Implementation Guide
TIFlow - Grenzüberschreitender Datenaustausch
Version 2.0.0-ballot.2 - ballot

## Resource Profile: GEM_ERPEU_PR_MedicationDispense - Detailed Descriptions

Draft as of 2026-06-30

Definitions for the GEM-ERPEU-PR-MedicationDispense resource profile.

- Key Elements Table
- Differential Elements Table
- Snapshot Elements Table

Guidance on how to interpret the contents of this table can be foundhere

0. MedicationDispense
Definition | Indicates that a medication product is to be or has been dispensed for a named person/patient. This includes a description of the medication product (supply) provided and the instructions for administering the medication. The medication dispense is the result of a pharmacy system responding to a medication order.
Short | Dispensing a medication to a named patient
Control | 0..*
Is Modifier | false
Summary | false
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty()) 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 (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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty()) dom-6: A resource should have narrative for robust management (text.`div`.exists()) mdd-1: whenHandedOver cannot be before whenPrepared (whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared)
2. MedicationDispense.meta
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Short | Metadata about the resource
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Meta
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. MedicationDispense.meta.versionId
Definition | The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.
Short | Version specific identifier
Comments | The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.
Control | 0..1
Type | id
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
6. MedicationDispense.meta.lastUpdated
Definition | When the resource last changed - e.g. when the version changed.
Short | When the resource version last changed
Comments | This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.
Control | 0..1
Type | instant
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
8. MedicationDispense.implicitRules
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Short | A set of rules under which this content was created
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
Control | 0..1
Type | uri
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
10. MedicationDispense.extension:rxPrescriptionProcessIdentifier
Slice Name | rxPrescriptionProcessIdentifier
Definition | This extension is used to track medication prescription transactions between the E-Rezept-Fachdienst and the ePA. The RxPrescriptionProcessIdentifier is generated by the ePA Medication Service and consists of the PrescriptionId and the authoredOn date of the operation parameters request. It ensures consistent referencing and management of medication-related resources across different systems.
Short | Optional Extensions Element
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(RxPrescriptionProcessIdentifierExtension) (Extension Type: Identifier(RxPrescriptionProcessIdentifier))
Is Modifier | false
Standard Status | Normative (from Trial Use)
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
12. MedicationDispense.extension:renderedDosageInstruction
Slice Name | renderedDosageInstruction
Definition | Ein menschenlesbarer, vollständiger Text der Dosierungsanweisungen. Der Text wird aus den strukturierten Dosage-Elementen generiert und dient der patientensicheren Darstellung der Dosierung. Er soll die maschinenlesbaren Angaben konsistent wiedergeben und in einer für Patient:innen verständlichen Form bereitstellen.
Short | Vollständige Darstellung der Dosierungsanweisungen (generiert aus den Dosage-Elementen).
Comments | Element `MedicationDispense.renderedDosageInstruction` has a context of MedicationDispense based on following the parent source element upwards and mapping to `MedicationDispense`. Element `MedicationDispense.renderedDosageInstruction` has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). The content of the renderedDosageInstructions must not be different than the dose represented in the dosageInstruction content.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(R5: Full representation of the dosage instructions (new)) (Extension Type: markdown)
Is Modifier | false
Must Support | true
Standard Status | Normative (from Trial Use)
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
14. MedicationDispense.extension:renderedDosageInstruction.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..0* This element is affected by the following invariants: ele-1
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
Slicing | This element introduces a set of slices on `MedicationDispense.extension.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
16. MedicationDispense.extension:renderedDosageInstruction.url
Definition | Source of the definition for the extension code - a logical name or a URL.
Short | identifies the meaning of the extension
Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Control | 1..1
Type | uri
XML Format | In the XML format, this property is represented as an attribute.
Fixed Value | `http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationDispense.renderedDosageInstruction`
18. MedicationDispense.extension:renderedDosageInstruction.value[x]
Definition | The full representation of the dose of the medication included in all dosage instructions. To be used when multiple dosage instructions are included to represent complex dosing such as increasing or tapering doses. Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).
Short | Full representation of the dosage instructionsValue of extension
Comments | The content of the renderedDosageInstructions must not be different than the dose represented in the dosageInstruction content.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | markdown, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Standard Status | Normative (from Trial Use)
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
20. MedicationDispense.extension:generatedDosageInstructionsMeta
Slice Name | generatedDosageInstructionsMeta
Definition | Diese Extension enthält zusätzliche Metadaten zu den automatisch generierten Dosierungsanweisungen, wie z.B. Informationen zur Generierung oder zum Ursprung der Daten.
Short | Metadaten zu den generierten Dosierungsanweisungen
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(Generated Dosage Instructions Meta) (Complex Extension)
Is Modifier | false
Must Support | true
Standard Status | Normative (from Trial Use)
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
22. MedicationDispense.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..* This element is affected by the following invariants: ele-1
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Summary | false
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
Slicing | This element introduces a set of slices on `MedicationDispense.modifierExtension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
24. MedicationDispense.identifier
Definition | Identifiers associated with this Medication Dispense that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server.
Short | ePrescription identifierExternal identifier
Comments | This is a business identifier, not a resource identifier.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 10..* This element is affected by the following invariants: ele-1
Type | Identifier
Is Modifier | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
Slicing | This element introduces a set of slices on `MedicationDispense.identifier`. The slices areUnordered and Open, and can be differentiated using the following discriminators: pattern @ $this
26. MedicationDispense.identifier:RxOriginatorProcessIdentifier
Slice Name | RxOriginatorProcessIdentifier
Definition | An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers. Identifiers associated with this Medication Dispense that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server.
Short | An identifier intended for computationExternal identifier
Comments | This is a business identifier, not a resource identifier.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..1* This element is affected by the following invariants: ele-1
Type | Identifier(RxOriginatorProcessIdentifier)
Is Modifier | false
Standard Status | Normative (from Trial Use)
Pattern Value | `{ "system" : "https://gematik.de/fhir/epa-medication/sid/rx-originator-process-identifier" }`
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
28. MedicationDispense.identifier:prescriptionID
Slice Name | prescriptionID
Definition | Identifiers associated with this Medication Dispense that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server.
Short | External identifier
Comments | This is a business identifier, not a resource identifier.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 10..1* This element is affected by the following invariants: ele-1
Type | Identifier(Identifikator Profil für E-Rezept-IDs)
Is Modifier | false
Pattern Value | `{ "system" : "https://gematik.de/fhir/erp/NamingSystem/GEM_ERP_NS_PrescriptionId" }`
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
30. MedicationDispense.status
Definition | A code specifying the state of the set of dispense events.
Short | completedpreparation | in-progress | cancelled | on-hold | completed | entered-in-error | stopped | declined | unknown
Comments | This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Control | 1..1
Binding | The codes SHALL be taken from https://gematik.de/fhir/terminology/ValueSet/ti-medication-dispense-status-vs http://hl7.org/fhir/ValueSet/medicationdispense-status|4.0.1 (required to `https://gematik.de/fhir/terminology/ValueSet/ti-medication-dispense-status-vs` ) A coded concept specifying the state of the dispense event.
Type | code
Is Modifier | true because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Fixed Value | `completed`
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
32. MedicationDispense.category
Definition | Indicates the type of medication dispense (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)).
Short | Fehlender oder nicht vorhandener Wert weist auf eine Abgabe mit Verschreibung hin.Type of medication dispense
Comments | The category can be used to include where the medication is expected to be consumed or other types of dispenses. Invariants can be used to bind to different value sets when profiling to bind.
Control | 0..1 This element is affected by the following invariants: ele-1
Binding | The codes SHALL be taken from The codes SHOULD be taken from https://gematik.de/fhir/terminology/ValueSet/ti-medication-dispense-category-vs http://hl7.org/fhir/ValueSet/medicationdispense-category|4.0.1 (required to `https://gematik.de/fhir/terminology/ValueSet/ti-medication-dispense-category-vs` ) Definiert den Kontext einer Abgabe: mit oder ohne ärztliche Verschreibung. A code describing where the dispensed medication is expected to be consumed or administered.
Type | CodeableConcept
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
34. MedicationDispense.medication[x]
Definition | The MedicationDispense references a medication which was dispensed Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications.
Short | What medication was supplied
Comments | If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended. For example, if you require form or lot number, then you must reference the Medication resource.
Control | 1..1 This element is affected by the following invariants: ele-1
Type | Reference(EU-Medication, Medication), CodeableConcept
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
36. MedicationDispense.subject
Definition | A link to a resource representing the person or the group to whom the medication will be given.
Short | Who the dispense is for
Comments | SubstanceAdministration->subject->Patient.
Control | 10..1 This element is affected by the following invariants: ele-1
Type | Reference(Patient, Patient, Group)
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ref-1: 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')))
38. MedicationDispense.subject.identifier
Definition | An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers. An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
Short | An identifier intended for computationLogical reference, when literal reference is not known
Comments | When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 10..1 This element is affected by the following invariants: ele-1
Type | Identifier(Identifier-Profil für die 10-stellige Krankenversichertennummer)
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
40. MedicationDispense.performer
Definition | References a pracitioner role in order to state practitioner and organization information Indicates who or what performed the event.
Short | Who performed event
Control | 10..1* This element is affected by the following invariants: ele-1
Type | BackboneElement
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
42. MedicationDispense.performer.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..* This element is affected by the following invariants: ele-1
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
44. MedicationDispense.performer.actor
Definition | The device, practitioner, etc. who performed the action. It should be assumed that the actor is the dispenser of the medication.
Short | Individual who was performing
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Control | 1..1 This element is affected by the following invariants: ele-1
Type | Reference(PractitionerRole Information Received from the EU, Practitioner, PractitionerRole, Organization, Patient, Device, RelatedPerson)
Is Modifier | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ref-1: 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')))
46. MedicationDispense.authorizingPrescription
Definition | Indicates the medication order that is being dispensed against.
Short | Medication order that authorizes the dispense
Comments | Maps to basedOn in Event logical model.
Control | 0..* This element is affected by the following invariants: ele-1
Type | Reference(MedicationRequest, MedicationRequest)
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ref-1: 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')))
48. MedicationDispense.authorizingPrescription.reference
Definition | A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Short | Literal reference, Relative, internal or absolute URL
Comments | Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
Control | 10..1 This element is affected by the following invariants: ref-1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
50. MedicationDispense.quantity
Definition | The amount of medication that has been dispensed. Includes unit of measure.
Short | Number of dispensed packages/ unitsAmount dispensed
Comments | The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Quantity(SimpleQuantity, SimpleQuantity)
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) qty-3: If a code for the unit is present, the system SHALL also be present (code.empty() or system.exists()) sqty-1: The comparator is not used on a SimpleQuantity (comparator.empty()) erp-eu-positiveAnzahlPackungen: Der Wert der Packungen muss positiv sein (größer gleich 0). (`value>=0`)
52. MedicationDispense.quantity.value
Definition | The value of the measured amount. The value includes an implicit precision in the presentation of the value.
Short | Numerical value (with implicit precision)
Comments | The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).
Control | 0..1
Type | decimal
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Precision is handled implicitly in almost all cases of measurement.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
54. MedicationDispense.quantity.comparator
Definition | Not allowed to be used in this context How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.
Short | < | <= | >= | > - how to understand the value
Control | 0..01
Binding | The codes SHALL be taken from QuantityComparator http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1 (required to `http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1` ) How the Quantity should be understood and represented.
Type | code
Is Modifier | true because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.
Meaning if Missing | If there is no comparator, then there is no modification of the value
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
56. MedicationDispense.quantity.unit
Definition | A human-readable form of the unit.
Short | Unit representation
Comments | Note that FHIR strings SHALL NOT exceed 1MB in size
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
58. MedicationDispense.whenPrepared
Definition | The time when the dispensed product was packaged and reviewed.
Short | When product was packaged and reviewed
Control | 0..1
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) erp-eu-abgabeDatumsFormat: Wert muss ein Datum in der Form: YYYY-MM-DD sein. (`toString().length()=10`)
60. MedicationDispense.whenHandedOver
Definition | The time the dispensed product was provided to the patient or their representative.
Short | When product was given out
Control | 10..1
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) erp-eu-abgabeDatumsFormat: Wert muss ein Datum in der Form: YYYY-MM-DD sein. (`toString().length()=10`)
62. MedicationDispense.dosageInstruction
Definition | Hier werden Informationen zur Dosierung angegeben. Indicates how the medication is to be used by the patient.
Short | Hier werden Informationen zur Dosierung angegeben.How the medication is to be used by the patient or administered by the caregiver
Comments | When the dose or rate is intended to change over the entire administration period (e.g. Tapering dose prescriptions), multiple instances of dosage instructions will need to be supplied to convey the different doses/rates. The pharmacist reviews the medication order prior to dispense and updates the dosageInstruction based on the actual product being dispensed.
Control | 0..* This element is affected by the following invariants: ele-1
Type | Dosage(Dosage DE)
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) DosageStructuredOrFreeTextWarning: Die Dosierungsangabe darf entweder nur als Freitext oder nur als vollständige strukturierte Information erfolgen — eine Mischung ist nicht erlaubt. (`(%resource.ofType(MedicationRequest).dosageInstruction | %resource.ofType(MedicationDispense).dosageInstruction | %resource.ofType(MedicationStatement).dosage).all( (text.exists() and timing.empty() and doseAndRate.empty()) or (text.empty() and (timing.exists() or doseAndRate.exists())) )`) DosageStructuredRequiresBoth: Wenn eine strukturierte Dosierungsangabe erfolgt, müssen sowohl timing als auch doseAndRate angegeben werden. (`(%resource.ofType(MedicationRequest).dosageInstruction | %resource.ofType(MedicationDispense).dosageInstruction | %resource.ofType(MedicationStatement).dosage).all( (timing.exists() implies doseAndRate.exists()) and (doseAndRate.exists() implies timing.exists()) )`) DosageDoseUnitSameCode: Die Dosiereinheit muss über alle Dosierungen gleich sein. (`(%resource.ofType(MedicationRequest).dosageInstruction | %resource.ofType(MedicationDispense).dosageInstruction | %resource.ofType(MedicationStatement).dosage).all( doseAndRate.exists() implies ( (%resource.ofType(MedicationRequest).dosageInstruction | %resource.ofType(MedicationDispense).dosageInstruction | %resource.ofType(MedicationStatement).dosage).doseAndRate.dose.ofType(Quantity).code | (%resource.ofType(MedicationRequest).dosageInstruction | %resource.ofType(MedicationDispense).dosageInstruction | %resource.ofType(MedicationStatement).dosage).doseAndRate.dose.ofType(Range).low.code | (%resource.ofType(MedicationRequest).dosageInstruction | %resource.ofType(MedicationDispense).dosageInstruction | %resource.ofType(MedicationStatement).dosage).doseAndRate.dose.ofType(Range).high.code ).distinct().count() = 1 )`) DosageWarnungViererschemaInText: Hinweis: In Dosage.text wurde ein Viererschema (z. B. 1-1-1-1) erkannt. Bitte prüfen, ob dies strukturiert abgebildet werden kann. (`text.exists() implies text.matches('.*\\d+\\s*[-–]\\s*\\d+\\s*[-–]\\s*\\d+\\s*[-–]\\d+.*').not()`) FreeTextSingleDosageOnlyWarning: Wenn eine Dosierung als reiner Freitext angegeben ist, soll nur genau ein Dosage-Element existieren. (`( (%resource.ofType(MedicationRequest).dosageInstruction | %resource.ofType(MedicationDispense).dosageInstruction | %resource.ofType(MedicationStatement).dosage ).exists(text.exists() and timing.empty() and doseAndRate.empty()) ) implies ( (%resource.ofType(MedicationRequest).dosageInstruction | %resource.ofType(MedicationDispense).dosageInstruction | %resource.ofType(MedicationStatement).dosage ).count() = 1 )`)
64. MedicationDispense.substitution
Definition | Indicates whether or not substitution was made as part of the dispense. In some cases, substitution will be expected but does not happen, in other cases substitution is not expected but does happen. This block explains what substitution did or did not happen and why. If nothing is specified, substitution was not done.
Short | Whether a substitution was performed on the dispense
Control | 0..1 This element is affected by the following invariants: ele-1
Type | BackboneElement
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
66. MedicationDispense.substitution.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..* This element is affected by the following invariants: ele-1
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
68. MedicationDispense.substitution.wasSubstituted
Definition | True if the dispenser dispensed a different drug or product from what was prescribed.
Short | Indicates whether a substitution was made on the dispensed medicationWhether a substitution was or was not performed on the dispense
Control | 1..1
Type | boolean
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

Guidance on how to interpret the contents of this table can be foundhere

0. MedicationDispense
2. MedicationDispense.identifier
Short | ePrescription identifier
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 1..?
4. MedicationDispense.identifier:prescriptionID
Slice Name | prescriptionID
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 1..1
Type | Identifier(Identifikator Profil für E-Rezept-IDs)
Pattern Value | `{ "system" : "https://gematik.de/fhir/erp/NamingSystem/GEM_ERP_NS_PrescriptionId" }`
6. MedicationDispense.status
Short | completed
Fixed Value | `completed`
8. MedicationDispense.medication[x]
Definition | The MedicationDispense references a medication which was dispensed
Type | Reference(EU-Medication)
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
10. MedicationDispense.performer
Definition | References a pracitioner role in order to state practitioner and organization information
12. MedicationDispense.performer.actor
Type | Reference(PractitionerRole Information Received from the EU)
14. MedicationDispense.quantity
Short | Number of dispensed packages/ units
Must Support | true
Invariants | erp-eu-positiveAnzahlPackungen: Der Wert der Packungen muss positiv sein (größer gleich 0). (`value>=0`)
16. MedicationDispense.quantity.value
Must Support | true
18. MedicationDispense.quantity.unit
Must Support | true
20. MedicationDispense.whenPrepared
Invariants | erp-eu-abgabeDatumsFormat: Wert muss ein Datum in der Form: YYYY-MM-DD sein. (`toString().length()=10`)
22. MedicationDispense.whenHandedOver
Invariants | erp-eu-abgabeDatumsFormat: Wert muss ein Datum in der Form: YYYY-MM-DD sein. (`toString().length()=10`)
24. MedicationDispense.substitution
26. MedicationDispense.substitution.wasSubstituted
Short | Indicates whether a substitution was made on the dispensed medication
Must Support | true

Guidance on how to interpret the contents of this table can be foundhere

0. MedicationDispense
Definition | Indicates that a medication product is to be or has been dispensed for a named person/patient. This includes a description of the medication product (supply) provided and the instructions for administering the medication. The medication dispense is the result of a pharmacy system responding to a medication order.
Short | Dispensing a medication to a named patient
Control | 0..*
Is Modifier | false
Summary | false
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (`contained.contained.empty()`) 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 (`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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (`contained.meta.security.empty()`) dom-6: A resource should have narrative for robust management (`text.`div`.exists()`) mdd-1: whenHandedOver cannot be before whenPrepared (`whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared`)
2. MedicationDispense.id
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Short | Logical id of this artifact
Comments | The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
Control | 0..1
Type | id
Is Modifier | false
Summary | true
4. MedicationDispense.meta
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Short | Metadata about the resource
Control | 0..1
Type | Meta
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
6. MedicationDispense.meta.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
8. MedicationDispense.meta.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `MedicationDispense.meta.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
10. MedicationDispense.meta.versionId
Definition | The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.
Short | Version specific identifier
Comments | The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.
Control | 0..1
Type | id
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
12. MedicationDispense.meta.lastUpdated
Definition | When the resource last changed - e.g. when the version changed.
Short | When the resource version last changed
Comments | This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.
Control | 0..1
Type | instant
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
14. MedicationDispense.meta.source
Definition | A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.
Short | Identifies where the resource comes from
Comments | In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.
Control | 0..1
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
16. MedicationDispense.meta.profile
Definition | A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.
Short | Profiles this resource claims to conform to
Comments | It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.
Control | 0..*
Type | canonical(StructureDefinition)
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
18. MedicationDispense.meta.security
Definition | Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.
Short | Security Labels applied to this resource
Comments | The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.
Control | 0..* This element is affected by the following invariants: ele-1
Binding | Unless not suitable, these codes SHALL be taken from All Security Labels (extensible to `http://hl7.org/fhir/ValueSet/security-labels` ) Security Labels from the Healthcare Privacy and Security Classification System.
Type | Coding
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
20. MedicationDispense.meta.tag
Definition | Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.
Short | Tags applied to this resource
Comments | The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.
Control | 0..* This element is affected by the following invariants: ele-1
Binding | For example codes, see CommonTags (example to `http://hl7.org/fhir/ValueSet/common-tags` ) Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
Type | Coding
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
22. MedicationDispense.implicitRules
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Short | A set of rules under which this content was created
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
Control | 0..1
Type | uri
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
24. MedicationDispense.language
Definition | The base language in which the resource is written.
Short | Language of the resource content
Comments | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Control | 0..1
Binding | The codes SHOULD be taken from CommonLanguages (preferred to `http://hl7.org/fhir/ValueSet/languages` ) A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
26. MedicationDispense.text
Definition | A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Short | Text summary of the resource, for human interpretation
Comments | Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
Control | 0..1
Type | Narrative
Is Modifier | false
Summary | false
Alternate Names | narrative, html, xhtml, display
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
28. MedicationDispense.contained
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Short | Contained, inline Resources
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Control | 0..*
Type | Resource
Is Modifier | false
Summary | false
Alternate Names | inline resources, anonymous resources, contained resources
30. MedicationDispense.extension
Definition | May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `MedicationDispense.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
32. MedicationDispense.extension:rxPrescriptionProcessIdentifier
Slice Name | rxPrescriptionProcessIdentifier
Definition | This extension is used to track medication prescription transactions between the E-Rezept-Fachdienst and the ePA. The RxPrescriptionProcessIdentifier is generated by the ePA Medication Service and consists of the PrescriptionId and the authoredOn date of the operation parameters request. It ensures consistent referencing and management of medication-related resources across different systems.
Short | Optional Extensions Element
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(RxPrescriptionProcessIdentifierExtension) (Extension Type: Identifier(RxPrescriptionProcessIdentifier))
Is Modifier | false
Standard Status | Normative (from Trial Use)
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
34. MedicationDispense.extension:renderedDosageInstruction
Slice Name | renderedDosageInstruction
Definition | Ein menschenlesbarer, vollständiger Text der Dosierungsanweisungen. Der Text wird aus den strukturierten Dosage-Elementen generiert und dient der patientensicheren Darstellung der Dosierung. Er soll die maschinenlesbaren Angaben konsistent wiedergeben und in einer für Patient:innen verständlichen Form bereitstellen.
Short | Vollständige Darstellung der Dosierungsanweisungen (generiert aus den Dosage-Elementen).
Comments | Element `MedicationDispense.renderedDosageInstruction` has a context of MedicationDispense based on following the parent source element upwards and mapping to `MedicationDispense`. Element `MedicationDispense.renderedDosageInstruction` has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). The content of the renderedDosageInstructions must not be different than the dose represented in the dosageInstruction content.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(R5: Full representation of the dosage instructions (new)) (Extension Type: markdown)
Is Modifier | false
Must Support | true
Standard Status | Normative (from Trial Use)
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
36. MedicationDispense.extension:renderedDosageInstruction.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
38. MedicationDispense.extension:renderedDosageInstruction.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..0
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `MedicationDispense.extension.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
40. MedicationDispense.extension:renderedDosageInstruction.url
Definition | Source of the definition for the extension code - a logical name or a URL.
Short | identifies the meaning of the extension
Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Control | 1..1
Type | uri
XML Format | In the XML format, this property is represented as an attribute.
Fixed Value | `http://hl7.org/fhir/5.0/StructureDefinition/extension-MedicationDispense.renderedDosageInstruction`
42. MedicationDispense.extension:renderedDosageInstruction.value[x]
Definition | The full representation of the dose of the medication included in all dosage instructions. To be used when multiple dosage instructions are included to represent complex dosing such as increasing or tapering doses.
Short | Full representation of the dosage instructions
Comments | The content of the renderedDosageInstructions must not be different than the dose represented in the dosageInstruction content.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | markdown
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Standard Status | Normative (from Trial Use)
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
44. MedicationDispense.extension:generatedDosageInstructionsMeta
Slice Name | generatedDosageInstructionsMeta
Definition | Diese Extension enthält zusätzliche Metadaten zu den automatisch generierten Dosierungsanweisungen, wie z.B. Informationen zur Generierung oder zum Ursprung der Daten.
Short | Metadaten zu den generierten Dosierungsanweisungen
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(Generated Dosage Instructions Meta) (Complex Extension)
Is Modifier | false
Must Support | true
Standard Status | Normative (from Trial Use)
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
46. MedicationDispense.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Summary | false
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `MedicationDispense.modifierExtension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
48. MedicationDispense.identifier
Definition | Identifiers associated with this Medication Dispense that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server.
Short | ePrescription identifier
Comments | This is a business identifier, not a resource identifier.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 1..* This element is affected by the following invariants: ele-1
Type | Identifier
Is Modifier | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
Slicing | This element introduces a set of slices on `MedicationDispense.identifier`. The slices areUnordered and Open, and can be differentiated using the following discriminators: pattern @ $this
50. MedicationDispense.identifier:RxOriginatorProcessIdentifier
Slice Name | RxOriginatorProcessIdentifier
Definition | An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.
Short | An identifier intended for computation
Comments | This is a business identifier, not a resource identifier.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Identifier(RxOriginatorProcessIdentifier)
Is Modifier | false
Standard Status | Normative (from Trial Use)
Pattern Value | `{ "system" : "https://gematik.de/fhir/epa-medication/sid/rx-originator-process-identifier" }`
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
52. MedicationDispense.identifier:prescriptionID
Slice Name | prescriptionID
Definition | Identifiers associated with this Medication Dispense that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to server.
Short | External identifier
Comments | This is a business identifier, not a resource identifier.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 1..1 This element is affected by the following invariants: ele-1
Type | Identifier(Identifikator Profil für E-Rezept-IDs)
Is Modifier | false
Pattern Value | `{ "system" : "https://gematik.de/fhir/erp/NamingSystem/GEM_ERP_NS_PrescriptionId" }`
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
54. MedicationDispense.partOf
Definition | The procedure that trigger the dispense.
Short | Event that dispense is part of
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Control | 0..* This element is affected by the following invariants: ele-1
Type | Reference(Procedure)
Is Modifier | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ref-1: 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'))`)
56. MedicationDispense.status
Definition | A code specifying the state of the set of dispense events.
Short | completed
Comments | This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Control | 1..1
Binding | The codes SHALL be taken from https://gematik.de/fhir/terminology/ValueSet/ti-medication-dispense-status-vs (required to `https://gematik.de/fhir/terminology/ValueSet/ti-medication-dispense-status-vs` ) A coded concept specifying the state of the dispense event.
Type | code
Is Modifier | true because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Fixed Value | `completed`
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
58. MedicationDispense.statusReason[x]
Definition | Indicates the reason why a dispense was not performed.
Short | Why a dispense was not performed
Control | 0..1 This element is affected by the following invariants: ele-1
Binding | For example codes, see MedicationDispense Status Reason Codes (example to `http://hl7.org/fhir/ValueSet/medicationdispense-status-reason` ) A code describing why a dispense was not performed.
Type | Choice of: CodeableConcept, Reference(DetectedIssue)
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
60. MedicationDispense.category
Definition | Indicates the type of medication dispense (for example, where the medication is expected to be consumed or administered (i.e. inpatient or outpatient)).
Short | Fehlender oder nicht vorhandener Wert weist auf eine Abgabe mit Verschreibung hin.
Comments | The category can be used to include where the medication is expected to be consumed or other types of dispenses. Invariants can be used to bind to different value sets when profiling to bind.
Control | 0..1 This element is affected by the following invariants: ele-1
Binding | The codes SHALL be taken from https://gematik.de/fhir/terminology/ValueSet/ti-medication-dispense-category-vs (required to `https://gematik.de/fhir/terminology/ValueSet/ti-medication-dispense-category-vs` ) Definiert den Kontext einer Abgabe: mit oder ohne ärztliche Verschreibung.
Type | CodeableConcept
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
62. MedicationDispense.medication[x]
Definition | The MedicationDispense references a medication which was dispensed
Short | What medication was supplied
Comments | If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended. For example, if you require form or lot number, then you must reference the Medication resource.
Control | 1..1 This element is affected by the following invariants: ele-1
Type | Reference(EU-Medication)
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
64. MedicationDispense.subject
Definition | A link to a resource representing the person or the group to whom the medication will be given.
Short | Who the dispense is for
Comments | SubstanceAdministration->subject->Patient.
Control | 1..1 This element is affected by the following invariants: ele-1
Type | Reference(Patient)
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ref-1: 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'))`)
66. MedicationDispense.subject.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
68. MedicationDispense.subject.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `MedicationDispense.subject.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
70. MedicationDispense.subject.reference
Definition | A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Short | Literal reference, Relative, internal or absolute URL
Comments | Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
Control | 0..1 This element is affected by the following invariants: ref-1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
72. MedicationDispense.subject.type
Definition | The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
Short | Type the reference refers to (e.g. "Patient")
Comments | This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
Control | 0..1
Binding | Unless not suitable, these codes SHALL be taken from ResourceType (extensible to `http://hl7.org/fhir/ValueSet/resource-types` ) Aa resource (or, for logical models, the URI of the logical model).
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
74. MedicationDispense.subject.identifier
Definition | An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.
Short | An identifier intended for computation
Comments | When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 1..1 This element is affected by the following invariants: ele-1
Type | Identifier(Identifier-Profil für die 10-stellige Krankenversichertennummer)
Is Modifier | false
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
76. MedicationDispense.subject.display
Definition | Plain text narrative that identifies the resource in addition to the resource reference.
Short | Text alternative for the resource
Comments | This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
78. MedicationDispense.context
Definition | The encounter or episode of care that establishes the context for this event.
Short | Encounter / Episode associated with event
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Reference(Encounter, EpisodeOfCare)
Is Modifier | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ref-1: 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'))`)
80. MedicationDispense.supportingInformation
Definition | Additional information that supports the medication being dispensed.
Short | Information that supports the dispensing of the medication
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Control | 0..* This element is affected by the following invariants: ele-1
Type | Reference(Resource)
Is Modifier | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ref-1: 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'))`)
82. MedicationDispense.performer
Definition | References a pracitioner role in order to state practitioner and organization information
Short | Who performed event
Control | 1..1 This element is affected by the following invariants: ele-1
Type | BackboneElement
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
84. MedicationDispense.performer.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
86. MedicationDispense.performer.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `MedicationDispense.performer.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
88. MedicationDispense.performer.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
90. MedicationDispense.performer.function
Definition | Distinguishes the type of performer in the dispense. For example, date enterer, packager, final checker.
Short | Who performed the dispense and what they did
Comments | Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Control | 0..1 This element is affected by the following invariants: ele-1
Binding | For example codes, see MedicationDispense Performer Function Codes (example to `http://hl7.org/fhir/ValueSet/medicationdispense-performer-function` ) A code describing the role an individual played in dispensing a medication.
Type | CodeableConcept
Is Modifier | false
Requirements | Allows disambiguation of the types of involvement of different performers.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
92. MedicationDispense.performer.actor
Definition | The device, practitioner, etc. who performed the action. It should be assumed that the actor is the dispenser of the medication.
Short | Individual who was performing
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Control | 1..1 This element is affected by the following invariants: ele-1
Type | Reference(PractitionerRole Information Received from the EU)
Is Modifier | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ref-1: 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'))`)
94. MedicationDispense.location
Definition | The principal physical location where the dispense was performed.
Short | Where the dispense occurred
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Reference(Location)
Is Modifier | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ref-1: 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'))`)
96. MedicationDispense.authorizingPrescription
Definition | Indicates the medication order that is being dispensed against.
Short | Medication order that authorizes the dispense
Comments | Maps to basedOn in Event logical model.
Control | 0..* This element is affected by the following invariants: ele-1
Type | Reference(MedicationRequest)
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ref-1: 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'))`)
98. MedicationDispense.authorizingPrescription.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
100. MedicationDispense.authorizingPrescription.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `MedicationDispense.authorizingPrescription.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
102. MedicationDispense.authorizingPrescription.reference
Definition | A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Short | Literal reference, Relative, internal or absolute URL
Comments | Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
Control | 1..1 This element is affected by the following invariants: ref-1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
104. MedicationDispense.authorizingPrescription.type
Definition | The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
Short | Type the reference refers to (e.g. "Patient")
Comments | This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
Control | 0..1
Binding | Unless not suitable, these codes SHALL be taken from ResourceType (extensible to `http://hl7.org/fhir/ValueSet/resource-types` ) Aa resource (or, for logical models, the URI of the logical model).
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
106. MedicationDispense.authorizingPrescription.identifier
Definition | An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
Short | Logical reference, when literal reference is not known
Comments | When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Identifier
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
108. MedicationDispense.authorizingPrescription.display
Definition | Plain text narrative that identifies the resource in addition to the resource reference.
Short | Text alternative for the resource
Comments | This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
110. MedicationDispense.type
Definition | Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc.
Short | Trial fill, partial fill, emergency fill, etc.
Comments | Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Control | 0..1 This element is affected by the following invariants: ele-1
Binding | For example codes, see ActPharmacySupplyType (example to `http://terminology.hl7.org/ValueSet/v3-ActPharmacySupplyType` ) Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc.
Type | CodeableConcept
Is Modifier | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
112. MedicationDispense.quantity
Definition | The amount of medication that has been dispensed. Includes unit of measure.
Short | Number of dispensed packages/ units
Comments | The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Quantity(SimpleQuantity)
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) qty-3: If a code for the unit is present, the system SHALL also be present (`code.empty() or system.exists()`) sqty-1: The comparator is not used on a SimpleQuantity (`comparator.empty()`) erp-eu-positiveAnzahlPackungen: Der Wert der Packungen muss positiv sein (größer gleich 0). (`value>=0`)
114. MedicationDispense.quantity.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
116. MedicationDispense.quantity.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `MedicationDispense.quantity.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
118. MedicationDispense.quantity.value
Definition | The value of the measured amount. The value includes an implicit precision in the presentation of the value.
Short | Numerical value (with implicit precision)
Comments | The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).
Control | 0..1
Type | decimal
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Precision is handled implicitly in almost all cases of measurement.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
120. MedicationDispense.quantity.comparator
Definition | Not allowed to be used in this context
Short | < | <= | >= | > - how to understand the value
Control | 0..0
Binding | The codes SHALL be taken from QuantityComparator (required to `http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1` ) How the Quantity should be understood and represented.
Type | code
Is Modifier | true because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.
Meaning if Missing | If there is no comparator, then there is no modification of the value
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
122. MedicationDispense.quantity.unit
Definition | A human-readable form of the unit.
Short | Unit representation
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
124. MedicationDispense.quantity.system
Definition | The identification of the system that provides the coded form of the unit.
Short | System that defines coded unit form
Control | 0..1 This element is affected by the following invariants: qty-3
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Need to know the system that defines the coded form of the unit.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
126. MedicationDispense.quantity.code
Definition | A computer processable form of the unit in some unit representation system.
Short | Coded form of the unit
Comments | The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.
Control | 0..1
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
128. MedicationDispense.daysSupply
Definition | The amount of medication expressed as a timing amount.
Short | Amount of medication expressed as a timing amount
Comments | The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Quantity(SimpleQuantity)
Is Modifier | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) qty-3: If a code for the unit is present, the system SHALL also be present (`code.empty() or system.exists()`) sqty-1: The comparator is not used on a SimpleQuantity (`comparator.empty()`)
130. MedicationDispense.whenPrepared
Definition | The time when the dispensed product was packaged and reviewed.
Short | When product was packaged and reviewed
Control | 0..1
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) erp-eu-abgabeDatumsFormat: Wert muss ein Datum in der Form: YYYY-MM-DD sein. (`toString().length()=10`)
132. MedicationDispense.whenHandedOver
Definition | The time the dispensed product was provided to the patient or their representative.
Short | When product was given out
Control | 1..1
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) erp-eu-abgabeDatumsFormat: Wert muss ein Datum in der Form: YYYY-MM-DD sein. (`toString().length()=10`)
134. MedicationDispense.destination
Definition | Identification of the facility/location where the medication was shipped to, as part of the dispense event.
Short | Where the medication was sent
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Reference(Location)
Is Modifier | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ref-1: 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'))`)
136. MedicationDispense.receiver
Definition | Identifies the person who picked up the medication. This will usually be a patient or their caregiver, but some cases exist where it can be a healthcare professional.
Short | Who collected the medication
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Control | 0..* This element is affected by the following invariants: ele-1
Type | Reference(Patient, Practitioner)
Is Modifier | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ref-1: 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'))`)
138. MedicationDispense.note
Definition | Extra information about the dispense that could not be conveyed in the other attributes.
Short | Information about the dispense
Comments | For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).
Control | 0..* This element is affected by the following invariants: ele-1
Type | Annotation
Is Modifier | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
140. MedicationDispense.dosageInstruction
Definition | Hier werden Informationen zur Dosierung angegeben.
Short | Hier werden Informationen zur Dosierung angegeben.
Comments | When the dose or rate is intended to change over the entire administration period (e.g. Tapering dose prescriptions), multiple instances of dosage instructions will need to be supplied to convey the different doses/rates. The pharmacist reviews the medication order prior to dispense and updates the dosageInstruction based on the actual product being dispensed.
Control | 0..* This element is affected by the following invariants: ele-1
Type | Dosage(Dosage DE)
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) DosageStructuredOrFreeTextWarning: Die Dosierungsangabe darf entweder nur als Freitext oder nur als vollständige strukturierte Information erfolgen — eine Mischung ist nicht erlaubt. (`(%resource.ofType(MedicationRequest).dosageInstruction | %resource.ofType(MedicationDispense).dosageInstruction | %resource.ofType(MedicationStatement).dosage).all( (text.exists() and timing.empty() and doseAndRate.empty()) or (text.empty() and (timing.exists() or doseAndRate.exists())) )`) DosageStructuredRequiresBoth: Wenn eine strukturierte Dosierungsangabe erfolgt, müssen sowohl timing als auch doseAndRate angegeben werden. (`(%resource.ofType(MedicationRequest).dosageInstruction | %resource.ofType(MedicationDispense).dosageInstruction | %resource.ofType(MedicationStatement).dosage).all( (timing.exists() implies doseAndRate.exists()) and (doseAndRate.exists() implies timing.exists()) )`) DosageDoseUnitSameCode: Die Dosiereinheit muss über alle Dosierungen gleich sein. (`(%resource.ofType(MedicationRequest).dosageInstruction | %resource.ofType(MedicationDispense).dosageInstruction | %resource.ofType(MedicationStatement).dosage).all( doseAndRate.exists() implies ( (%resource.ofType(MedicationRequest).dosageInstruction | %resource.ofType(MedicationDispense).dosageInstruction | %resource.ofType(MedicationStatement).dosage).doseAndRate.dose.ofType(Quantity).code | (%resource.ofType(MedicationRequest).dosageInstruction | %resource.ofType(MedicationDispense).dosageInstruction | %resource.ofType(MedicationStatement).dosage).doseAndRate.dose.ofType(Range).low.code | (%resource.ofType(MedicationRequest).dosageInstruction | %resource.ofType(MedicationDispense).dosageInstruction | %resource.ofType(MedicationStatement).dosage).doseAndRate.dose.ofType(Range).high.code ).distinct().count() = 1 )`) DosageWarnungViererschemaInText: Hinweis: In Dosage.text wurde ein Viererschema (z. B. 1-1-1-1) erkannt. Bitte prüfen, ob dies strukturiert abgebildet werden kann. (`text.exists() implies text.matches('.*\\d+\\s*[-–]\\s*\\d+\\s*[-–]\\s*\\d+\\s*[-–]\\d+.*').not()`) FreeTextSingleDosageOnlyWarning: Wenn eine Dosierung als reiner Freitext angegeben ist, soll nur genau ein Dosage-Element existieren. (`( (%resource.ofType(MedicationRequest).dosageInstruction | %resource.ofType(MedicationDispense).dosageInstruction | %resource.ofType(MedicationStatement).dosage ).exists(text.exists() and timing.empty() and doseAndRate.empty()) ) implies ( (%resource.ofType(MedicationRequest).dosageInstruction | %resource.ofType(MedicationDispense).dosageInstruction | %resource.ofType(MedicationStatement).dosage ).count() = 1 )`)
142. MedicationDispense.substitution
Definition | Indicates whether or not substitution was made as part of the dispense. In some cases, substitution will be expected but does not happen, in other cases substitution is not expected but does happen. This block explains what substitution did or did not happen and why. If nothing is specified, substitution was not done.
Short | Whether a substitution was performed on the dispense
Control | 0..1 This element is affected by the following invariants: ele-1
Type | BackboneElement
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
144. MedicationDispense.substitution.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
146. MedicationDispense.substitution.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `MedicationDispense.substitution.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
148. MedicationDispense.substitution.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
150. MedicationDispense.substitution.wasSubstituted
Definition | True if the dispenser dispensed a different drug or product from what was prescribed.
Short | Indicates whether a substitution was made on the dispensed medication
Control | 1..1
Type | boolean
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
152. MedicationDispense.substitution.type
Definition | A code signifying whether a different drug was dispensed from what was prescribed.
Short | Code signifying whether a different drug was dispensed from what was prescribed
Comments | Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Control | 0..1 This element is affected by the following invariants: ele-1
Binding | For example codes, see ActSubstanceAdminSubstitutionCode (example to `http://terminology.hl7.org/ValueSet/v3-ActSubstanceAdminSubstitutionCode` ) A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription.
Type | CodeableConcept
Is Modifier | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
154. MedicationDispense.substitution.reason
Definition | Indicates the reason for the substitution (or lack of substitution) from what was prescribed.
Short | Why was substitution made
Comments | Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Control | 0..* This element is affected by the following invariants: ele-1
Binding | For example codes, see SubstanceAdminSubstitutionReason (example to `http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason` ) A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed.
Type | CodeableConcept
Is Modifier | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
156. MedicationDispense.substitution.responsibleParty
Definition | The person or organization that has primary responsibility for the substitution.
Short | Who is responsible for the substitution
Comments | References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Control | 0..* This element is affected by the following invariants: ele-1
Type | Reference(Practitioner, PractitionerRole)
Is Modifier | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ref-1: 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'))`)
158. MedicationDispense.detectedIssue
Definition | Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. drug-drug interaction, duplicate therapy, dosage alert etc.
Short | Clinical issue with action
Comments | This element can include a detected issue that has been identified either by a decision support system or by a clinician and may include information on the steps that were taken to address the issue.
Control | 0..* This element is affected by the following invariants: ele-1
Type | Reference(DetectedIssue)
Is Modifier | false
Alternate Names | Contraindication, Drug Utilization Review (DUR), Alert
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ref-1: 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'))`)
160. MedicationDispense.eventHistory
Definition | A summary of the events of interest that have occurred, such as when the dispense was verified.
Short | A list of relevant lifecycle events
Comments | This might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.).
Control | 0..* This element is affected by the following invariants: ele-1
Type | Reference(Provenance)
Is Modifier | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ref-1: 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'))`)