense.statusReason in "Medical Reason"
        or MedicationDispense.statusReason in "Patient Refusal"

For a more complete discussion of representation of negation within US Quality Core and quality improvement artifacts, see the Negation in US Quality Core topic.