2026 US Quality Core Implementation Guide
0.5.0 - release

2026 US Quality Core Implementation Guide - Downloaded Version 0.5.0 See the Directory of published versions

## Resource Profile: US Quality Core MedicationDispense

Official URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-medicationdispense | Version: 0.5.0 | Highlight text changes?
Active as of 2026-06-05 | Computable Name: USQualityCoreMedicationDispense

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​ | unknown
- medication[x]: (USCDI+ Quality) (USCDI) What medication was supplied
- quantity: (USCDI+ Quality) (USCDI) Amount dispensed
- daysSupply: (USCDI+ Quality) Amount of medication expressed as a timing amount
- dosageInstruction: (USCDI+ Quality) (USCDI) How the medication is to be used by the patient or administered by the caregiver
- dosageInstruction.text: (USCDI+ Quality) (USCDI) Free text dosage instructions e.g. SIG
- dosageInstruction.timing: (USCDI+ Quality) (USCDI) When medication should be administered
- dosageInstruction.route: (USCDI+ Quality) How drug should enter body
- dosageInstruction.doseAndRate: (USCDI+ Quality) (USCDI) Amount of medication administered
- dosageInstruction.doseAndRate.dose[x]: (USCDI+ Quality) (USCDI) Amount of medication per dose

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

To represent that a medication dispense intentionally did not occur for a medical, patient, or system reason, use the US Quality Core MedicationDispense Declined profile.

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

Usages:

- Examples for this Profile: MedicationDispense/cmd-example and MedicationDispense/example
- CapabilityStatements using this Profile: US Quality Core Client CapabilityStatement and US Quality Core Server CapabilityStatement

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

- Key Elements Table
- Differential Table
- Snapshot Table
- Statistics/References
- All

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense | C | 0..* | USCoreMedicationDispenseProfile(6.1.0) | Dispensing a medication to a named patient Constraints: mdd-1, us-core-20
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ C | 1..1 | code | (USCDI+ Quality) (USCDI) preparation​ | in-progress​ | cancelled​ | on-hold​ | completed​ | entered-in-error​ | stopped​ | unknown Binding: Non-Negative MedicationDispense Status (required)
medication[x] | S Σ | 1..1 |  | (USCDI+ Quality) (USCDI) What medication was supplied Binding: Medication Clinical Drug (extensible): The set of RxNorm codes to represent medications
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(US Quality Core Medication) |
subject | S Σ | 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) Medication order that authorizes the dispense
type | S | 0..1 | CodeableConcept | (USCDI) Trial fill, partial fill, emergency fill, etc. Binding: V3 Value SetActPharmacySupplyType (extensible)
quantity | S | 0..1 | Quantity | (USCDI+ Quality) (USCDI) Amount dispensed Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
daysSupply |  | 0..1 | SimpleQuantity | (USCDI+ Quality) Amount of medication expressed as a timing amount
whenPrepared | Σ | 0..1 | dateTime | When product was packaged and reviewed
whenHandedOver | S C | 0..1 | dateTime | (USCDI) When product was given out or mailed
dosageInstruction | S | 0..* | Dosage | (USCDI+ Quality) (USCDI) How the medication is to be used by the patient or administered by the caregiver
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
text | S Σ | 0..1 | string | (USCDI+ Quality) (USCDI) Free text dosage instructions e.g. SIG
timing | S Σ | 0..1 | Timing | (USCDI+ Quality) (USCDI) When medication should be administered
route | Σ | 0..1 | CodeableConcept | (USCDI+ Quality) How drug should enter body Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
doseAndRate | S Σ | 0..* | Element | (USCDI+ Quality) (USCDI) Amount of medication administered
dose[x] | S Σ | 0..1 |  | (USCDI+ Quality) (USCDI) Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
doseQuantity |  |  | Quantity S |
doseRange |  |  | Range |
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationDispense.status | Base | required | Non-Negative MedicationDispense Status | 📦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 | example | SNOMED CT Route Codes | 📦4.0.1 | FHIR Std.
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`
us-core-20 | error | MedicationDispense | whenHandedOver SHALL be present if the status is "completed" | `status='completed' implies whenHandedOver.exists()`

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense |  | 0..* | USCoreMedicationDispenseProfile(6.1.0) | Dispensing a medication to a named patient
status |  | 1..1 | code | (USCDI+ Quality) (USCDI) preparation​ | in-progress​ | cancelled​ | on-hold​ | completed​ | entered-in-error​ | stopped​ | unknown Binding: Non-Negative MedicationDispense Status (required)
medication[x] |  | 1..1 |  | (USCDI+ Quality) (USCDI) What medication was supplied Binding: Medication Clinical Drug (extensible): The set of RxNorm codes to represent medications
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(US Quality Core Medication) |
subject |  | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who the dispense is for
authorizingPrescription |  | 0..* | Reference(US Quality Core MedicationRequest) | (USCDI) Medication order that authorizes the dispense
type |  | 0..1 | CodeableConcept | (USCDI) Trial fill, partial fill, emergency fill, etc. Binding: V3 Value SetActPharmacySupplyType (extensible)
quantity |  | 0..1 | Quantity | (USCDI+ Quality) (USCDI) Amount dispensed
daysSupply |  | 0..1 | SimpleQuantity | (USCDI+ Quality) Amount of medication expressed as a timing amount
whenPrepared |  | 0..1 | dateTime | When product was packaged and reviewed
whenHandedOver |  | 0..1 | dateTime | (USCDI) When product was given out or mailed
dosageInstruction |  | 0..* | Dosage | (USCDI+ Quality) (USCDI) How the medication is to be used by the patient or administered by the caregiver
text |  | 0..1 | string | (USCDI+ Quality) (USCDI) Free text dosage instructions e.g. SIG
timing |  | 0..1 | Timing | (USCDI+ Quality) (USCDI) When medication should be administered
route |  | 0..1 | CodeableConcept | (USCDI+ Quality) How drug should enter body
doseAndRate |  | 0..* | Element | (USCDI+ Quality) (USCDI) Amount of medication administered
dose[x] |  | 0..1 |  | (USCDI+ Quality) (USCDI) Amount of medication per dose
doseQuantity |  |  | Quantity |
doseRange |  |  | Range |
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
MedicationDispense.status | Base | required | Non-Negative MedicationDispense Status | 📦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.

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense | C | 0..* | USCoreMedicationDispenseProfile(6.1.0) | Dispensing a medication to a named patient Constraints: mdd-1, us-core-20
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 Bindings | Purpose
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
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | External identifier
partOf |  | 0..* | Reference(Procedure) | Event that dispense is part of
status | ?!S Σ C | 1..1 | code | (USCDI+ Quality) (USCDI) preparation​ | in-progress​ | cancelled​ | on-hold​ | completed​ | entered-in-error​ | stopped​ | unknown Binding: Non-Negative MedicationDispense Status (required)
statusReason[x] |  | 0..1 |  | Why a dispense was not performed Binding: MedicationDispense Status Reason Codes (example): A code describing why a dispense was not performed.
statusReasonCodeableConcept |  |  | CodeableConcept |
statusReasonReference |  |  | Reference(DetectedIssue) |
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] | S Σ | 1..1 |  | (USCDI+ Quality) (USCDI) What medication was supplied Binding: Medication Clinical Drug (extensible): The set of RxNorm codes to represent medications
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(US Quality Core Medication) |
subject | S Σ | 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) Medication order that authorizes the dispense
type | S | 0..1 | CodeableConcept | (USCDI) Trial fill, partial fill, emergency fill, etc. Binding: V3 Value SetActPharmacySupplyType (extensible)
quantity | S | 0..1 | Quantity | (USCDI+ Quality) (USCDI) Amount dispensed Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
daysSupply |  | 0..1 | SimpleQuantity | (USCDI+ Quality) Amount of medication expressed as a timing amount
whenPrepared | Σ | 0..1 | dateTime | When product was packaged and reviewed
whenHandedOver | S C | 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+ Quality) (USCDI) How the medication is to be used by the patient or administered by the caregiver
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 | S Σ | 0..1 | string | (USCDI+ Quality) (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 | S Σ | 0..1 | Timing | (USCDI+ Quality) (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 | (USCDI+ Quality) How drug should enter body Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
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 | S Σ | 0..* | Element | (USCDI+ Quality) (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 | 0..1 | CodeableConcept | The kind of dose or rate specified Binding: DoseAndRateType (example): The kind of dose or rate specified.
dose[x] | S Σ | 0..1 |  | (USCDI+ Quality) (USCDI) Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
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
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 | Non-Negative MedicationDispense Status | 📦0.5.0 | This IG
MedicationDispense.statusReason[x] | Base | example | Medication dispense status reason codes | 📦4.0.1 | FHIR Std.
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 | example | 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 | example | DoseAndRateType | 📦4.0.1 | FHIR Std.
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`
us-core-20 | error | MedicationDispense | whenHandedOver SHALL be present if the status is "completed" | `status='completed' implies whenHandedOver.exists()`

Summary

Structures

This structure refers to these other structures:

- US Quality Core Medication (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-medication)
- US Quality Core Patient (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient)
- US Quality Core MedicationRequest (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-medicationrequest)

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense | C | 0..* | USCoreMedicationDispenseProfile(6.1.0) | Dispensing a medication to a named patient Constraints: mdd-1, us-core-20
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ C | 1..1 | code | (USCDI+ Quality) (USCDI) preparation​ | in-progress​ | cancelled​ | on-hold​ | completed​ | entered-in-error​ | stopped​ | unknown Binding: Non-Negative MedicationDispense Status (required)
medication[x] | S Σ | 1..1 |  | (USCDI+ Quality) (USCDI) What medication was supplied Binding: Medication Clinical Drug (extensible): The set of RxNorm codes to represent medications
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(US Quality Core Medication) |
subject | S Σ | 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) Medication order that authorizes the dispense
type | S | 0..1 | CodeableConcept | (USCDI) Trial fill, partial fill, emergency fill, etc. Binding: V3 Value SetActPharmacySupplyType (extensible)
quantity | S | 0..1 | Quantity | (USCDI+ Quality) (USCDI) Amount dispensed Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
daysSupply |  | 0..1 | SimpleQuantity | (USCDI+ Quality) Amount of medication expressed as a timing amount
whenPrepared | Σ | 0..1 | dateTime | When product was packaged and reviewed
whenHandedOver | S C | 0..1 | dateTime | (USCDI) When product was given out or mailed
dosageInstruction | S | 0..* | Dosage | (USCDI+ Quality) (USCDI) How the medication is to be used by the patient or administered by the caregiver
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
text | S Σ | 0..1 | string | (USCDI+ Quality) (USCDI) Free text dosage instructions e.g. SIG
timing | S Σ | 0..1 | Timing | (USCDI+ Quality) (USCDI) When medication should be administered
route | Σ | 0..1 | CodeableConcept | (USCDI+ Quality) How drug should enter body Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
doseAndRate | S Σ | 0..* | Element | (USCDI+ Quality) (USCDI) Amount of medication administered
dose[x] | S Σ | 0..1 |  | (USCDI+ Quality) (USCDI) Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
doseQuantity |  |  | Quantity S |
doseRange |  |  | Range |
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MedicationDispense.status | Base | required | Non-Negative MedicationDispense Status | 📦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 | example | SNOMED CT Route Codes | 📦4.0.1 | FHIR Std.
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`
us-core-20 | error | MedicationDispense | whenHandedOver SHALL be present if the status is "completed" | `status='completed' implies whenHandedOver.exists()`

Differential View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense |  | 0..* | USCoreMedicationDispenseProfile(6.1.0) | Dispensing a medication to a named patient
status |  | 1..1 | code | (USCDI+ Quality) (USCDI) preparation​ | in-progress​ | cancelled​ | on-hold​ | completed​ | entered-in-error​ | stopped​ | unknown Binding: Non-Negative MedicationDispense Status (required)
medication[x] |  | 1..1 |  | (USCDI+ Quality) (USCDI) What medication was supplied Binding: Medication Clinical Drug (extensible): The set of RxNorm codes to represent medications
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(US Quality Core Medication) |
subject |  | 1..1 | Reference(US Quality Core Patient) | (USCDI) Who the dispense is for
authorizingPrescription |  | 0..* | Reference(US Quality Core MedicationRequest) | (USCDI) Medication order that authorizes the dispense
type |  | 0..1 | CodeableConcept | (USCDI) Trial fill, partial fill, emergency fill, etc. Binding: V3 Value SetActPharmacySupplyType (extensible)
quantity |  | 0..1 | Quantity | (USCDI+ Quality) (USCDI) Amount dispensed
daysSupply |  | 0..1 | SimpleQuantity | (USCDI+ Quality) Amount of medication expressed as a timing amount
whenPrepared |  | 0..1 | dateTime | When product was packaged and reviewed
whenHandedOver |  | 0..1 | dateTime | (USCDI) When product was given out or mailed
dosageInstruction |  | 0..* | Dosage | (USCDI+ Quality) (USCDI) How the medication is to be used by the patient or administered by the caregiver
text |  | 0..1 | string | (USCDI+ Quality) (USCDI) Free text dosage instructions e.g. SIG
timing |  | 0..1 | Timing | (USCDI+ Quality) (USCDI) When medication should be administered
route |  | 0..1 | CodeableConcept | (USCDI+ Quality) How drug should enter body
doseAndRate |  | 0..* | Element | (USCDI+ Quality) (USCDI) Amount of medication administered
dose[x] |  | 0..1 |  | (USCDI+ Quality) (USCDI) Amount of medication per dose
doseQuantity |  |  | Quantity |
doseRange |  |  | Range |
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
MedicationDispense.status | Base | required | Non-Negative MedicationDispense Status | 📦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.

Snapshot ViewView

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MedicationDispense | C | 0..* | USCoreMedicationDispenseProfile(6.1.0) | Dispensing a medication to a named patient Constraints: mdd-1, us-core-20
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 Bindings | Purpose
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
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | External identifier
partOf |  | 0..* | Reference(Procedure) | Event that dispense is part of
status | ?!S Σ C | 1..1 | code | (USCDI+ Quality) (USCDI) preparation​ | in-progress​ | cancelled​ | on-hold​ | completed​ | entered-in-error​ | stopped​ | unknown Binding: Non-Negative MedicationDispense Status (required)
statusReason[x] |  | 0..1 |  | Why a dispense was not performed Binding: MedicationDispense Status Reason Codes (example): A code describing why a dispense was not performed.
statusReasonCodeableConcept |  |  | CodeableConcept |
statusReasonReference |  |  | Reference(DetectedIssue) |
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] | S Σ | 1..1 |  | (USCDI+ Quality) (USCDI) What medication was supplied Binding: Medication Clinical Drug (extensible): The set of RxNorm codes to represent medications
medicationCodeableConcept |  |  | CodeableConcept |
medicationReference |  |  | Reference(US Quality Core Medication) |
subject | S Σ | 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) Medication order that authorizes the dispense
type | S | 0..1 | CodeableConcept | (USCDI) Trial fill, partial fill, emergency fill, etc. Binding: V3 Value SetActPharmacySupplyType (extensible)
quantity | S | 0..1 | Quantity | (USCDI+ Quality) (USCDI) Amount dispensed Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
UCUMCodes | Max Binding
daysSupply |  | 0..1 | SimpleQuantity | (USCDI+ Quality) Amount of medication expressed as a timing amount
whenPrepared | Σ | 0..1 | dateTime | When product was packaged and reviewed
whenHandedOver | S C | 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+ Quality) (USCDI) How the medication is to be used by the patient or administered by the caregiver
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 | S Σ | 0..1 | string | (USCDI+ Quality) (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 | S Σ | 0..1 | Timing | (USCDI+ Quality) (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 | (USCDI+ Quality) How drug should enter body Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
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 | S Σ | 0..* | Element | (USCDI+ Quality) (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 | 0..1 | CodeableConcept | The kind of dose or rate specified Binding: DoseAndRateType (example): The kind of dose or rate specified.
dose[x] | S Σ | 0..1 |  | (USCDI+ Quality) (USCDI) Amount of medication per dose Binding: Common UCUM units (preferred)
Additional Bindings | Purpose
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
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 | Non-Negative MedicationDispense Status | 📦0.5.0 | This IG
MedicationDispense.statusReason[x] | Base | example | Medication dispense status reason codes | 📦4.0.1 | FHIR Std.
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 | example | 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 | example | DoseAndRateType | 📦4.0.1 | FHIR Std.
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`
us-core-20 | error | MedicationDispense | whenHandedOver SHALL be present if the status is "completed" | `status='completed' implies whenHandedOver.exists()`

Summary

Structures

This structure refers to these other structures:

- US Quality Core Medication (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-medication)
- US Quality Core Patient (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient)
- US Quality Core MedicationRequest (http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-medicationrequest)

Other representations of profile: CSV, Excel, Schematron

### Notes:

#### CQL Authoring Usage (Informational)

To create an expression specifically requesting information that a MedicationDispense intentionally did not occur for a medical, patient or system reason, use the profile USQualityCore-medicationnotdispensed.

The following example illustrates the use of the MedicationDispense profile:

    define "Dementia Medication Dispensed":
      ["MedicationDispense": "Dementia Medications"] MedicationDispense
        where MedicationDispense.status in { 'active', 'completed', 'on-hold' }