Implementation Guide
ePA Medication Service
Version 1.0.5-1 - release

## Resource Profile: EPA MedicationDispense

Official URL: https://gematik.de/fhir/epa-medication/StructureDefinition/epa-medication-dispense | Version: 1.0.5-1
Active as of 2025-02-28 | Computable Name: EPAMedicationDispense

Defines the medication dispense resource for the Medication Service in the ePA system.

Usage:

- Use this Resource Profile: EPA Operation ProvideDispensation ERP Input-Parameters
- Examples for this Resource Profile: MedicationDispense/46865835-8c8f-4139-86ba-271bd3565250 and MedicationDispense/4e6e1623-778e-44a3-b208-8479f5339e43
- CapabilityStatements using this Resource Profile: EPA CapabilityStatement für den the Medication Service

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

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

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
MedicationDispense | C | 0..* | MedicationDispense | Dispensing a medication to a named patient dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-6: A resource should have narrative for robust management dom-5: If a resource is contained in another resource, it SHALL NOT have a security label mdd-1: whenHandedOver cannot be before whenPrepared
meta | S Σ | 0..1 | Meta | Metadata about the resource ele-1: All FHIR elements must have a @value or children
versionId | S Σ | 0..1 | id | Version specific identifier ele-1: All FHIR elements must have a @value or children
lastUpdated | S Σ | 0..1 | instant | When the resource version last changed ele-1: All FHIR elements must have a @value or children
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
Slices for extension |  |  |  | Content/Rules for all slices
extension:rxPrescriptionProcessIdentifier |  | 0..1 | RxPrescriptionProcessIdentifier | Extension URL: https://gematik.de/fhir/epa-medication/StructureDefinition/rx-prescription-process-identifier-extension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension | ?!N | 0..* | Extension | Extensions that cannot be ignored Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
Slices for identifier |  | 0..* | Identifier | External identifier Slice: Unordered, Open by pattern:$this ele-1: All FHIR elements must have a @value or children
identifier:RxOriginatorProcessIdentifier |  | 0..1 | RxOriginatorProcessIdentifier | External identifier ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
system |  | 1..1 | uri | The namespace for the identifier value Fixed Value: https://gematik.de/fhir/epa-medication/sid/rx-originator-process-identifier
status | ?!Σ | 1..1 | code | Status of medication dispense Binding: TI Medication Dispense ValueSet (required) ele-1: All FHIR elements must have a @value or children
medication[x] | S Σ | 1..1 | Reference(Medication) | What medication was supplied ele-1: All FHIR elements must have a @value or children
subject | S Σ C | 1..1 | Reference(Patient) | Who the dispense is for ele-1: All FHIR elements must have a @value or children ref-1: SHALL have a contained resource if a local reference is provided
reference | Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL ele-1: All FHIR elements must have a @value or children
identifier | S Σ | 1..1 | IdentifierKvid10 | Logical reference, when literal reference is not known ele-1: All FHIR elements must have a @value or children
performer | S | 1..1 | BackboneElement | Who performed event ele-1: All FHIR elements must have a @value or children
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
actor | C | 1..1 | Reference(Organization | PractitionerRole) | Individual who was performing ele-1: All FHIR elements must have a @value or children ref-1: SHALL have a contained resource if a local reference is provided
authorizingPrescription | C | 0..* | Reference(MedicationRequest) | Medication order that authorizes the dispense ele-1: All FHIR elements must have a @value or children ref-1: SHALL have a contained resource if a local reference is provided
reference | S Σ C | 1..1 | string | Literal reference, Relative, internal or absolute URL ele-1: All FHIR elements must have a @value or children
whenHandedOver | S | 1..1 | dateTime | When product was given out ele-1: All FHIR elements must have a @value or children
dosageInstruction | S | 0..* | Dosage | Hier werden Informationen zur Dosierung angegeben. ele-1: All FHIR elements must have a @value or children
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
text | S Σ | 0..1 | string | Hier kann die Dosieranweisung in Form eines Freitextes abgebildet werden. ele-1: All FHIR elements must have a @value or children
substitution | S | 0..1 | BackboneElement | Whether a substitution was performed on the dispense ele-1: All FHIR elements must have a @value or children
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
wasSubstituted |  | 1..1 | boolean | Whether a substitution was or was not performed on the dispense ele-1: All FHIR elements must have a @value or children
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet | URI
MedicationDispense.status | required | TIMedicationDispenseStatusVS `https://gematik.de/fhir/terminology/ValueSet/ti-medication-dispense-status-vs`

#### Constraints

Id | Grade | Path(s) | Details | Requirements
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** elements | 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 |
ref-1 | error | MedicationDispense.subject, MedicationDispense.performer.actor, MedicationDispense.authorizingPrescription | SHALL have a contained resource if a local reference is provided : reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) |

This structure is derived from MedicationDispense

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
MedicationDispense |  | 0..* | MedicationDispense | Dispensing a medication to a named patient
meta | S | 0..1 | Meta | Metadata about the resource
versionId | S | 0..1 | id | Version specific identifier
lastUpdated | S | 0..1 | instant | When the resource version last changed
Slices for extension |  |  |  | Content/Rules for all slices
extension:rxPrescriptionProcessIdentifier |  | 0..1 | RxPrescriptionProcessIdentifier | Extension URL: https://gematik.de/fhir/epa-medication/StructureDefinition/rx-prescription-process-identifier-extension
Slices for identifier |  | 0..* | Identifier | External identifier Slice: Unordered, Open by pattern:$this
identifier:RxOriginatorProcessIdentifier |  | 0..1 | RxOriginatorProcessIdentifier | External identifier Required Pattern: At least the following
system |  | 1..1 | uri | The namespace for the identifier value Fixed Value: https://gematik.de/fhir/epa-medication/sid/rx-originator-process-identifier
status |  | 1..1 | code | Status of medication dispense Binding: TI Medication Dispense ValueSet (required)
medication[x] | S | 1..1 | Reference(Medication) | What medication was supplied
subject | S | 1..1 | Reference(Patient) | Who the dispense is for
identifier | S | 1..1 | IdentifierKvid10 | Logical reference, when literal reference is not known
performer | S | 1..1 | BackboneElement | Who performed event
actor |  | 1..1 | Reference(Organization | PractitionerRole) | Individual who was performing
authorizingPrescription |  |  |  |
reference | S | 1..1 | string | Literal reference, Relative, internal or absolute URL
whenHandedOver | S | 1..1 | dateTime | When product was given out
dosageInstruction | S | 0..* | Dosage | Hier werden Informationen zur Dosierung angegeben.
text | S | 0..1 | string | Hier kann die Dosieranweisung in Form eines Freitextes abgebildet werden.
substitution | S | 0..1 | BackboneElement | Whether a substitution was performed on the dispense
Documentation for this format

#### Terminology Bindings (Differential)

Path | Conformance | ValueSet | URI
MedicationDispense.status | required | TIMedicationDispenseStatusVS `https://gematik.de/fhir/terminology/ValueSet/ti-medication-dispense-status-vs`

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
MedicationDispense | C | 0..* | MedicationDispense | Dispensing a medication to a named patient mdd-1: whenHandedOver cannot be before whenPrepared
id | Σ | 0..1 | id | Logical id of this artifact
meta | S Σ | 0..1 | Meta | Metadata about the resource
id |  | 0..1 | string | Unique id for inter-element referencing
extension | N | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
versionId | S Σ | 0..1 | id | Version specific identifier
lastUpdated | S Σ | 0..1 | instant | When the resource version last changed
source | Σ | 0..1 | uri | Identifies where the resource comes from
profile | Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to
security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag | Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
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
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension | N | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
extension:rxPrescriptionProcessIdentifier |  | 0..1 | RxPrescriptionProcessIdentifier | Extension URL: https://gematik.de/fhir/epa-medication/StructureDefinition/rx-prescription-process-identifier-extension
modifierExtension | ?!N | 0..* | Extension | Extensions that cannot be ignored Slice: Unordered, Open by value:url
Slices for identifier |  | 0..* | Identifier | External identifier Slice: Unordered, Open by pattern:$this
identifier:RxOriginatorProcessIdentifier |  | 0..1 | RxOriginatorProcessIdentifier | External identifier Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
use |  | 0..1 | code | usual | official | temp | secondary | old (If known)
type |  | 0..1 | CodeableConcept | Description of identifier
system |  | 1..1 | uri | The namespace for the identifier value Fixed Value: https://gematik.de/fhir/epa-medication/sid/rx-originator-process-identifier
value |  | 0..1 | string | The value that is unique
period |  | 0..1 | Period | Time period when id is/was valid for use
assigner |  | 0..1 | Reference(Organization) | Organization that issued id (may be just text)
partOf | C | 0..* | Reference(Procedure) | Event that dispense is part of ref-1: SHALL have a contained resource if a local reference is provided
status | ?!Σ | 1..1 | code | Status of medication dispense Binding: TI Medication Dispense ValueSet (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 | Reference(Medication) | What medication was supplied
subject | S Σ C | 1..1 | Reference(Patient) | Who the dispense is for ref-1: SHALL have a contained resource if a local reference is provided
id |  | 0..1 | string | Unique id for inter-element referencing
extension | N | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
reference | Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier | S Σ | 1..1 | IdentifierKvid10 | Logical reference, when literal reference is not known
display | Σ | 0..1 | string | Text alternative for the resource
context | C | 0..1 | Reference(Encounter | EpisodeOfCare) | Encounter / Episode associated with event ref-1: SHALL have a contained resource if a local reference is provided
supportingInformation | C | 0..* | Reference(Resource) | Information that supports the dispensing of the medication ref-1: SHALL have a contained resource if a local reference is provided
performer | S | 1..1 | BackboneElement | Who performed event
id |  | 0..1 | string | Unique id for inter-element referencing
extension | N | 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
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 | C | 1..1 | Reference(Organization | PractitionerRole) | Individual who was performing ref-1: SHALL have a contained resource if a local reference is provided
location | C | 0..1 | Reference(Location) | Where the dispense occurred ref-1: SHALL have a contained resource if a local reference is provided
authorizingPrescription | C | 0..* | Reference(MedicationRequest) | Medication order that authorizes the dispense ref-1: SHALL have a contained resource if a local reference is provided
id |  | 0..1 | string | Unique id for inter-element referencing
extension | N | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
reference | S Σ C | 1..1 | string | Literal reference, Relative, internal or absolute URL
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known
display | Σ | 0..1 | string | Text alternative for the resource
type |  | 0..1 | CodeableConcept | Trial fill, partial fill, emergency fill, etc. Binding: ActPharmacySupplyType (example): Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc.
quantity | C | 0..1 | SimpleQuantity | Amount dispensed qty-3: If a code for the unit is present, the system SHALL also be present sqty-1: The comparator is not used on a SimpleQuantity
daysSupply | C | 0..1 | SimpleQuantity | Amount of medication expressed as a timing amount qty-3: If a code for the unit is present, the system SHALL also be present sqty-1: The comparator is not used on a SimpleQuantity
whenPrepared | Σ | 0..1 | dateTime | When product was packaged and reviewed
whenHandedOver | S | 1..1 | dateTime | When product was given out
destination | C | 0..1 | Reference(Location) | Where the medication was sent ref-1: SHALL have a contained resource if a local reference is provided
receiver | C | 0..* | Reference(Patient | Practitioner) | Who collected the medication ref-1: SHALL have a contained resource if a local reference is provided
note |  | 0..* | Annotation | Information about the dispense
dosageInstruction | S | 0..* | Dosage | Hier werden Informationen zur Dosierung angegeben.
id |  | 0..1 | string | Unique id for inter-element referencing
extension | N | 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 | Hier kann die Dosieranweisung in Form eines Freitextes abgebildet werden.
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 | Σ | 0..1 | Timing | 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 (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 | Σ | 0..* | Element | Amount of medication administered
id |  | 0..1 | string | Unique id for inter-element referencing
extension | N | 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] | Σ | 0..1 |  | Amount of medication per dose
doseRange |  |  | Range |
doseQuantity |  |  | Quantity(SimpleQuantity) |
rate[x] | Σ | 0..1 |  | Amount of medication per unit of time
rateRatio |  |  | Ratio |
rateRange |  |  | Range |
rateQuantity |  |  | Quantity(SimpleQuantity) |
maxDosePerPeriod | Σ C | 0..1 | Ratio | Upper limit on medication per unit of time rat-1: Numerator and denominator SHALL both be present, or both are absent. If both are absent, there SHALL be some extension present
maxDosePerAdministration | Σ C | 0..1 | SimpleQuantity | Upper limit on medication per administration qty-3: If a code for the unit is present, the system SHALL also be present sqty-1: The comparator is not used on a SimpleQuantity
maxDosePerLifetime | Σ C | 0..1 | SimpleQuantity | Upper limit on medication per lifetime of the patient qty-3: If a code for the unit is present, the system SHALL also be present sqty-1: The comparator is not used on a SimpleQuantity
substitution | S | 0..1 | BackboneElement | Whether a substitution was performed on the dispense
id |  | 0..1 | string | Unique id for inter-element referencing
extension | N | 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
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: ActSubstanceAdminSubstitutionCode (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: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
responsibleParty | C | 0..* | Reference(Practitioner | PractitionerRole) | Who is responsible for the substitution ref-1: SHALL have a contained resource if a local reference is provided
detectedIssue | C | 0..* | Reference(DetectedIssue) | Clinical issue with action ref-1: SHALL have a contained resource if a local reference is provided
eventHistory | C | 0..* | Reference(Provenance) | A list of relevant lifecycle events ref-1: SHALL have a contained resource if a local reference is provided
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet | URI
MedicationDispense.meta.security | extensible | All Security Labels `http://hl7.org/fhir/ValueSet/security-labels` from the FHIR Standard
MedicationDispense.meta.tag | example | CommonTags `http://hl7.org/fhir/ValueSet/common-tags` from the FHIR Standard
MedicationDispense.language | preferred | CommonLanguages `http://hl7.org/fhir/ValueSet/languages` from the FHIR Standard
Additional Bindings | Purpose
AllLanguages | Max Binding
MedicationDispense.status | required | TIMedicationDispenseStatusVS `https://gematik.de/fhir/terminology/ValueSet/ti-medication-dispense-status-vs`
MedicationDispense.statusReason[x] | example | MedicationDispense Status Reason Codes `http://hl7.org/fhir/ValueSet/medicationdispense-status-reason` from the FHIR Standard
MedicationDispense.category | preferred | MedicationDispense Category Codes `http://hl7.org/fhir/ValueSet/medicationdispense-category` from the FHIR Standard
MedicationDispense.subject.type | extensible | ResourceType `http://hl7.org/fhir/ValueSet/resource-types` from the FHIR Standard
MedicationDispense.performer.function | example | MedicationDispense Performer Function Codes `http://hl7.org/fhir/ValueSet/medicationdispense-performer-function` from the FHIR Standard
MedicationDispense.authorizingPrescription.type | extensible | ResourceType `http://hl7.org/fhir/ValueSet/resource-types` from the FHIR Standard
MedicationDispense.type | example | ActPharmacySupplyType `http://terminology.hl7.org/ValueSet/v3-ActPharmacySupplyType`
MedicationDispense.dosageInstruction.additionalInstruction | example | SNOMEDCTAdditionalDosageInstructions `http://hl7.org/fhir/ValueSet/additional-instruction-codes` from the FHIR Standard
MedicationDispense.dosageInstruction.asNeeded[x] | example | SNOMEDCTMedicationAsNeededReasonCodes `http://hl7.org/fhir/ValueSet/medication-as-needed-reason` from the FHIR Standard
MedicationDispense.dosageInstruction.site | example | SNOMEDCTAnatomicalStructureForAdministrationSiteCodes `http://hl7.org/fhir/ValueSet/approach-site-codes` from the FHIR Standard
MedicationDispense.dosageInstruction.route | example | SNOMEDCTRouteCodes `http://hl7.org/fhir/ValueSet/route-codes` from the FHIR Standard
MedicationDispense.dosageInstruction.method | example | SNOMEDCTAdministrationMethodCodes `http://hl7.org/fhir/ValueSet/administration-method-codes` from the FHIR Standard
MedicationDispense.dosageInstruction.doseAndRate.type | example | DoseAndRateType `http://hl7.org/fhir/ValueSet/dose-rate-type` from the FHIR Standard
MedicationDispense.substitution.type | example | ActSubstanceAdminSubstitutionCode `http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode`
MedicationDispense.substitution.reason | example | SubstanceAdminSubstitutionReason `http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason`

#### Constraints

Id | Grade | Path(s) | Details | Requirements
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** elements | 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 |
qty-3 | error | MedicationDispense.quantity, MedicationDispense.daysSupply, MedicationDispense.dosageInstruction.maxDosePerAdministration, MedicationDispense.dosageInstruction.maxDosePerLifetime | If a code for the unit is present, the system SHALL also be present : code.empty() or system.exists() |
rat-1 | error | MedicationDispense.dosageInstruction.maxDosePerPeriod | Numerator and denominator SHALL both be present, or both are absent. If both are absent, there SHALL be some extension present : (numerator.empty() xor denominator.exists()) and (numerator.exists() or extension.exists()) |
ref-1 | error | MedicationDispense.partOf, MedicationDispense.subject, MedicationDispense.context, MedicationDispense.supportingInformation, MedicationDispense.performer.actor, MedicationDispense.location, MedicationDispense.authorizingPrescription, MedicationDispense.destination, MedicationDispense.receiver, MedicationDispense.substitution.responsibleParty, MedicationDispense.detectedIssue, MedicationDispense.eventHistory | SHALL have a contained resource if a local reference is provided : reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) |
sqty-1 | error | MedicationDispense.quantity, MedicationDispense.daysSupply, MedicationDispense.dosageInstruction.maxDosePerAdministration, MedicationDispense.dosageInstruction.maxDosePerLifetime | The comparator is not used on a SimpleQuantity : comparator.empty() |

This structure is derived from MedicationDispense

Summary

Mandatory: 4 elements(1 nested mandatory element)
Must-Support: 12 elements

Structures

This structure refers to these other structures:

- RxOriginatorProcessIdentifier (https://gematik.de/fhir/epa-medication/StructureDefinition/rx-originator-process-identifier)
- Identifier-Profil für die 10-stellige Krankenversichertennummer (http://fhir.de/StructureDefinition/identifier-kvid-10)

Extensions

This structure refers to these extensions:

- https://gematik.de/fhir/epa-medication/StructureDefinition/rx-prescription-process-identifier-extension

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of MedicationDispense.identifier

Key Elements View

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
MedicationDispense | C | 0..* | MedicationDispense | Dispensing a medication to a named patient dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-6: A resource should have narrative for robust management dom-5: If a resource is contained in another resource, it SHALL NOT have a security label mdd-1: whenHandedOver cannot be before whenPrepared
meta | S Σ | 0..1 | Meta | Metadata about the resource ele-1: All FHIR elements must have a @value or children
versionId | S Σ | 0..1 | id | Version specific identifier ele-1: All FHIR elements must have a @value or children
lastUpdated | S Σ | 0..1 | instant | When the resource version last changed ele-1: All FHIR elements must have a @value or children
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
Slices for extension |  |  |  | Content/Rules for all slices
extension:rxPrescriptionProcessIdentifier |  | 0..1 | RxPrescriptionProcessIdentifier | Extension URL: https://gematik.de/fhir/epa-medication/StructureDefinition/rx-prescription-process-identifier-extension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension | ?!N | 0..* | Extension | Extensions that cannot be ignored Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
Slices for identifier |  | 0..* | Identifier | External identifier Slice: Unordered, Open by pattern:$this ele-1: All FHIR elements must have a @value or children
identifier:RxOriginatorProcessIdentifier |  | 0..1 | RxOriginatorProcessIdentifier | External identifier ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
system |  | 1..1 | uri | The namespace for the identifier value Fixed Value: https://gematik.de/fhir/epa-medication/sid/rx-originator-process-identifier
status | ?!Σ | 1..1 | code | Status of medication dispense Binding: TI Medication Dispense ValueSet (required) ele-1: All FHIR elements must have a @value or children
medication[x] | S Σ | 1..1 | Reference(Medication) | What medication was supplied ele-1: All FHIR elements must have a @value or children
subject | S Σ C | 1..1 | Reference(Patient) | Who the dispense is for ele-1: All FHIR elements must have a @value or children ref-1: SHALL have a contained resource if a local reference is provided
reference | Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL ele-1: All FHIR elements must have a @value or children
identifier | S Σ | 1..1 | IdentifierKvid10 | Logical reference, when literal reference is not known ele-1: All FHIR elements must have a @value or children
performer | S | 1..1 | BackboneElement | Who performed event ele-1: All FHIR elements must have a @value or children
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
actor | C | 1..1 | Reference(Organization | PractitionerRole) | Individual who was performing ele-1: All FHIR elements must have a @value or children ref-1: SHALL have a contained resource if a local reference is provided
authorizingPrescription | C | 0..* | Reference(MedicationRequest) | Medication order that authorizes the dispense ele-1: All FHIR elements must have a @value or children ref-1: SHALL have a contained resource if a local reference is provided
reference | S Σ C | 1..1 | string | Literal reference, Relative, internal or absolute URL ele-1: All FHIR elements must have a @value or children
whenHandedOver | S | 1..1 | dateTime | When product was given out ele-1: All FHIR elements must have a @value or children
dosageInstruction | S | 0..* | Dosage | Hier werden Informationen zur Dosierung angegeben. ele-1: All FHIR elements must have a @value or children
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
text | S Σ | 0..1 | string | Hier kann die Dosieranweisung in Form eines Freitextes abgebildet werden. ele-1: All FHIR elements must have a @value or children
substitution | S | 0..1 | BackboneElement | Whether a substitution was performed on the dispense ele-1: All FHIR elements must have a @value or children
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
wasSubstituted |  | 1..1 | boolean | Whether a substitution was or was not performed on the dispense ele-1: All FHIR elements must have a @value or children
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet | URI
MedicationDispense.status | required | TIMedicationDispenseStatusVS `https://gematik.de/fhir/terminology/ValueSet/ti-medication-dispense-status-vs`

#### Constraints

Id | Grade | Path(s) | Details | Requirements
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** elements | 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 |
ref-1 | error | MedicationDispense.subject, MedicationDispense.performer.actor, MedicationDispense.authorizingPrescription | SHALL have a contained resource if a local reference is provided : reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) |

Differential View

This structure is derived from MedicationDispense

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
MedicationDispense |  | 0..* | MedicationDispense | Dispensing a medication to a named patient
meta | S | 0..1 | Meta | Metadata about the resource
versionId | S | 0..1 | id | Version specific identifier
lastUpdated | S | 0..1 | instant | When the resource version last changed
Slices for extension |  |  |  | Content/Rules for all slices
extension:rxPrescriptionProcessIdentifier |  | 0..1 | RxPrescriptionProcessIdentifier | Extension URL: https://gematik.de/fhir/epa-medication/StructureDefinition/rx-prescription-process-identifier-extension
Slices for identifier |  | 0..* | Identifier | External identifier Slice: Unordered, Open by pattern:$this
identifier:RxOriginatorProcessIdentifier |  | 0..1 | RxOriginatorProcessIdentifier | External identifier Required Pattern: At least the following
system |  | 1..1 | uri | The namespace for the identifier value Fixed Value: https://gematik.de/fhir/epa-medication/sid/rx-originator-process-identifier
status |  | 1..1 | code | Status of medication dispense Binding: TI Medication Dispense ValueSet (required)
medication[x] | S | 1..1 | Reference(Medication) | What medication was supplied
subject | S | 1..1 | Reference(Patient) | Who the dispense is for
identifier | S | 1..1 | IdentifierKvid10 | Logical reference, when literal reference is not known
performer | S | 1..1 | BackboneElement | Who performed event
actor |  | 1..1 | Reference(Organization | PractitionerRole) | Individual who was performing
authorizingPrescription |  |  |  |
reference | S | 1..1 | string | Literal reference, Relative, internal or absolute URL
whenHandedOver | S | 1..1 | dateTime | When product was given out
dosageInstruction | S | 0..* | Dosage | Hier werden Informationen zur Dosierung angegeben.
text | S | 0..1 | string | Hier kann die Dosieranweisung in Form eines Freitextes abgebildet werden.
substitution | S | 0..1 | BackboneElement | Whether a substitution was performed on the dispense
Documentation for this format

#### Terminology Bindings (Differential)

Path | Conformance | ValueSet | URI
MedicationDispense.status | required | TIMedicationDispenseStatusVS `https://gematik.de/fhir/terminology/ValueSet/ti-medication-dispense-status-vs`

Snapshot View

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
MedicationDispense | C | 0..* | MedicationDispense | Dispensing a medication to a named patient mdd-1: whenHandedOver cannot be before whenPrepared
id | Σ | 0..1 | id | Logical id of this artifact
meta | S Σ | 0..1 | Meta | Metadata about the resource
id |  | 0..1 | string | Unique id for inter-element referencing
extension | N | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
versionId | S Σ | 0..1 | id | Version specific identifier
lastUpdated | S Σ | 0..1 | instant | When the resource version last changed
source | Σ | 0..1 | uri | Identifies where the resource comes from
profile | Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to
security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag | Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
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
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension | N | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
extension:rxPrescriptionProcessIdentifier |  | 0..1 | RxPrescriptionProcessIdentifier | Extension URL: https://gematik.de/fhir/epa-medication/StructureDefinition/rx-prescription-process-identifier-extension
modifierExtension | ?!N | 0..* | Extension | Extensions that cannot be ignored Slice: Unordered, Open by value:url
Slices for identifier |  | 0..* | Identifier | External identifier Slice: Unordered, Open by pattern:$this
identifier:RxOriginatorProcessIdentifier |  | 0..1 | RxOriginatorProcessIdentifier | External identifier Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
use |  | 0..1 | code | usual | official | temp | secondary | old (If known)
type |  | 0..1 | CodeableConcept | Description of identifier
system |  | 1..1 | uri | The namespace for the identifier value Fixed Value: https://gematik.de/fhir/epa-medication/sid/rx-originator-process-identifier
value |  | 0..1 | string | The value that is unique
period |  | 0..1 | Period | Time period when id is/was valid for use
assigner |  | 0..1 | Reference(Organization) | Organization that issued id (may be just text)
partOf | C | 0..* | Reference(Procedure) | Event that dispense is part of ref-1: SHALL have a contained resource if a local reference is provided
status | ?!Σ | 1..1 | code | Status of medication dispense Binding: TI Medication Dispense ValueSet (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 | Reference(Medication) | What medication was supplied
subject | S Σ C | 1..1 | Reference(Patient) | Who the dispense is for ref-1: SHALL have a contained resource if a local reference is provided
id |  | 0..1 | string | Unique id for inter-element referencing
extension | N | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
reference | Σ C | 0..1 | string | Literal reference, Relative, internal or absolute URL
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier | S Σ | 1..1 | IdentifierKvid10 | Logical reference, when literal reference is not known
display | Σ | 0..1 | string | Text alternative for the resource
context | C | 0..1 | Reference(Encounter | EpisodeOfCare) | Encounter / Episode associated with event ref-1: SHALL have a contained resource if a local reference is provided
supportingInformation | C | 0..* | Reference(Resource) | Information that supports the dispensing of the medication ref-1: SHALL have a contained resource if a local reference is provided
performer | S | 1..1 | BackboneElement | Who performed event
id |  | 0..1 | string | Unique id for inter-element referencing
extension | N | 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
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 | C | 1..1 | Reference(Organization | PractitionerRole) | Individual who was performing ref-1: SHALL have a contained resource if a local reference is provided
location | C | 0..1 | Reference(Location) | Where the dispense occurred ref-1: SHALL have a contained resource if a local reference is provided
authorizingPrescription | C | 0..* | Reference(MedicationRequest) | Medication order that authorizes the dispense ref-1: SHALL have a contained resource if a local reference is provided
id |  | 0..1 | string | Unique id for inter-element referencing
extension | N | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
reference | S Σ C | 1..1 | string | Literal reference, Relative, internal or absolute URL
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known
display | Σ | 0..1 | string | Text alternative for the resource
type |  | 0..1 | CodeableConcept | Trial fill, partial fill, emergency fill, etc. Binding: ActPharmacySupplyType (example): Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc.
quantity | C | 0..1 | SimpleQuantity | Amount dispensed qty-3: If a code for the unit is present, the system SHALL also be present sqty-1: The comparator is not used on a SimpleQuantity
daysSupply | C | 0..1 | SimpleQuantity | Amount of medication expressed as a timing amount qty-3: If a code for the unit is present, the system SHALL also be present sqty-1: The comparator is not used on a SimpleQuantity
whenPrepared | Σ | 0..1 | dateTime | When product was packaged and reviewed
whenHandedOver | S | 1..1 | dateTime | When product was given out
destination | C | 0..1 | Reference(Location) | Where the medication was sent ref-1: SHALL have a contained resource if a local reference is provided
receiver | C | 0..* | Reference(Patient | Practitioner) | Who collected the medication ref-1: SHALL have a contained resource if a local reference is provided
note |  | 0..* | Annotation | Information about the dispense
dosageInstruction | S | 0..* | Dosage | Hier werden Informationen zur Dosierung angegeben.
id |  | 0..1 | string | Unique id for inter-element referencing
extension | N | 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 | Hier kann die Dosieranweisung in Form eines Freitextes abgebildet werden.
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 | Σ | 0..1 | Timing | 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 (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 | Σ | 0..* | Element | Amount of medication administered
id |  | 0..1 | string | Unique id for inter-element referencing
extension | N | 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] | Σ | 0..1 |  | Amount of medication per dose
doseRange |  |  | Range |
doseQuantity |  |  | Quantity(SimpleQuantity) |
rate[x] | Σ | 0..1 |  | Amount of medication per unit of time
rateRatio |  |  | Ratio |
rateRange |  |  | Range |
rateQuantity |  |  | Quantity(SimpleQuantity) |
maxDosePerPeriod | Σ C | 0..1 | Ratio | Upper limit on medication per unit of time rat-1: Numerator and denominator SHALL both be present, or both are absent. If both are absent, there SHALL be some extension present
maxDosePerAdministration | Σ C | 0..1 | SimpleQuantity | Upper limit on medication per administration qty-3: If a code for the unit is present, the system SHALL also be present sqty-1: The comparator is not used on a SimpleQuantity
maxDosePerLifetime | Σ C | 0..1 | SimpleQuantity | Upper limit on medication per lifetime of the patient qty-3: If a code for the unit is present, the system SHALL also be present sqty-1: The comparator is not used on a SimpleQuantity
substitution | S | 0..1 | BackboneElement | Whether a substitution was performed on the dispense
id |  | 0..1 | string | Unique id for inter-element referencing
extension | N | 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
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: ActSubstanceAdminSubstitutionCode (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: SubstanceAdminSubstitutionReason (example): A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
responsibleParty | C | 0..* | Reference(Practitioner | PractitionerRole) | Who is responsible for the substitution ref-1: SHALL have a contained resource if a local reference is provided
detectedIssue | C | 0..* | Reference(DetectedIssue) | Clinical issue with action ref-1: SHALL have a contained resource if a local reference is provided
eventHistory | C | 0..* | Reference(Provenance) | A list of relevant lifecycle events ref-1: SHALL have a contained resource if a local reference is provided
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet | URI
MedicationDispense.meta.security | extensible | All Security Labels `http://hl7.org/fhir/ValueSet/security-labels` from the FHIR Standard
MedicationDispense.meta.tag | example | CommonTags `http://hl7.org/fhir/ValueSet/common-tags` from the FHIR Standard
MedicationDispense.language | preferred | CommonLanguages `http://hl7.org/fhir/ValueSet/languages` from the FHIR Standard
Additional Bindings | Purpose
AllLanguages | Max Binding
MedicationDispense.status | required | TIMedicationDispenseStatusVS `https://gematik.de/fhir/terminology/ValueSet/ti-medication-dispense-status-vs`
MedicationDispense.statusReason[x] | example | MedicationDispense Status Reason Codes `http://hl7.org/fhir/ValueSet/medicationdispense-status-reason` from the FHIR Standard
MedicationDispense.category | preferred | MedicationDispense Category Codes `http://hl7.org/fhir/ValueSet/medicationdispense-category` from the FHIR Standard
MedicationDispense.subject.type | extensible | ResourceType `http://hl7.org/fhir/ValueSet/resource-types` from the FHIR Standard
MedicationDispense.performer.function | example | MedicationDispense Performer Function Codes `http://hl7.org/fhir/ValueSet/medicationdispense-performer-function` from the FHIR Standard
MedicationDispense.authorizingPrescription.type | extensible | ResourceType `http://hl7.org/fhir/ValueSet/resource-types` from the FHIR Standard
MedicationDispense.type | example | ActPharmacySupplyType `http://terminology.hl7.org/ValueSet/v3-ActPharmacySupplyType`
MedicationDispense.dosageInstruction.additionalInstruction | example | SNOMEDCTAdditionalDosageInstructions `http://hl7.org/fhir/ValueSet/additional-instruction-codes` from the FHIR Standard
MedicationDispense.dosageInstruction.asNeeded[x] | example | SNOMEDCTMedicationAsNeededReasonCodes `http://hl7.org/fhir/ValueSet/medication-as-needed-reason` from the FHIR Standard
MedicationDispense.dosageInstruction.site | example | SNOMEDCTAnatomicalStructureForAdministrationSiteCodes `http://hl7.org/fhir/ValueSet/approach-site-codes` from the FHIR Standard
MedicationDispense.dosageInstruction.route | example | SNOMEDCTRouteCodes `http://hl7.org/fhir/ValueSet/route-codes` from the FHIR Standard
MedicationDispense.dosageInstruction.method | example | SNOMEDCTAdministrationMethodCodes `http://hl7.org/fhir/ValueSet/administration-method-codes` from the FHIR Standard
MedicationDispense.dosageInstruction.doseAndRate.type | example | DoseAndRateType `http://hl7.org/fhir/ValueSet/dose-rate-type` from the FHIR Standard
MedicationDispense.substitution.type | example | ActSubstanceAdminSubstitutionCode `http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode`
MedicationDispense.substitution.reason | example | SubstanceAdminSubstitutionReason `http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason`

#### Constraints

Id | Grade | Path(s) | Details | Requirements
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** elements | 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 |
qty-3 | error | MedicationDispense.quantity, MedicationDispense.daysSupply, MedicationDispense.dosageInstruction.maxDosePerAdministration, MedicationDispense.dosageInstruction.maxDosePerLifetime | If a code for the unit is present, the system SHALL also be present : code.empty() or system.exists() |
rat-1 | error | MedicationDispense.dosageInstruction.maxDosePerPeriod | Numerator and denominator SHALL both be present, or both are absent. If both are absent, there SHALL be some extension present : (numerator.empty() xor denominator.exists()) and (numerator.exists() or extension.exists()) |
ref-1 | error | MedicationDispense.partOf, MedicationDispense.subject, MedicationDispense.context, MedicationDispense.supportingInformation, MedicationDispense.performer.actor, MedicationDispense.location, MedicationDispense.authorizingPrescription, MedicationDispense.destination, MedicationDispense.receiver, MedicationDispense.substitution.responsibleParty, MedicationDispense.detectedIssue, MedicationDispense.eventHistory | SHALL have a contained resource if a local reference is provided : reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) |
sqty-1 | error | MedicationDispense.quantity, MedicationDispense.daysSupply, MedicationDispense.dosageInstruction.maxDosePerAdministration, MedicationDispense.dosageInstruction.maxDosePerLifetime | The comparator is not used on a SimpleQuantity : comparator.empty() |

This structure is derived from MedicationDispense

Summary

Mandatory: 4 elements(1 nested mandatory element)
Must-Support: 12 elements

Structures

This structure refers to these other structures:

- RxOriginatorProcessIdentifier (https://gematik.de/fhir/epa-medication/StructureDefinition/rx-originator-process-identifier)
- Identifier-Profil für die 10-stellige Krankenversichertennummer (http://fhir.de/StructureDefinition/identifier-kvid-10)

Extensions

This structure refers to these extensions:

- https://gematik.de/fhir/epa-medication/StructureDefinition/rx-prescription-process-identifier-extension

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of MedicationDispense.identifier

Other representations of profile: CSV, Excel, Schematron