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 Declined

Official URL: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-medicationdispensedeclined | Version: 0.5.0 | Highlight text changes?
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:

- Examples for this Profile: MedicationDispense/negation-example and MedicationDispense/negation-with-code-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, 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
status | ?!S Σ C | 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
medication[x] | S Σ | 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 | 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)
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 Bindings | Purpose
UCUMCodes | Max Binding
daysSupply |  | 0..1 | SimpleQuantity | Amount of medication expressed as a timing amount
whenHandedOver | S C | 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 | S Σ | 0..1 | string | (USCDI) Free text dosage instructions e.g. SIG
timing | S Σ | 0..1 | Timing | (USCDI) When medication should be administered
route | Σ | 0..1 | CodeableConcept | How drug should enter body Binding: SNOMEDCTRouteCodes (preferred)
doseAndRate | S Σ | 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] | S Σ | 0..1 |  | (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 | 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()`

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: 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
medication[x] |  | 1..1 | CodeableConcept, Reference(US Core Medication Profile(7.0.0)) | (USCDI) What medication was supplied Binding: Medication Clinical Drug (extensible): The set of RxNorm codes to represent medications
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
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()`

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, 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 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
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 | ?!S Σ C | 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] | S Σ | 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 | 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)
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 Bindings | Purpose
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 | 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)
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) 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) 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 | S Σ | 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] | S Σ | 0..1 |  | (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 | 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()`

Summary

Mandatory: 2 elements(1 nested mandatory element)
Fixed: 1 element

Structures

This structure refers to these other structures:

- 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)

Extensions

This structure refers to these extensions:

- http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded
- http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet

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, 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
status | ?!S Σ C | 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
medication[x] | S Σ | 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 | 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)
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 Bindings | Purpose
UCUMCodes | Max Binding
daysSupply |  | 0..1 | SimpleQuantity | Amount of medication expressed as a timing amount
whenHandedOver | S C | 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 | S Σ | 0..1 | string | (USCDI) Free text dosage instructions e.g. SIG
timing | S Σ | 0..1 | Timing | (USCDI) When medication should be administered
route | Σ | 0..1 | CodeableConcept | How drug should enter body Binding: SNOMEDCTRouteCodes (preferred)
doseAndRate | S Σ | 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] | S Σ | 0..1 |  | (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 | 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

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: 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
medication[x] |  | 1..1 | CodeableConcept, Reference(US Core Medication Profile(7.0.0)) | (USCDI) What medication was supplied Binding: Medication Clinical Drug (extensible): The set of RxNorm codes to represent medications
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
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

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, 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 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
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 | ?!S Σ C | 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] | S Σ | 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 | 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)
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 Bindings | Purpose
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 | 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)
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) 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) 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 | S Σ | 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] | S Σ | 0..1 |  | (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 | 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()`

Summary

Mandatory: 2 elements(1 nested mandatory element)
Fixed: 1 element

Structures

This structure refers to these other structures:

- 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)

Extensions

This structure refers to these extensions:

- http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded
- http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet

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.