ERA FHIR specification
1.0.0 - draft

ERA FHIR specification - Local Development build (v1.0.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: MedicationListMedicationDispense - Detailed Descriptions

Draft as of 2026-10-28

Definitions for the MedicationListMedicationDispense resource profile.

See the documentation on how to interpret the contents of this table

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.

ShortDispensing a medication to a named patient
Control0..*
Is Modifierfalse
Summaryfalse
Invariantsdom-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)
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.

ShortMetadata about the resource
Control0..1
TypeMeta
Is Modifierfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. 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.


A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

ShortProfiles 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.

Control10..1*
Typecanonical(StructureDefinition)
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Fixed Value
{
  "profile" : "http://resepti.kanta.fi/fhir/StructureDefinition/MedicationListMedicationDispense"
}
<profile value="http://resepti.kanta.fi/fhir/StructureDefinition/MedicationListMedicationDispense"/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
6. MedicationDispense.meta.tag
Definition

CDA R2 header specification templateId (specification package version)


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.

ShortCDA R2 header specification templateId (specification package version)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.

Control10..1*
BindingFor example codes, see CommonTagshttp://hl7.org/fhir/ValueSet/common-tags|4.0.1
(example to http://hl7.org/fhir/ValueSet/common-tags|4.0.1)

Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

TypeCoding
Is Modifierfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
8. MedicationDispense.meta.tag.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

ShortIdentity of the terminology system
Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

Control10..1
Typeuri
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Fixed Value
{
  "system" : "http://resepti.kanta.fi/fhir/cdaHeaderTemplateId"
}
<system value="http://resepti.kanta.fi/fhir/cdaHeaderTemplateId"/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
10. MedicationDispense.meta.tag.code
Definition

CDA R2 header specification templateId (specification package version).


A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

ShortCDA R2 header specification templateId (specification package version)Symbol in syntax defined by the system
Control10..1
Typecode
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Need to refer to a particular code in the system.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
12. 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.

ShortA 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.

Control0..1
Typeuri
Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
14. MedicationDispense.extension
Definition

An Extension


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.

ShortExtensionAdditional 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.

Control60..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-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())
SlicingThis element introduces a set of slices on MedicationDispense.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

    16. MedicationDispense.extension:versionNumber
    Slice NameversionNumber
    Definition

    Lääkitysasiakirjan versiointinumero.

    ShortAsiakirjan versio
    Control1..1
    This element is affected by the following invariants: ele-1
    TypeExtension(Extension versionNumber) (Extension Type: positiveInt)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-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())
    18. MedicationDispense.extension:versionNumber.url
    Definition

    Source of the definition for the extension code - a logical name or a URL.

    Shortidentifies 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.

    Control1..1
    Typeuri
    Is Modifierfalse
    XML FormatIn the XML format, this property is represented as an attribute.
    Summaryfalse
    Fixed Value
    {
      "url" : "http://resepti.kanta.fi/StructureDefinition/extension/versionNumber"
    }
    <url value="http://resepti.kanta.fi/StructureDefinition/extension/versionNumber"/>
    20. MedicationDispense.extension:versionNumber.value[x]
    Definition

    Lääkitysasiakirjan versiointinumero.


    Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

    ShortAsiakirjan versioValue of extension
    Control10..1
    TypepositiveInt, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    22. MedicationDispense.extension:effectiveTime
    Slice NameeffectiveTime
    Definition

    The creation time of a document

    ShortThe creation time of a document
    Control1..*
    This element is affected by the following invariants: ele-1
    TypeExtension(Extension effectiveTime) (Extension Type: dateTime)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-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())
    24. MedicationDispense.extension:dosePackaging
    Slice NamedosePackaging
    Definition

    Information about whether the drug was dispensed with dose dispensing.

    ShortDose dispensing information
    Control1..*
    This element is affected by the following invariants: ele-1
    TypeExtension(Extension dosePackaging) (Extension Type: boolean)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-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())
    26. MedicationDispense.extension:fullyDispensed
    Slice NamefullyDispensed
    Definition

    Information on whether the medicine has been fully dispensed.

    ShortA fully dispensed entry
    Control1..*
    This element is affected by the following invariants: ele-1
    TypeExtension(Extension fullyDispensed) (Extension Type: boolean)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-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())
    28. MedicationDispense.extension:continuum
    Slice Namecontinuum
    Definition

    Identifiers of medicine continuum: The identifier of the medicine in use and part identifier of medicine continuum.

    ShortThe identifier of the medicine in use and part identifier of medicine continuum.
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(Extension continuum) (Complex Extension)
    Is Modifierfalse
    Invariantsele-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())
    30. MedicationDispense.extension:continuum.extension
    Definition

    An Extension


    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.

    ShortExtensionAdditional 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.

    Control0..*
    TypeExtension
    Is Modifierfalse
    Summaryfalse
    Alternate Namesextensions, user content
    Invariantsele-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())
    SlicingThis 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
    • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

      32. MedicationDispense.extension:continuum.extension:medicineId
      Slice NamemedicineId
      Definition

      Automatically produced by an information system, a technical OID identifier that combines the entries of the same prescribed drug.

      ShortThe identifier of the drug in useAdditional content defined by implementations
      Control0..1*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Invariantsele-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:continuum.extension:medicineId.url
      Definition

      Source of the definition for the extension code - a logical name or a URL.

      Shortidentifies 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.

      Control1..1
      Typeuri
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      Fixed Value
      {
        "url" : "medicineId"
      }
      <url value="medicineId"/>
      36. MedicationDispense.extension:continuum.extension:medicineId.value[x]
      Definition

      Automatically produced by an information system, a technical OID identifier that combines the entries of the same prescribed drug.


      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

      ShortThe identifier of the drug in useValue of extension
      Control10..1
      TypeIdentifier, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, 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, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      38. MedicationDispense.extension:continuum.extension:medicineId.value[x].use
      Definition

      The purpose of this identifier.

      Shortusual | official | temp | secondary | old (If known)
      Comments

      Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

      Control0..1
      BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
      (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

      Identifies the purpose for this identifier, if known .

      Typecode
      Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      40. MedicationDispense.extension:continuum.extension:medicineId.value[x].system
      Definition

      Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

      ShortThe namespace for the identifier value
      Comments

      Identifier.system is always case sensitive.

      Control10..1
      Typeuri
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

      Fixed Value
      {
        "system" : "urn:ietf:rfc:3986"
      }
      <system value="urn:ietf:rfc:3986"/>
      ExampleGeneral: http://www.acme.com/identifiers/patient
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      42. MedicationDispense.extension:continuum.extension:medicineId.value[x].value
      Definition

      Automatically produced by an information system, a technical OID identifier that combines the entries of the same prescribed drug.


      The portion of the identifier typically relevant to the user and which is unique within the context of the system.

      ShortThe identifier of the drug in useThe value that is unique
      Comments

      If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

      Control10..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      ExampleGeneral: 123456
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      44. MedicationDispense.extension:continuum.extension:medicineIdPart
      Slice NamemedicineIdPart
      Definition

      Automatically produced by the information system. Separates the different continuums of the same drug (that is, simultaneously used prescriptions for the same drug). As a rule, the drug used has only one medicine continuum at a time (only one active prescription). When it is necessary to have two or more active prescriptions for a drug, for example, when the patient uses two different strengths of the drug, the medicine continuums are separated by the part identifier of the medicine continuum.

      ShortPart identifier of medicine continuumAdditional content defined by implementations
      Control0..1*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Invariantsele-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.extension:continuum.extension:medicineIdPart.url
      Definition

      Source of the definition for the extension code - a logical name or a URL.

      Shortidentifies 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.

      Control1..1
      Typeuri
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      Fixed Value
      {
        "url" : "medicineIdPart"
      }
      <url value="medicineIdPart"/>
      48. MedicationDispense.extension:continuum.extension:medicineIdPart.value[x]
      Definition

      Automatically produced by the information system. Separates the different continuums of the same drug (that is, simultaneously used prescriptions for the same drug). As a rule, the drug used has only one medicine continuum at a time (only one active prescription). When it is necessary to have two or more active prescriptions for a drug, for example, when the patient uses two different strengths of the drug, the medicine continuums are separated by the part identifier of the medicine continuum.


      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

      ShortPart identifier of medicine continuumValue of extension
      Control10..1
      TypepositiveInt, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      50. MedicationDispense.extension:continuum.extension:newest
      Slice Namenewest
      Definition

      Information maintained by the Kanta Prescription Centre on what is the latest prescription in the medicine continuum. The value True says that the prescription is the latest prescription in the continuum.

      ShortStatus information 'Latest'Additional content defined by implementations
      Control0..0*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Invariantsele-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())
      54. MedicationDispense.extension:continuum.url
      Definition

      Source of the definition for the extension code - a logical name or a URL.

      Shortidentifies 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.

      Control1..1
      Typeuri
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      Fixed Value
      {
        "url" : "http://resepti.kanta.fi/fhir/StructureDefinition/extension/continuum"
      }
      <url value="http://resepti.kanta.fi/fhir/StructureDefinition/extension/continuum"/>
      56. MedicationDispense.extension:continuum.value[x]
      Definition

      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

      ShortValue of extension
      Control0..01
      TypeChoice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      58. MedicationDispense.extension:additionalInformation
      Slice NameadditionalInformation
      Definition

      Further clarification of the drug dispensation to Kela.

      ShortFurther clarification of the drug dispensation to Kela
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(Extension additionalInformation) (Extension Type: string)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-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())
      60. MedicationDispense.extension:cost
      Slice Namecost
      Definition

      Dispensation price in euros.

      ShortThe price of dispensation
      Control1..1
      This element is affected by the following invariants: ele-1
      TypeExtension(Extension cost) (Extension Type: Money)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-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())
      62. MedicationDispense.extension:amountOfPackages
      Slice NameamountOfPackages
      Definition

      Number of dispensed drug packages.

      ShortThe number of packages
      Control1..*
      This element is affected by the following invariants: ele-1
      TypeExtension(Extension amountOfPackages) (Extension Type: positiveInt)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-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())
      64. MedicationDispense.extension:additionalPackage
      Slice NameadditionalPackage
      Definition

      Different packages have been dispensed in the dispense.

      ShortInformation of different packages
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(Extension additionalPackage) (Complex Extension)
      Is Modifierfalse
      Invariantsele-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())
      66. MedicationDispense.extension:previousDispenseChange
      Slice NamepreviousDispenseChange
      Definition

      Toimituksen kauppanimen muutospäivä, kauppanimen muutospäivänä toimitetun valmisteen kauppanimi, kauppanimen muutospäivänä toimitetun valmisteen VNR-numero, kauppanimen muutospäivänä toimitetun valmisteen vahvuus, kauppanimen muutospäivänä toimitetun valmisteen lääkemuoto.

      ShortToimituksen kauppanimen muutospäivä, kauppanimen muutospäivänä toimitetun valmisteen VNR-numero ja kauppanimi, kauppanimen muutospäivänä toimitetun valmisteen vahvuus, kauppanimen muutospäivänä toimitetun valmisteen lääkemuoto.
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(Extension previousDispenseChange) (Complex Extension)
      Is Modifierfalse
      Invariantsele-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())
      68. 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).

      ShortExtensions 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.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
      Summaryfalse
      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 Namesextensions, user content
      Invariantsele-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())
      70. 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.

      ShortExternal identifier
      Comments

      This is a business identifier, not a resource identifier.

      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..*
      TypeIdentifier
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      SlicingThis element introduces a set of slices on MedicationDispense.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ system
      • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

        72. MedicationDispense.identifier:id
        Slice Nameid
        Definition

        Unique identifier of the dispensation document. For example, the identifier may be an identifier that identifies a particular version of the dispensation document.


        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.

        ShortDocument identifier (unique identifier of the dispensation document)External identifier
        Comments

        This is a business identifier, not a resource identifier.

        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control10..1*
        TypeIdentifier
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        74. MedicationDispense.identifier:id.use
        Definition

        The purpose of this identifier.

        Shortusual | official | temp | secondary | old (If known)
        Comments

        Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

        Control0..1
        BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
        (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

        Identifies the purpose for this identifier, if known .

        Typecode
        Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        76. MedicationDispense.identifier:id.system
        Definition

        Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

        ShortThe namespace for the identifier value
        Comments

        Note. Here a separate namespace was created, another option would have been to put urn:ietf:rfc:3986 as system and encode the identifiers with the type element (own codes for id and setId).


        Identifier.system is always case sensitive.

        Control10..1
        Typeuri
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

        Fixed Value
        {
          "system" : "http://resepti.kanta.fi/fhir/id/id"
        }
        <system value="http://resepti.kanta.fi/fhir/id/id"/>
        ExampleGeneral: http://www.acme.com/identifiers/patient
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        78. MedicationDispense.identifier:id.value
        Definition

        An unique OID identifier of the dispensation document


        The portion of the identifier typically relevant to the user and which is unique within the context of the system.

        ShortAn unique OID identifier of the dispensation documentThe value that is unique
        Comments

        Note. Here a separate namespace was created, another option would have been to put urn:ietf:rfc:3986 as system and encode the identifiers with the type element (own codes for id and setId). (If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986.)


        If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

        Control10..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        ExampleGeneral: 123456
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        80. MedicationDispense.identifier:setId
        Slice NamesetId
        Definition

        Identifier of the original drug dispensation document that connects different versions of the document.


        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.

        ShortThe identifier of the original dispensation documentExternal identifier
        Comments

        This is a business identifier, not a resource identifier.

        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control10..1*
        TypeIdentifier
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        82. MedicationDispense.identifier:setId.use
        Definition

        The purpose of this identifier.

        Shortusual | official | temp | secondary | old (If known)
        Comments

        Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

        Control0..1
        BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
        (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

        Identifies the purpose for this identifier, if known .

        Typecode
        Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        84. MedicationDispense.identifier:setId.system
        Definition

        Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

        ShortThe namespace for the identifier value
        Comments

        Note. Here a separate namespace was created, another option would have been to put urn:ietf:rfc:3986 as system and encode the identifiers with the type element (own codes for id and setId). (If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986.)


        Identifier.system is always case sensitive.

        Control10..1
        Typeuri
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

        Fixed Value
        {
          "system" : "http://resepti.kanta.fi/fhir/id/setId"
        }
        <system value="http://resepti.kanta.fi/fhir/id/setId"/>
        ExampleGeneral: http://www.acme.com/identifiers/patient
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        86. MedicationDispense.identifier:setId.value
        Definition

        Identifier of the original drug dispensation document that connects different versions of the document.


        The portion of the identifier typically relevant to the user and which is unique within the context of the system.

        ShortThe identifier of the original dispensation documentThe value that is unique
        Comments

        Note. Here a separate namespace was created, another option would have been to put urn:ietf:rfc:3986 as system and encode the identifiers with the type element (own codes for id and setId). (If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986.)


        If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

        Control10..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        ExampleGeneral: 123456
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        88. MedicationDispense.partOf
        Definition

        The procedure that trigger the dispense.

        ShortEvent that dispense is part of
        Control0..0*
        TypeReference(Procedure)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        90. MedicationDispense.status
        Definition

        A standard value is used: Completed


        A code specifying the state of the set of dispense events.

        Shortpreparation | 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.

        Control1..1
        BindingThe codes SHALL be taken from MedicationDispense Status Codeshttp://hl7.org/fhir/ValueSet/medicationdispense-status|4.0.1
        (required to http://hl7.org/fhir/ValueSet/medicationdispense-status|4.0.1)

        A coded concept specifying the state of the dispense event.

        Typecode
        Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Fixed Value
        {
          "status" : "completed"
        }
        <status value="completed"/>
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        92. MedicationDispense.statusReason[x]
        Definition

        This information tells whether information from the drug dispensation or its different versions (i.e., correction of dispensation) is returned. This is represented as a code from the Kanta code system 'Sähköinen lääkemääräys - Reseptisanoman tyyppi', depending on the dispensation document: 10 = Prescription dispensation or 12 = Correction of prescription dispensation


        Indicates the reason why a dispense was not performed.

        ShortType of prescription messageWhy a dispense was not performed
        Control10..1
        BindingFor example codes, see MedicationDispense Status Reason Codeshttp://hl7.org/fhir/ValueSet/medicationdispense-status-reason|4.0.1
        (example to http://hl7.org/fhir/ValueSet/medicationdispense-status-reason|4.0.1)

        A code describing why a dispense was not performed.

        TypeCodeableConcept, Reference(DetectedIssue)
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        94. MedicationDispense.statusReason[x].coding
        Definition

        Kanta code system 'Sähköinen lääkemääräys - Reseptisanoman tyyppi'.


        A reference to a code defined by a terminology system.

        ShortType of prescription messageCode defined by a terminology system
        Comments

        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

        Control10..1*
        TypeCoding
        Is Modifierfalse
        Summarytrue
        Requirements

        Allows for alternative encodings within a code system, and translations to other code systems.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        96. MedicationDispense.statusReason[x].coding.system
        Definition

        OID of the Kanta code system 'Sähköinen lääkemääräys - Reseptisanoman tyyppi'.


        The identification of the code system that defines the meaning of the symbol in the code.

        ShortOID of the Kanta code system 'Sähköinen lääkemääräys - Reseptisanoman tyyppi'Identity of the terminology system
        Comments

        The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

        Control10..1
        Typeuri
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        Need to be unambiguous about the source of the definition of the symbol.

        Fixed Value
        {
          "system" : "urn:oid:1.2.246.537.5.40105.2006"
        }
        <system value="urn:oid:1.2.246.537.5.40105.2006"/>
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        98. MedicationDispense.statusReason[x].coding.code
        Definition

        Code of the Kanta code system 'Sähköinen lääkemääräys - Reseptisanoman tyyppi': 10 = Prescription dispensation 11 = Invalidation of prescription dispensation 12 = Correction of prescription dispensation


        A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

        ShortCode of the Kanta code system 'Sähköinen lääkemääräys - Reseptisanoman tyyppi'.Symbol in syntax defined by the system
        Control10..1
        Typecode
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        Need to refer to a particular code in the system.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        100. 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)).

        ShortType 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.

        Control0..01
        BindingThe codes SHOULD be taken from MedicationDispense Category Codeshttp://hl7.org/fhir/ValueSet/medicationdispense-category|4.0.1
        (preferred to http://hl7.org/fhir/ValueSet/medicationdispense-category|4.0.1)

        A code describing where the dispensed medication is expected to be consumed or administered.

        TypeCodeableConcept
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        102. MedicationDispense.medication[x]
        Definition

        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.

        ShortReference to MedicationListMedication resourceWhat 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.

        Control1..1
        TypeReference(MedicationListMedication, Medication)contained, CodeableConcept
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        104. MedicationDispense.subject
        Definition

        A link to a resource representing the person or the group to whom the medication will be given.

        ShortWho the dispense is for
        Comments

        SubstanceAdministration->subject->Patient.

        Control0..01
        TypeReference(Patient, Group)
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        106. MedicationDispense.context
        Definition

        The encounter or episode of care that establishes the context for this event.

        ShortEncounter / Episode associated with event
        Control0..01
        TypeReference(Encounter, EpisodeOfCare)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        108. MedicationDispense.supportingInformation
        Definition

        Additional information that supports the medication being dispensed.

        ShortInformation that supports the dispensing of the medication
        Control0..0*
        TypeReference(Resource)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        110. MedicationDispense.location
        Definition

        The principal physical location where the dispense was performed.

        ShortWhere the dispense occurred
        Control0..01
        TypeReference(Location)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        112. MedicationDispense.authorizingPrescription
        Definition

        Reference to the unique identifier of the MedicationRequest resource to which the MedicationDispense resource is linked (MedicationRequest.id).


        Indicates the medication order that is being dispensed against.

        ShortReference to the unique identifier of the MedicationRequest resource to which the MedicationDispense is linkedMedication order that authorizes the dispense
        Comments

        Maps to basedOn in Event logical model.

        Control10..1*
        TypeReference(MedicationRequest)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        114. MedicationDispense.authorizingPrescription.extension
        Definition

        An Extension


        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.

        ShortExtensionAdditional 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.

        Control10..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-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())
        SlicingThis 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
        • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

          116. MedicationDispense.authorizingPrescription.extension:prescriptionSetId
          Slice NameprescriptionSetId
          Definition

          setId, the original identifier of the prescription document, with which the drug dispensation is associated

          ShortsetId, the original identifier of the prescription document, with which the drug dispensation is associated
          Control1..1
          TypeExtension(Extension prescriptionSetId) (Extension Type: Identifier)
          Is Modifierfalse
          Summaryfalse
          Invariantsele-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())
          118. MedicationDispense.authorizingPrescription.identifier
          Definition

          Unique identifier of the MedicationRequest resource to which the MedicationDispense resource is linked


          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.

          ShortUnique identifier of the MedicationRequest resource to which the MedicationDispense resource is linkedLogical 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).

          NoteThis is a business identifier, not a resource identifier (see discussion)
          Control10..1
          TypeIdentifier
          Is Modifierfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          120. MedicationDispense.authorizingPrescription.identifier.use
          Definition

          The purpose of this identifier.

          Shortusual | official | temp | secondary | old (If known)
          Comments

          Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

          Control0..1
          BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
          (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

          Identifies the purpose for this identifier, if known .

          Typecode
          Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          122. MedicationDispense.authorizingPrescription.identifier.system
          Definition

          Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

          ShortThe namespace for the identifier value
          Comments

          Identifier.system is always case sensitive.

          Control10..1
          Typeuri
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

          Fixed Value
          {
            "system" : "http://resepti.kanta.fi/fhir/id/id"
          }
          <system value="http://resepti.kanta.fi/fhir/id/id"/>
          ExampleGeneral: http://www.acme.com/identifiers/patient
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          124. MedicationDispense.authorizingPrescription.identifier.value
          Definition

          The unique OID identifier of the prescription.


          The portion of the identifier typically relevant to the user and which is unique within the context of the system.

          ShortThe unique OID identifier of the prescriptionThe value that is unique
          Comments

          If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

          Control10..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          ExampleGeneral: 123456
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          126. 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.

          ShortTrial fill, partial fill, emergency fill, etc.
          Control0..01
          BindingFor example codes, see ActPharmacySupplyTypehttp://terminology.hl7.org/ValueSet/v3-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.

          TypeCodeableConcept
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          128. MedicationDispense.quantity
          Definition

          The amount of the drug provided by the prescription at that dispensation. The amount of the drug supplied as a numerical value (e.g., 100) and the unit (e.g., tab).


          The amount of medication that has been dispensed. Includes unit of measure.

          ShortTotal amount of drug and unit of the amountAmount dispensed
          Control10..1
          TypeQuantity(SimpleQuantity)
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          sqty-1: The comparator is not used on a SimpleQuantity (comparator.empty())
          130. MedicationDispense.quantity.extension
          Definition

          An Extension


          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.

          ShortExtensionAdditional 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.

          Control10..*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Alternate Namesextensions, user content
          Invariantsele-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())
          SlicingThis 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
          • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

            132. MedicationDispense.quantity.extension:amountFormula
            Slice NameamountFormula
            Definition

            The dispensed amount of drug as a calculation formula.

            ShortThe dispensed amount of drug as a calculation formula
            Control0..1
            TypeExtension(Extension amountFormula) (Complex Extension)
            Is Modifierfalse
            Invariantsele-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())
            134. MedicationDispense.quantity.extension:amountText
            Slice NameamountText
            Definition

            The dispensed amount of the drug as text (e.g., 1 suppository + 20 g ointment). The unit is also recorded in the text.

            ShortThe amount of drug as text
            Control0..1
            TypeExtension(Extension amountText) (Extension Type: string)
            Is Modifierfalse
            Summaryfalse
            Invariantsele-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())
            136. MedicationDispense.quantity.extension:totalDispensedAmount
            Slice NametotalDispensedAmount
            Definition

            Kyseisen lääkemääräyksen kaikilla toimituskerroilla yhteensä toimitettu lääkkeen määrä. Jos kyseessä on lääkemääräyksen ensimmäinen toimitus, arvo on sama kuin kyseisellä toimituskerralla toimitettu määrä. Voi palautua yhdellä vaihtoehtoisella tavalla: lääkkeen kokonaismäärä ja määrän yksikkö, lääkkeen määrä laskukaavana tai lääkkeen määrä tekstinä.

            ShortLääkemääräyksellä yhteensä toimitettu määrä
            Control0..1
            TypeExtension(Extension totalDispensedAmount) (Complex Extension)
            Is Modifierfalse
            Invariantsele-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())
            138. MedicationDispense.quantity.extension:remainingAmount
            Slice NameremainingAmount
            Definition

            The amount of the drug remaining (to be dispensed) in the prescription. Can be returned in the following ways: the total amount of the drug and the unit, the amount of the drug as a calculation formula or the amount of the drug as text. This information is not returned by the basic medication list search or in the search for discontinued medications if the dispensation is not related to the latest prescription in the continuum.

            ShortLääkemääräyksellä jäljellä oleva määrä
            Control1..1
            TypeExtension(Extension remainingAmount) (Complex Extension)
            Is Modifierfalse
            Invariantsele-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())
            140. MedicationDispense.quantity.value
            Definition

            The dispensed amount of the medicine as a numerical value (e.g., 100).


            The value of the measured amount. The value includes an implicit precision in the presentation of the value.

            ShortTotal amount of medicine, amountNumerical 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).

            Control0..1
            Typedecimal
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Precision is handled implicitly in almost all cases of measurement.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            142. 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
            Control0..01
            BindingThe codes SHALL be taken from QuantityComparatorhttp://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.

            Typecode
            Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            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 MissingIf there is no comparator, then there is no modification of the value
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            144. MedicationDispense.quantity.unit
            Definition

            The dispensed amount of drug as a numerical value, unit (e.g., tab).


            A human-readable form of the unit.

            ShortThe total amount of medicine, unitUnit representation
            Control0..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            146. MedicationDispense.daysSupply
            Definition

            The amount of medication expressed as a timing amount.

            ShortAmount of medication expressed as a timing amount
            Control0..01
            TypeQuantity(SimpleQuantity)
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            sqty-1: The comparator is not used on a SimpleQuantity (comparator.empty())
            148. MedicationDispense.whenPrepared
            Definition

            The time when the dispensed product was packaged and reviewed.

            ShortWhen product was packaged and reviewed
            Control0..01
            TypedateTime
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            150. MedicationDispense.whenHandedOver
            Definition

            Dispensation date of the drug.


            The time the dispensed product was provided to the patient or their representative.

            ShortDispensation dateWhen product was given out
            Control10..1
            TypedateTime
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            152. MedicationDispense.destination
            Definition

            Identification of the facility/location where the medication was shipped to, as part of the dispense event.

            ShortWhere the medication was sent
            Control0..01
            TypeReference(Location)
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            154. 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.

            ShortWho collected the medication
            Control0..0*
            TypeReference(Patient, Practitioner)
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            156. MedicationDispense.note
            Definition

            Extra information about the dispense that could not be conveyed in the other attributes.

            ShortInformation about the dispense
            Control0..1*
            TypeAnnotation
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            158. MedicationDispense.note.text
            Definition

            Pharmacy's note on drug dispensing. The name of the pharmacist who prepared the drug for dispensing is recorded in the field dedicated for notes. This information is mandatory when, in addition to receiving the prescription and dispensing the drug, another pharmacist has been required for the preparation of the drug for dispensing.


            The text of the annotation in markdown format.

            ShortPharmacy's note on drug dispensingThe annotation - text content (as markdown)
            Control1..1
            Typemarkdown
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            160. 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.

            ShortWhether a substitution was performed on the dispense
            Control10..1
            TypeBackboneElement
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            162. 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).

            ShortExtensions 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.

            Control0..*
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summarytrue
            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 Namesextensions, user content, modifiers
            Invariantsele-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())
            164. MedicationDispense.substitution.wasSubstituted
            Definition

            Information about whether the drug has been substituted in dispensing.


            True if the dispenser dispensed a different drug or product from what was prescribed.

            ShortDrug substituted in dispensingWhether a substitution was or was not performed on the dispense
            Control1..1
            Typeboolean
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            166. MedicationDispense.substitution.reason
            Definition

            Information of a forbidden drug change or the reason for dispensing a drug outside the reference pricing system. According to the Kanta code system 'Sähköinen lääkemääräys - Lääkevaihtokielto tai lääkevaihdon syy'. Also, provide the additional information for dispensing a drug outside the reference pricing system.


            Indicates the reason for the substitution (or lack of substitution) from what was prescribed.

            ShortThe reason and additional information for dispensing a drug outside the reference pricing systemWhy was substitution made
            Control0..1*
            BindingFor example codes, see SubstanceAdminSubstitutionReasonhttp://terminology.hl7.org/ValueSet/v3-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.

            TypeCodeableConcept
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            168. MedicationDispense.substitution.reason.coding
            Definition

            Information of a forbidden drug change or the reason for dispensing a drug outside the reference pricing system. According to the Kanta code system 'Sähköinen lääkemääräys - Lääkevaihtokielto tai lääkevaihdon syy'.


            A reference to a code defined by a terminology system.

            ShortReason for dispensing a drug outside the reference pricing systemCode defined by a terminology system
            Comments

            Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

            Control10..1*
            TypeCoding
            Is Modifierfalse
            Summarytrue
            Requirements

            Allows for alternative encodings within a code system, and translations to other code systems.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            170. MedicationDispense.substitution.reason.coding.system
            Definition

            OID of the Kanta code system 'Sähköinen lääkemääräys - Lääkevaihtokielto tai lääkevaihdon syy'.


            The identification of the code system that defines the meaning of the symbol in the code.

            ShortOID of the Kanta code system 'Sähköinen lääkemääräys - Lääkevaihtokielto tai lääkevaihdon syy'Identity of the terminology system
            Comments

            The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

            Control10..1
            Typeuri
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Need to be unambiguous about the source of the definition of the symbol.

            Fixed Value
            {
              "system" : "urn:oid:1.2.246.537.5.40183.2009"
            }
            <system value="urn:oid:1.2.246.537.5.40183.2009"/>
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            172. MedicationDispense.substitution.reason.coding.code
            Definition

            Code of the Kanta code system 'Sähköinen lääkemääräys - Lääkevaihtokielto tai lääkevaihdon syy'.


            A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

            ShortCode of the Kanta code system 'Sähköinen lääkemääräys - Lääkevaihtokielto tai lääkevaihdon syy'Symbol in syntax defined by the system
            Control10..1
            Typecode
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Need to refer to a particular code in the system.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            174. MedicationDispense.substitution.reason.text
            Definition

            Further clarification on the dispensing of a drug outside of the reference pricing system. Always returned if the reason for the dispensation outside of the reference pricing system is M (other reason).


            A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

            ShortAdditional information for dispensing a drug outside the reference pricing systemPlain text representation of the concept
            Comments

            Very often the text is the same as a displayName of one of the codings.

            Control0..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            176. 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.

            ShortClinical 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.

            Control0..0*
            TypeReference(DetectedIssue)
            Is Modifierfalse
            Summaryfalse
            Alternate NamesContraindication, Drug Utilization Review (DUR), Alert
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            178. MedicationDispense.eventHistory
            Definition

            A summary of the events of interest that have occurred, such as when the dispense was verified.

            ShortA 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.).

            Control0..0*
            TypeReference(Provenance)
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

            See the documentation on how to interpret the contents of this table

            0. MedicationDispense
            2. MedicationDispense.meta
            4. MedicationDispense.meta.profile
            Control1..1
            Fixed Value
            {
              "profile" : "http://resepti.kanta.fi/fhir/StructureDefinition/MedicationListMedicationDispense"
            }
            <profile value="http://resepti.kanta.fi/fhir/StructureDefinition/MedicationListMedicationDispense"/>
            6. MedicationDispense.meta.tag
            Definition

            CDA R2 header specification templateId (specification package version)

            ShortCDA R2 header specification templateId (specification package version)
            Control1..1
            8. MedicationDispense.meta.tag.system
            Control1..?
            Fixed Value
            {
              "system" : "http://resepti.kanta.fi/fhir/cdaHeaderTemplateId"
            }
            <system value="http://resepti.kanta.fi/fhir/cdaHeaderTemplateId"/>
            10. MedicationDispense.meta.tag.code
            Definition

            CDA R2 header specification templateId (specification package version).

            ShortCDA R2 header specification templateId (specification package version)
            Control1..?
            12. MedicationDispense.extension
            Control6..?
            SlicingThis element introduces a set of slices on MedicationDispense.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

              14. MedicationDispense.extension:versionNumber
              Slice NameversionNumber
              Control1..1
              TypeExtension(Extension versionNumber) (Extension Type: positiveInt)
              Is Modifierfalse
              16. MedicationDispense.extension:versionNumber.value[x]
              Control1..?
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              18. MedicationDispense.extension:effectiveTime
              Slice NameeffectiveTime
              Control1..?
              TypeExtension(Extension effectiveTime) (Extension Type: dateTime)
              Is Modifierfalse
              20. MedicationDispense.extension:dosePackaging
              Slice NamedosePackaging
              Control1..?
              TypeExtension(Extension dosePackaging) (Extension Type: boolean)
              Is Modifierfalse
              22. MedicationDispense.extension:fullyDispensed
              Slice NamefullyDispensed
              Control1..?
              TypeExtension(Extension fullyDispensed) (Extension Type: boolean)
              Is Modifierfalse
              24. MedicationDispense.extension:continuum
              Slice Namecontinuum
              Definition

              Identifiers of medicine continuum: The identifier of the medicine in use and part identifier of medicine continuum.

              ShortThe identifier of the medicine in use and part identifier of medicine continuum.
              Control0..1
              TypeExtension(Extension continuum) (Complex Extension)
              Is Modifierfalse
              26. MedicationDispense.extension:continuum.extension
              Control0..?
              SlicingThis 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
              • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

                28. MedicationDispense.extension:continuum.extension:medicineId
                Slice NamemedicineId
                Control0..1
                30. MedicationDispense.extension:continuum.extension:medicineIdPart
                Slice NamemedicineIdPart
                Control0..1
                32. MedicationDispense.extension:continuum.extension:newest
                Slice Namenewest
                Control0..0
                34. MedicationDispense.extension:additionalInformation
                Slice NameadditionalInformation
                Control0..?
                TypeExtension(Extension additionalInformation) (Extension Type: string)
                Is Modifierfalse
                36. MedicationDispense.extension:cost
                Slice Namecost
                Definition

                Dispensation price in euros.

                Control1..1
                TypeExtension(Extension cost) (Extension Type: Money)
                Is Modifierfalse
                38. MedicationDispense.extension:amountOfPackages
                Slice NameamountOfPackages
                Control1..?
                TypeExtension(Extension amountOfPackages) (Extension Type: positiveInt)
                Is Modifierfalse
                40. MedicationDispense.extension:additionalPackage
                Slice NameadditionalPackage
                Control0..?
                TypeExtension(Extension additionalPackage) (Complex Extension)
                Is Modifierfalse
                42. MedicationDispense.extension:previousDispenseChange
                Slice NamepreviousDispenseChange
                Control0..1
                TypeExtension(Extension previousDispenseChange) (Complex Extension)
                Is Modifierfalse
                44. MedicationDispense.identifier
                NoteThis is a business identifier, not a resource identifier (see discussion)
                SlicingThis element introduces a set of slices on MedicationDispense.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ system
                • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

                  46. MedicationDispense.identifier:id
                  Slice Nameid
                  Definition

                  Unique identifier of the dispensation document. For example, the identifier may be an identifier that identifies a particular version of the dispensation document.

                  ShortDocument identifier (unique identifier of the dispensation document)
                  NoteThis is a business identifier, not a resource identifier (see discussion)
                  Control1..1
                  48. MedicationDispense.identifier:id.system
                  Comments

                  Note. Here a separate namespace was created, another option would have been to put urn:ietf:rfc:3986 as system and encode the identifiers with the type element (own codes for id and setId).

                  Control1..?
                  Fixed Value
                  {
                    "system" : "http://resepti.kanta.fi/fhir/id/id"
                  }
                  <system value="http://resepti.kanta.fi/fhir/id/id"/>
                  50. MedicationDispense.identifier:id.value
                  Definition

                  An unique OID identifier of the dispensation document

                  ShortAn unique OID identifier of the dispensation document
                  Comments

                  Note. Here a separate namespace was created, another option would have been to put urn:ietf:rfc:3986 as system and encode the identifiers with the type element (own codes for id and setId). (If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986.)

                  Control1..?
                  52. MedicationDispense.identifier:setId
                  Slice NamesetId
                  Definition

                  Identifier of the original drug dispensation document that connects different versions of the document.

                  ShortThe identifier of the original dispensation document
                  NoteThis is a business identifier, not a resource identifier (see discussion)
                  Control1..1
                  54. MedicationDispense.identifier:setId.system
                  Comments

                  Note. Here a separate namespace was created, another option would have been to put urn:ietf:rfc:3986 as system and encode the identifiers with the type element (own codes for id and setId). (If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986.)

                  Control1..?
                  Fixed Value
                  {
                    "system" : "http://resepti.kanta.fi/fhir/id/setId"
                  }
                  <system value="http://resepti.kanta.fi/fhir/id/setId"/>
                  56. MedicationDispense.identifier:setId.value
                  Definition

                  Identifier of the original drug dispensation document that connects different versions of the document.

                  ShortThe identifier of the original dispensation document
                  Comments

                  Note. Here a separate namespace was created, another option would have been to put urn:ietf:rfc:3986 as system and encode the identifiers with the type element (own codes for id and setId). (If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986.)

                  Control1..?
                  58. MedicationDispense.partOf
                  Control0..0
                  60. MedicationDispense.status
                  Definition

                  A standard value is used: Completed

                  Fixed Value
                  {
                    "status" : "completed"
                  }
                  <status value="completed"/>
                  62. MedicationDispense.statusReason[x]
                  Definition

                  This information tells whether information from the drug dispensation or its different versions (i.e., correction of dispensation) is returned. This is represented as a code from the Kanta code system 'Sähköinen lääkemääräys - Reseptisanoman tyyppi', depending on the dispensation document: 10 = Prescription dispensation or 12 = Correction of prescription dispensation

                  ShortType of prescription message
                  Control1..?
                  TypeCodeableConcept, Reference(DetectedIssue)
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  64. MedicationDispense.statusReason[x].coding
                  Definition

                  Kanta code system 'Sähköinen lääkemääräys - Reseptisanoman tyyppi'.

                  ShortType of prescription message
                  Control1..1
                  66. MedicationDispense.statusReason[x].coding.system
                  Definition

                  OID of the Kanta code system 'Sähköinen lääkemääräys - Reseptisanoman tyyppi'.

                  ShortOID of the Kanta code system 'Sähköinen lääkemääräys - Reseptisanoman tyyppi'
                  Control1..?
                  Fixed Value
                  {
                    "system" : "urn:oid:1.2.246.537.5.40105.2006"
                  }
                  <system value="urn:oid:1.2.246.537.5.40105.2006"/>
                  68. MedicationDispense.statusReason[x].coding.code
                  Definition

                  Code of the Kanta code system 'Sähköinen lääkemääräys - Reseptisanoman tyyppi': 10 = Prescription dispensation 11 = Invalidation of prescription dispensation 12 = Correction of prescription dispensation

                  ShortCode of the Kanta code system 'Sähköinen lääkemääräys - Reseptisanoman tyyppi'.
                  Control1..?
                  70. MedicationDispense.category
                  Control0..0
                  72. MedicationDispense.medication[x]
                  ShortReference to MedicationListMedication resource
                  TypeReference(MedicationListMedication)contained, CodeableConcept
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  74. MedicationDispense.subject
                  Control0..0
                  76. MedicationDispense.context
                  Control0..0
                  78. MedicationDispense.supportingInformation
                  Control0..0
                  80. MedicationDispense.performer
                  82. MedicationDispense.performer.actor
                  ShortReference to the information of the person who performed the dispensation
                  TypeReference(MedicationListPractitionerRole)contained
                  84. MedicationDispense.performer.actor.reference
                  Control1..?
                  86. MedicationDispense.location
                  Control0..0
                  88. MedicationDispense.authorizingPrescription
                  Definition

                  Reference to the unique identifier of the MedicationRequest resource to which the MedicationDispense resource is linked (MedicationRequest.id).

                  ShortReference to the unique identifier of the MedicationRequest resource to which the MedicationDispense is linked
                  Control1..1
                  90. MedicationDispense.authorizingPrescription.extension
                  Control1..?
                  SlicingThis 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
                  • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

                    92. MedicationDispense.authorizingPrescription.extension:prescriptionSetId
                    Slice NameprescriptionSetId
                    Definition

                    setId, the original identifier of the prescription document, with which the drug dispensation is associated

                    ShortsetId, the original identifier of the prescription document, with which the drug dispensation is associated
                    Control1..1
                    TypeExtension(Extension prescriptionSetId) (Extension Type: Identifier)
                    Is Modifierfalse
                    94. MedicationDispense.authorizingPrescription.identifier
                    Definition

                    Unique identifier of the MedicationRequest resource to which the MedicationDispense resource is linked

                    ShortUnique identifier of the MedicationRequest resource to which the MedicationDispense resource is linked
                    NoteThis is a business identifier, not a resource identifier (see discussion)
                    Control1..?
                    96. MedicationDispense.authorizingPrescription.identifier.system
                    Control1..?
                    Fixed Value
                    {
                      "system" : "http://resepti.kanta.fi/fhir/id/id"
                    }
                    <system value="http://resepti.kanta.fi/fhir/id/id"/>
                    98. MedicationDispense.authorizingPrescription.identifier.value
                    Definition

                    The unique OID identifier of the prescription.

                    ShortThe unique OID identifier of the prescription
                    Control1..?
                    100. MedicationDispense.type
                    Control0..0
                    102. MedicationDispense.quantity
                    Definition

                    The amount of the drug provided by the prescription at that dispensation. The amount of the drug supplied as a numerical value (e.g., 100) and the unit (e.g., tab).

                    ShortTotal amount of drug and unit of the amount
                    Control1..?
                    104. MedicationDispense.quantity.extension
                    Control1..?
                    SlicingThis 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
                    • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

                      106. MedicationDispense.quantity.extension:amountFormula
                      Slice NameamountFormula
                      Definition

                      The dispensed amount of drug as a calculation formula.

                      ShortThe dispensed amount of drug as a calculation formula
                      Control0..1
                      TypeExtension(Extension amountFormula) (Complex Extension)
                      Is Modifierfalse
                      108. MedicationDispense.quantity.extension:amountText
                      Slice NameamountText
                      Control0..1
                      TypeExtension(Extension amountText) (Extension Type: string)
                      Is Modifierfalse
                      110. MedicationDispense.quantity.extension:totalDispensedAmount
                      Slice NametotalDispensedAmount
                      Control0..1
                      TypeExtension(Extension totalDispensedAmount) (Complex Extension)
                      Is Modifierfalse
                      112. MedicationDispense.quantity.extension:remainingAmount
                      Slice NameremainingAmount
                      Definition

                      The amount of the drug remaining (to be dispensed) in the prescription. Can be returned in the following ways: the total amount of the drug and the unit, the amount of the drug as a calculation formula or the amount of the drug as text. This information is not returned by the basic medication list search or in the search for discontinued medications if the dispensation is not related to the latest prescription in the continuum.

                      Control1..1
                      TypeExtension(Extension remainingAmount) (Complex Extension)
                      Is Modifierfalse
                      114. MedicationDispense.quantity.value
                      Definition

                      The dispensed amount of the medicine as a numerical value (e.g., 100).

                      ShortTotal amount of medicine, amount
                      116. MedicationDispense.quantity.unit
                      Definition

                      The dispensed amount of drug as a numerical value, unit (e.g., tab).

                      ShortThe total amount of medicine, unit
                      118. MedicationDispense.daysSupply
                      Control0..0
                      120. MedicationDispense.whenPrepared
                      Control0..0
                      122. MedicationDispense.whenHandedOver
                      Definition

                      Dispensation date of the drug.

                      ShortDispensation date
                      Control1..?
                      124. MedicationDispense.destination
                      Control0..0
                      126. MedicationDispense.receiver
                      Control0..0
                      128. MedicationDispense.note
                      Control0..1
                      130. MedicationDispense.note.text
                      Definition

                      Pharmacy's note on drug dispensing. The name of the pharmacist who prepared the drug for dispensing is recorded in the field dedicated for notes. This information is mandatory when, in addition to receiving the prescription and dispensing the drug, another pharmacist has been required for the preparation of the drug for dispensing.

                      ShortPharmacy's note on drug dispensing
                      132. MedicationDispense.dosageInstruction
                      134. MedicationDispense.dosageInstruction.text
                      Definition

                      The intended use of the drug written during dispensation if the intended use written on the prescription is unclear.

                      ShortIntended use of the drug on a dispensation information sticker
                      136. MedicationDispense.dosageInstruction.patientInstruction
                      Definition

                      Dispensation instruction printed on a dispensation information sticker if the dosage instructions written on the prescription are unclear. If the dosage information is given in structured format, the dosage instructions provided for the prescription by the system may not be changed.

                      ShortDosage instructions on a dispensation information sticker
                      138. MedicationDispense.substitution
                      Control1..?
                      140. MedicationDispense.substitution.wasSubstituted
                      Definition

                      Information about whether the drug has been substituted in dispensing.

                      ShortDrug substituted in dispensing
                      142. MedicationDispense.substitution.reason
                      Definition

                      Information of a forbidden drug change or the reason for dispensing a drug outside the reference pricing system. According to the Kanta code system 'Sähköinen lääkemääräys - Lääkevaihtokielto tai lääkevaihdon syy'. Also, provide the additional information for dispensing a drug outside the reference pricing system.

                      ShortThe reason and additional information for dispensing a drug outside the reference pricing system
                      Control0..1
                      144. MedicationDispense.substitution.reason.coding
                      Definition

                      Information of a forbidden drug change or the reason for dispensing a drug outside the reference pricing system. According to the Kanta code system 'Sähköinen lääkemääräys - Lääkevaihtokielto tai lääkevaihdon syy'.

                      ShortReason for dispensing a drug outside the reference pricing system
                      Control1..1
                      146. MedicationDispense.substitution.reason.coding.system
                      Definition

                      OID of the Kanta code system 'Sähköinen lääkemääräys - Lääkevaihtokielto tai lääkevaihdon syy'.

                      ShortOID of the Kanta code system 'Sähköinen lääkemääräys - Lääkevaihtokielto tai lääkevaihdon syy'
                      Control1..?
                      Fixed Value
                      {
                        "system" : "urn:oid:1.2.246.537.5.40183.2009"
                      }
                      <system value="urn:oid:1.2.246.537.5.40183.2009"/>
                      148. MedicationDispense.substitution.reason.coding.code
                      Definition

                      Code of the Kanta code system 'Sähköinen lääkemääräys - Lääkevaihtokielto tai lääkevaihdon syy'.

                      ShortCode of the Kanta code system 'Sähköinen lääkemääräys - Lääkevaihtokielto tai lääkevaihdon syy'
                      Control1..?
                      150. MedicationDispense.substitution.reason.text
                      Definition

                      Further clarification on the dispensing of a drug outside of the reference pricing system. Always returned if the reason for the dispensation outside of the reference pricing system is M (other reason).

                      ShortAdditional information for dispensing a drug outside the reference pricing system
                      152. MedicationDispense.detectedIssue
                      Control0..0
                      154. MedicationDispense.eventHistory
                      Control0..0

                      See the documentation on how to interpret the contents of this table

                      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.

                      ShortDispensing a medication to a named patient
                      Control0..*
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsdom-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.

                      ShortLogical 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.

                      Control0..1
                      Typeid
                      Is Modifierfalse
                      Summarytrue
                      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.

                      ShortMetadata about the resource
                      Control0..1
                      TypeMeta
                      Is Modifierfalse
                      Summarytrue
                      Invariantsele-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.

                      ShortUnique id for inter-element referencing
                      Control0..1
                      Typestring
                      Is Modifierfalse
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Summaryfalse
                      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.

                      ShortAdditional 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.

                      Control0..*
                      TypeExtension
                      Is Modifierfalse
                      Summaryfalse
                      Alternate Namesextensions, user content
                      Invariantsele-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())
                      SlicingThis 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.

                        ShortVersion 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.

                        Control0..1
                        Typeid
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Invariantsele-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.

                        ShortWhen 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.

                        Control0..1
                        Typeinstant
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Invariantsele-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.

                        ShortIdentifies 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.

                        Control0..1
                        Typeuri
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Invariantsele-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.

                        ShortProfiles 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.

                        Control1..1
                        Typecanonical(StructureDefinition)
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Fixed Value
                        {
                          "profile" : "http://resepti.kanta.fi/fhir/StructureDefinition/MedicationListMedicationDispense"
                        }
                        <profile value="http://resepti.kanta.fi/fhir/StructureDefinition/MedicationListMedicationDispense"/>
                        Invariantsele-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.

                        ShortSecurity 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.

                        Control0..*
                        BindingUnless not suitable, these codes SHALL be taken from All Security Labels
                        (extensible to http://hl7.org/fhir/ValueSet/security-labels|4.0.1)

                        Security Labels from the Healthcare Privacy and Security Classification System.

                        TypeCoding
                        Is Modifierfalse
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        20. MedicationDispense.meta.tag
                        Definition

                        CDA R2 header specification templateId (specification package version)

                        ShortCDA R2 header specification templateId (specification package version)
                        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.

                        Control1..1
                        BindingFor example codes, see CommonTags
                        (example to http://hl7.org/fhir/ValueSet/common-tags|4.0.1)

                        Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

                        TypeCoding
                        Is Modifierfalse
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        22. MedicationDispense.meta.tag.id
                        Definition

                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                        ShortUnique id for inter-element referencing
                        Control0..1
                        Typestring
                        Is Modifierfalse
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Summaryfalse
                        24. MedicationDispense.meta.tag.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.

                        ShortAdditional 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.

                        Control0..*
                        TypeExtension
                        Is Modifierfalse
                        Summaryfalse
                        Alternate Namesextensions, user content
                        Invariantsele-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())
                        SlicingThis element introduces a set of slices on MedicationDispense.meta.tag.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 26. MedicationDispense.meta.tag.system
                          Definition

                          The identification of the code system that defines the meaning of the symbol in the code.

                          ShortIdentity of the terminology system
                          Comments

                          The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                          Control1..1
                          Typeuri
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Requirements

                          Need to be unambiguous about the source of the definition of the symbol.

                          Fixed Value
                          {
                            "system" : "http://resepti.kanta.fi/fhir/cdaHeaderTemplateId"
                          }
                          <system value="http://resepti.kanta.fi/fhir/cdaHeaderTemplateId"/>
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          28. MedicationDispense.meta.tag.version
                          Definition

                          The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                          ShortVersion of the system - if relevant
                          Comments

                          Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                          NoteThis is a business version Id, not a resource version Id (see discussion)
                          Control0..1
                          Typestring
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          30. MedicationDispense.meta.tag.code
                          Definition

                          CDA R2 header specification templateId (specification package version).

                          ShortCDA R2 header specification templateId (specification package version)
                          Control1..1
                          Typecode
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Requirements

                          Need to refer to a particular code in the system.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          32. MedicationDispense.meta.tag.display
                          Definition

                          A representation of the meaning of the code in the system, following the rules of the system.

                          ShortRepresentation defined by the system
                          Control0..1
                          Typestring
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Requirements

                          Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          34. MedicationDispense.meta.tag.userSelected
                          Definition

                          Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                          ShortIf this coding was chosen directly by the user
                          Comments

                          Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                          Control0..1
                          Typeboolean
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Requirements

                          This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          36. 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.

                          ShortA 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.

                          Control0..1
                          Typeuri
                          Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          38. MedicationDispense.language
                          Definition

                          The base language in which the resource is written.

                          ShortLanguage 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).

                          Control0..1
                          BindingThe codes SHOULD be taken from CommonLanguages
                          (preferred to http://hl7.org/fhir/ValueSet/languages|4.0.1)

                          A human language.

                          Additional BindingsPurpose
                          AllLanguagesMax Binding
                          Typecode
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summaryfalse
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          40. 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.

                          ShortText 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.

                          Control0..1
                          TypeNarrative
                          Is Modifierfalse
                          Summaryfalse
                          Alternate Namesnarrative, html, xhtml, display
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          42. 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.

                          ShortContained, 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.

                          Control0..*
                          TypeResource
                          Is Modifierfalse
                          Summaryfalse
                          Alternate Namesinline resources, anonymous resources, contained resources
                          44. MedicationDispense.extension
                          Definition

                          An Extension

                          ShortExtension
                          Control6..*
                          TypeExtension
                          Is Modifierfalse
                          Summaryfalse
                          Invariantsele-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())
                          SlicingThis element introduces a set of slices on MedicationDispense.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

                            46. MedicationDispense.extension:versionNumber
                            Slice NameversionNumber
                            Definition

                            Lääkitysasiakirjan versiointinumero.

                            ShortAsiakirjan versio
                            Control1..1
                            This element is affected by the following invariants: ele-1
                            TypeExtension(Extension versionNumber) (Extension Type: positiveInt)
                            Is Modifierfalse
                            Summaryfalse
                            Invariantsele-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())
                            48. MedicationDispense.extension:versionNumber.id
                            Definition

                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                            ShortUnique id for inter-element referencing
                            Control0..1
                            Typestring
                            Is Modifierfalse
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Summaryfalse
                            50. MedicationDispense.extension:versionNumber.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.

                            ShortAdditional 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.

                            Control0..*
                            TypeExtension
                            Is Modifierfalse
                            Summaryfalse
                            Alternate Namesextensions, user content
                            Invariantsele-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())
                            SlicingThis 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
                            • 52. MedicationDispense.extension:versionNumber.url
                              Definition

                              Source of the definition for the extension code - a logical name or a URL.

                              Shortidentifies 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.

                              Control1..1
                              Typeuri
                              Is Modifierfalse
                              XML FormatIn the XML format, this property is represented as an attribute.
                              Summaryfalse
                              Fixed Value
                              {
                                "url" : "http://resepti.kanta.fi/StructureDefinition/extension/versionNumber"
                              }
                              <url value="http://resepti.kanta.fi/StructureDefinition/extension/versionNumber"/>
                              54. MedicationDispense.extension:versionNumber.value[x]
                              Definition

                              Lääkitysasiakirjan versiointinumero.

                              ShortAsiakirjan versio
                              Control1..1
                              TypepositiveInt
                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              56. MedicationDispense.extension:effectiveTime
                              Slice NameeffectiveTime
                              Definition

                              The creation time of a document

                              ShortThe creation time of a document
                              Control1..*
                              This element is affected by the following invariants: ele-1
                              TypeExtension(Extension effectiveTime) (Extension Type: dateTime)
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-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())
                              58. MedicationDispense.extension:dosePackaging
                              Slice NamedosePackaging
                              Definition

                              Information about whether the drug was dispensed with dose dispensing.

                              ShortDose dispensing information
                              Control1..*
                              This element is affected by the following invariants: ele-1
                              TypeExtension(Extension dosePackaging) (Extension Type: boolean)
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-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())
                              60. MedicationDispense.extension:fullyDispensed
                              Slice NamefullyDispensed
                              Definition

                              Information on whether the medicine has been fully dispensed.

                              ShortA fully dispensed entry
                              Control1..*
                              This element is affected by the following invariants: ele-1
                              TypeExtension(Extension fullyDispensed) (Extension Type: boolean)
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-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())
                              62. MedicationDispense.extension:continuum
                              Slice Namecontinuum
                              Definition

                              Identifiers of medicine continuum: The identifier of the medicine in use and part identifier of medicine continuum.

                              ShortThe identifier of the medicine in use and part identifier of medicine continuum.
                              Control0..1
                              This element is affected by the following invariants: ele-1
                              TypeExtension(Extension continuum) (Complex Extension)
                              Is Modifierfalse
                              Invariantsele-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())
                              64. MedicationDispense.extension:continuum.id
                              Definition

                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                              ShortUnique id for inter-element referencing
                              Control0..1
                              Typestring
                              Is Modifierfalse
                              XML FormatIn the XML format, this property is represented as an attribute.
                              Summaryfalse
                              66. MedicationDispense.extension:continuum.extension
                              Definition

                              An Extension

                              ShortExtension
                              Control0..*
                              TypeExtension
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-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())
                              SlicingThis 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
                              • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

                                68. MedicationDispense.extension:continuum.extension:medicineId
                                Slice NamemedicineId
                                Definition

                                Automatically produced by an information system, a technical OID identifier that combines the entries of the same prescribed drug.

                                ShortThe identifier of the drug in use
                                Control0..1
                                TypeExtension
                                Is Modifierfalse
                                Summaryfalse
                                Invariantsele-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())
                                70. MedicationDispense.extension:continuum.extension:medicineId.id
                                Definition

                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                ShortUnique id for inter-element referencing
                                Control0..1
                                Typestring
                                Is Modifierfalse
                                XML FormatIn the XML format, this property is represented as an attribute.
                                Summaryfalse
                                72. MedicationDispense.extension:continuum.extension:medicineId.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.

                                ShortAdditional 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.

                                Control0..*
                                TypeExtension
                                Is Modifierfalse
                                Summaryfalse
                                Alternate Namesextensions, user content
                                Invariantsele-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())
                                SlicingThis element introduces a set of slices on MedicationDispense.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • value @ url
                                • 74. MedicationDispense.extension:continuum.extension:medicineId.url
                                  Definition

                                  Source of the definition for the extension code - a logical name or a URL.

                                  Shortidentifies 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.

                                  Control1..1
                                  Typeuri
                                  Is Modifierfalse
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  Summaryfalse
                                  Fixed Value
                                  {
                                    "url" : "medicineId"
                                  }
                                  <url value="medicineId"/>
                                  76. MedicationDispense.extension:continuum.extension:medicineId.value[x]
                                  Definition

                                  Automatically produced by an information system, a technical OID identifier that combines the entries of the same prescribed drug.

                                  ShortThe identifier of the drug in use
                                  Control1..1
                                  TypeIdentifier
                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                  Is Modifierfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  78. MedicationDispense.extension:continuum.extension:medicineId.value[x].id
                                  Definition

                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                  ShortUnique id for inter-element referencing
                                  Control0..1
                                  Typestring
                                  Is Modifierfalse
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  Summaryfalse
                                  80. MedicationDispense.extension:continuum.extension:medicineId.value[x].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.

                                  ShortAdditional 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.

                                  Control0..*
                                  TypeExtension
                                  Is Modifierfalse
                                  Summaryfalse
                                  Alternate Namesextensions, user content
                                  Invariantsele-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())
                                  SlicingThis element introduces a set of slices on MedicationDispense.extension.extension.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • value @ url
                                  • 82. MedicationDispense.extension:continuum.extension:medicineId.value[x].use
                                    Definition

                                    The purpose of this identifier.

                                    Shortusual | official | temp | secondary | old (If known)
                                    Comments

                                    Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                                    Control0..1
                                    BindingThe codes SHALL be taken from IdentifierUse
                                    (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                                    Identifies the purpose for this identifier, if known .

                                    Typecode
                                    Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Requirements

                                    Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    84. MedicationDispense.extension:continuum.extension:medicineId.value[x].type
                                    Definition

                                    A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                                    ShortDescription of identifier
                                    Comments

                                    This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                                    Control0..1
                                    BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                                    (extensible to http://hl7.org/fhir/ValueSet/identifier-type|4.0.1)

                                    A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summarytrue
                                    Requirements

                                    Allows users to make use of identifiers when the identifier system is not known.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    86. MedicationDispense.extension:continuum.extension:medicineId.value[x].system
                                    Definition

                                    Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                                    ShortThe namespace for the identifier value
                                    Comments

                                    Identifier.system is always case sensitive.

                                    Control1..1
                                    Typeuri
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Requirements

                                    There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                                    Fixed Value
                                    {
                                      "system" : "urn:ietf:rfc:3986"
                                    }
                                    <system value="urn:ietf:rfc:3986"/>
                                    ExampleGeneral: http://www.acme.com/identifiers/patient
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    88. MedicationDispense.extension:continuum.extension:medicineId.value[x].value
                                    Definition

                                    Automatically produced by an information system, a technical OID identifier that combines the entries of the same prescribed drug.

                                    ShortThe identifier of the drug in use
                                    Comments

                                    If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                                    Control1..1
                                    Typestring
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    ExampleGeneral: 123456
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    90. MedicationDispense.extension:continuum.extension:medicineId.value[x].period
                                    Definition

                                    Time period during which identifier is/was valid for use.

                                    ShortTime period when id is/was valid for use
                                    Control0..1
                                    TypePeriod
                                    Is Modifierfalse
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    92. MedicationDispense.extension:continuum.extension:medicineId.value[x].assigner
                                    Definition

                                    Organization that issued/manages the identifier.

                                    ShortOrganization that issued id (may be just text)
                                    Comments

                                    The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                                    Control0..1
                                    TypeReference(Organization)
                                    Is Modifierfalse
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    94. MedicationDispense.extension:continuum.extension:medicineIdPart
                                    Slice NamemedicineIdPart
                                    Definition

                                    Automatically produced by the information system. Separates the different continuums of the same drug (that is, simultaneously used prescriptions for the same drug). As a rule, the drug used has only one medicine continuum at a time (only one active prescription). When it is necessary to have two or more active prescriptions for a drug, for example, when the patient uses two different strengths of the drug, the medicine continuums are separated by the part identifier of the medicine continuum.

                                    ShortPart identifier of medicine continuum
                                    Control0..1
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-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())
                                    96. MedicationDispense.extension:continuum.extension:medicineIdPart.id
                                    Definition

                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    98. MedicationDispense.extension:continuum.extension:medicineIdPart.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.

                                    ShortAdditional 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.

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-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())
                                    SlicingThis element introduces a set of slices on MedicationDispense.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                    • value @ url
                                    • 100. MedicationDispense.extension:continuum.extension:medicineIdPart.url
                                      Definition

                                      Source of the definition for the extension code - a logical name or a URL.

                                      Shortidentifies 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.

                                      Control1..1
                                      Typeuri
                                      Is Modifierfalse
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      Summaryfalse
                                      Fixed Value
                                      {
                                        "url" : "medicineIdPart"
                                      }
                                      <url value="medicineIdPart"/>
                                      102. MedicationDispense.extension:continuum.extension:medicineIdPart.value[x]
                                      Definition

                                      Automatically produced by the information system. Separates the different continuums of the same drug (that is, simultaneously used prescriptions for the same drug). As a rule, the drug used has only one medicine continuum at a time (only one active prescription). When it is necessary to have two or more active prescriptions for a drug, for example, when the patient uses two different strengths of the drug, the medicine continuums are separated by the part identifier of the medicine continuum.

                                      ShortPart identifier of medicine continuum
                                      Control1..1
                                      TypepositiveInt
                                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      104. MedicationDispense.extension:continuum.extension:newest
                                      Slice Namenewest
                                      Definition

                                      Information maintained by the Kanta Prescription Centre on what is the latest prescription in the medicine continuum. The value True says that the prescription is the latest prescription in the continuum.

                                      ShortStatus information 'Latest'
                                      Control0..0
                                      TypeExtension
                                      Is Modifierfalse
                                      Summaryfalse
                                      Invariantsele-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())
                                      110. MedicationDispense.extension:continuum.url
                                      Definition

                                      Source of the definition for the extension code - a logical name or a URL.

                                      Shortidentifies 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.

                                      Control1..1
                                      Typeuri
                                      Is Modifierfalse
                                      XML FormatIn the XML format, this property is represented as an attribute.
                                      Summaryfalse
                                      Fixed Value
                                      {
                                        "url" : "http://resepti.kanta.fi/fhir/StructureDefinition/extension/continuum"
                                      }
                                      <url value="http://resepti.kanta.fi/fhir/StructureDefinition/extension/continuum"/>
                                      112. MedicationDispense.extension:continuum.value[x]
                                      Definition

                                      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                      ShortValue of extension
                                      Control0..0
                                      TypeChoice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      114. MedicationDispense.extension:additionalInformation
                                      Slice NameadditionalInformation
                                      Definition

                                      Further clarification of the drug dispensation to Kela.

                                      ShortFurther clarification of the drug dispensation to Kela
                                      Control0..*
                                      This element is affected by the following invariants: ele-1
                                      TypeExtension(Extension additionalInformation) (Extension Type: string)
                                      Is Modifierfalse
                                      Summaryfalse
                                      Invariantsele-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())
                                      116. MedicationDispense.extension:cost
                                      Slice Namecost
                                      Definition

                                      Dispensation price in euros.

                                      ShortThe price of dispensation
                                      Control1..1
                                      This element is affected by the following invariants: ele-1
                                      TypeExtension(Extension cost) (Extension Type: Money)
                                      Is Modifierfalse
                                      Summaryfalse
                                      Invariantsele-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())
                                      118. MedicationDispense.extension:amountOfPackages
                                      Slice NameamountOfPackages
                                      Definition

                                      Number of dispensed drug packages.

                                      ShortThe number of packages
                                      Control1..*
                                      This element is affected by the following invariants: ele-1
                                      TypeExtension(Extension amountOfPackages) (Extension Type: positiveInt)
                                      Is Modifierfalse
                                      Summaryfalse
                                      Invariantsele-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())
                                      120. MedicationDispense.extension:additionalPackage
                                      Slice NameadditionalPackage
                                      Definition

                                      Different packages have been dispensed in the dispense.

                                      ShortInformation of different packages
                                      Control0..*
                                      This element is affected by the following invariants: ele-1
                                      TypeExtension(Extension additionalPackage) (Complex Extension)
                                      Is Modifierfalse
                                      Invariantsele-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())
                                      122. MedicationDispense.extension:previousDispenseChange
                                      Slice NamepreviousDispenseChange
                                      Definition

                                      Toimituksen kauppanimen muutospäivä, kauppanimen muutospäivänä toimitetun valmisteen kauppanimi, kauppanimen muutospäivänä toimitetun valmisteen VNR-numero, kauppanimen muutospäivänä toimitetun valmisteen vahvuus, kauppanimen muutospäivänä toimitetun valmisteen lääkemuoto.

                                      ShortToimituksen kauppanimen muutospäivä, kauppanimen muutospäivänä toimitetun valmisteen VNR-numero ja kauppanimi, kauppanimen muutospäivänä toimitetun valmisteen vahvuus, kauppanimen muutospäivänä toimitetun valmisteen lääkemuoto.
                                      Control0..1
                                      This element is affected by the following invariants: ele-1
                                      TypeExtension(Extension previousDispenseChange) (Complex Extension)
                                      Is Modifierfalse
                                      Invariantsele-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())
                                      124. 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).

                                      ShortExtensions 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.

                                      Control0..*
                                      TypeExtension
                                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                                      Summaryfalse
                                      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 Namesextensions, user content
                                      Invariantsele-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())
                                      126. 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.

                                      ShortExternal identifier
                                      Comments

                                      This is a business identifier, not a resource identifier.

                                      NoteThis is a business identifier, not a resource identifier (see discussion)
                                      Control0..*
                                      TypeIdentifier
                                      Is Modifierfalse
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      SlicingThis element introduces a set of slices on MedicationDispense.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                      • value @ system
                                      • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

                                        128. MedicationDispense.identifier:id
                                        Slice Nameid
                                        Definition

                                        Unique identifier of the dispensation document. For example, the identifier may be an identifier that identifies a particular version of the dispensation document.

                                        ShortDocument identifier (unique identifier of the dispensation document)
                                        Comments

                                        This is a business identifier, not a resource identifier.

                                        NoteThis is a business identifier, not a resource identifier (see discussion)
                                        Control1..1
                                        TypeIdentifier
                                        Is Modifierfalse
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        130. MedicationDispense.identifier:id.id
                                        Definition

                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                        ShortUnique id for inter-element referencing
                                        Control0..1
                                        Typestring
                                        Is Modifierfalse
                                        XML FormatIn the XML format, this property is represented as an attribute.
                                        Summaryfalse
                                        132. MedicationDispense.identifier:id.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.

                                        ShortAdditional 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.

                                        Control0..*
                                        TypeExtension
                                        Is Modifierfalse
                                        Summaryfalse
                                        Alternate Namesextensions, user content
                                        Invariantsele-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())
                                        SlicingThis element introduces a set of slices on MedicationDispense.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                        • value @ url
                                        • 134. MedicationDispense.identifier:id.use
                                          Definition

                                          The purpose of this identifier.

                                          Shortusual | official | temp | secondary | old (If known)
                                          Comments

                                          Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                                          Control0..1
                                          BindingThe codes SHALL be taken from IdentifierUse
                                          (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                                          Identifies the purpose for this identifier, if known .

                                          Typecode
                                          Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summarytrue
                                          Requirements

                                          Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          136. MedicationDispense.identifier:id.type
                                          Definition

                                          A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                                          ShortDescription of identifier
                                          Comments

                                          This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                                          Control0..1
                                          BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                                          (extensible to http://hl7.org/fhir/ValueSet/identifier-type|4.0.1)

                                          A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Summarytrue
                                          Requirements

                                          Allows users to make use of identifiers when the identifier system is not known.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          138. MedicationDispense.identifier:id.system
                                          Definition

                                          Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                                          ShortThe namespace for the identifier value
                                          Comments

                                          Note. Here a separate namespace was created, another option would have been to put urn:ietf:rfc:3986 as system and encode the identifiers with the type element (own codes for id and setId).

                                          Control1..1
                                          Typeuri
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summarytrue
                                          Requirements

                                          There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                                          Fixed Value
                                          {
                                            "system" : "http://resepti.kanta.fi/fhir/id/id"
                                          }
                                          <system value="http://resepti.kanta.fi/fhir/id/id"/>
                                          ExampleGeneral: http://www.acme.com/identifiers/patient
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          140. MedicationDispense.identifier:id.value
                                          Definition

                                          An unique OID identifier of the dispensation document

                                          ShortAn unique OID identifier of the dispensation document
                                          Comments

                                          Note. Here a separate namespace was created, another option would have been to put urn:ietf:rfc:3986 as system and encode the identifiers with the type element (own codes for id and setId). (If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986.)

                                          Control1..1
                                          Typestring
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summarytrue
                                          ExampleGeneral: 123456
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          142. MedicationDispense.identifier:id.period
                                          Definition

                                          Time period during which identifier is/was valid for use.

                                          ShortTime period when id is/was valid for use
                                          Control0..1
                                          TypePeriod
                                          Is Modifierfalse
                                          Summarytrue
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          144. MedicationDispense.identifier:id.assigner
                                          Definition

                                          Organization that issued/manages the identifier.

                                          ShortOrganization that issued id (may be just text)
                                          Comments

                                          The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                                          Control0..1
                                          TypeReference(Organization)
                                          Is Modifierfalse
                                          Summarytrue
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          146. MedicationDispense.identifier:setId
                                          Slice NamesetId
                                          Definition

                                          Identifier of the original drug dispensation document that connects different versions of the document.

                                          ShortThe identifier of the original dispensation document
                                          Comments

                                          This is a business identifier, not a resource identifier.

                                          NoteThis is a business identifier, not a resource identifier (see discussion)
                                          Control1..1
                                          TypeIdentifier
                                          Is Modifierfalse
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          148. MedicationDispense.identifier:setId.id
                                          Definition

                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                          ShortUnique id for inter-element referencing
                                          Control0..1
                                          Typestring
                                          Is Modifierfalse
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          Summaryfalse
                                          150. MedicationDispense.identifier:setId.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.

                                          ShortAdditional 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.

                                          Control0..*
                                          TypeExtension
                                          Is Modifierfalse
                                          Summaryfalse
                                          Alternate Namesextensions, user content
                                          Invariantsele-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())
                                          SlicingThis element introduces a set of slices on MedicationDispense.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                          • value @ url
                                          • 152. MedicationDispense.identifier:setId.use
                                            Definition

                                            The purpose of this identifier.

                                            Shortusual | official | temp | secondary | old (If known)
                                            Comments

                                            Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                                            Control0..1
                                            BindingThe codes SHALL be taken from IdentifierUse
                                            (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                                            Identifies the purpose for this identifier, if known .

                                            Typecode
                                            Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            Requirements

                                            Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            154. MedicationDispense.identifier:setId.type
                                            Definition

                                            A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                                            ShortDescription of identifier
                                            Comments

                                            This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                                            Control0..1
                                            BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                                            (extensible to http://hl7.org/fhir/ValueSet/identifier-type|4.0.1)

                                            A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                                            TypeCodeableConcept
                                            Is Modifierfalse
                                            Summarytrue
                                            Requirements

                                            Allows users to make use of identifiers when the identifier system is not known.

                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            156. MedicationDispense.identifier:setId.system
                                            Definition

                                            Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                                            ShortThe namespace for the identifier value
                                            Comments

                                            Note. Here a separate namespace was created, another option would have been to put urn:ietf:rfc:3986 as system and encode the identifiers with the type element (own codes for id and setId). (If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986.)

                                            Control1..1
                                            Typeuri
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            Requirements

                                            There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                                            Fixed Value
                                            {
                                              "system" : "http://resepti.kanta.fi/fhir/id/setId"
                                            }
                                            <system value="http://resepti.kanta.fi/fhir/id/setId"/>
                                            ExampleGeneral: http://www.acme.com/identifiers/patient
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            158. MedicationDispense.identifier:setId.value
                                            Definition

                                            Identifier of the original drug dispensation document that connects different versions of the document.

                                            ShortThe identifier of the original dispensation document
                                            Comments

                                            Note. Here a separate namespace was created, another option would have been to put urn:ietf:rfc:3986 as system and encode the identifiers with the type element (own codes for id and setId). (If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986.)

                                            Control1..1
                                            Typestring
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            ExampleGeneral: 123456
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            160. MedicationDispense.identifier:setId.period
                                            Definition

                                            Time period during which identifier is/was valid for use.

                                            ShortTime period when id is/was valid for use
                                            Control0..1
                                            TypePeriod
                                            Is Modifierfalse
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            162. MedicationDispense.identifier:setId.assigner
                                            Definition

                                            Organization that issued/manages the identifier.

                                            ShortOrganization that issued id (may be just text)
                                            Comments

                                            The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                                            Control0..1
                                            TypeReference(Organization)
                                            Is Modifierfalse
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            164. MedicationDispense.partOf
                                            Definition

                                            The procedure that trigger the dispense.

                                            ShortEvent that dispense is part of
                                            Control0..0
                                            TypeReference(Procedure)
                                            Is Modifierfalse
                                            Summaryfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            166. MedicationDispense.status
                                            Definition

                                            A standard value is used: Completed

                                            Shortpreparation | 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.

                                            Control1..1
                                            BindingThe codes SHALL be taken from MedicationDispense Status Codes
                                            (required to http://hl7.org/fhir/ValueSet/medicationdispense-status|4.0.1)

                                            A coded concept specifying the state of the dispense event.

                                            Typecode
                                            Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            Fixed Value
                                            {
                                              "status" : "completed"
                                            }
                                            <status value="completed"/>
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            168. MedicationDispense.statusReason[x]
                                            Definition

                                            This information tells whether information from the drug dispensation or its different versions (i.e., correction of dispensation) is returned. This is represented as a code from the Kanta code system 'Sähköinen lääkemääräys - Reseptisanoman tyyppi', depending on the dispensation document: 10 = Prescription dispensation or 12 = Correction of prescription dispensation

                                            ShortType of prescription message
                                            Control1..1
                                            BindingFor example codes, see MedicationDispense Status Reason Codes
                                            (example to http://hl7.org/fhir/ValueSet/medicationdispense-status-reason|4.0.1)

                                            A code describing why a dispense was not performed.

                                            TypeCodeableConcept
                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                            Is Modifierfalse
                                            Summaryfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            170. MedicationDispense.statusReason[x].id
                                            Definition

                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                            ShortUnique id for inter-element referencing
                                            Control0..1
                                            Typestring
                                            Is Modifierfalse
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            Summaryfalse
                                            172. MedicationDispense.statusReason[x].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.

                                            ShortAdditional 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.

                                            Control0..*
                                            TypeExtension
                                            Is Modifierfalse
                                            Summaryfalse
                                            Alternate Namesextensions, user content
                                            Invariantsele-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())
                                            SlicingThis element introduces a set of slices on MedicationDispense.statusReason[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                            • value @ url
                                            • 174. MedicationDispense.statusReason[x].coding
                                              Definition

                                              Kanta code system 'Sähköinen lääkemääräys - Reseptisanoman tyyppi'.

                                              ShortType of prescription message
                                              Comments

                                              Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                              Control1..1
                                              TypeCoding
                                              Is Modifierfalse
                                              Summarytrue
                                              Requirements

                                              Allows for alternative encodings within a code system, and translations to other code systems.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              176. MedicationDispense.statusReason[x].coding.id
                                              Definition

                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                              ShortUnique id for inter-element referencing
                                              Control0..1
                                              Typestring
                                              Is Modifierfalse
                                              XML FormatIn the XML format, this property is represented as an attribute.
                                              Summaryfalse
                                              178. MedicationDispense.statusReason[x].coding.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.

                                              ShortAdditional 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.

                                              Control0..*
                                              TypeExtension
                                              Is Modifierfalse
                                              Summaryfalse
                                              Alternate Namesextensions, user content
                                              Invariantsele-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())
                                              SlicingThis element introduces a set of slices on MedicationDispense.statusReason[x].coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                              • value @ url
                                              • 180. MedicationDispense.statusReason[x].coding.system
                                                Definition

                                                OID of the Kanta code system 'Sähköinen lääkemääräys - Reseptisanoman tyyppi'.

                                                ShortOID of the Kanta code system 'Sähköinen lääkemääräys - Reseptisanoman tyyppi'
                                                Comments

                                                The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                Control1..1
                                                Typeuri
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                Need to be unambiguous about the source of the definition of the symbol.

                                                Fixed Value
                                                {
                                                  "system" : "urn:oid:1.2.246.537.5.40105.2006"
                                                }
                                                <system value="urn:oid:1.2.246.537.5.40105.2006"/>
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                182. MedicationDispense.statusReason[x].coding.version
                                                Definition

                                                The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                ShortVersion of the system - if relevant
                                                Comments

                                                Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                NoteThis is a business version Id, not a resource version Id (see discussion)
                                                Control0..1
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                184. MedicationDispense.statusReason[x].coding.code
                                                Definition

                                                Code of the Kanta code system 'Sähköinen lääkemääräys - Reseptisanoman tyyppi': 10 = Prescription dispensation 11 = Invalidation of prescription dispensation 12 = Correction of prescription dispensation

                                                ShortCode of the Kanta code system 'Sähköinen lääkemääräys - Reseptisanoman tyyppi'.
                                                Control1..1
                                                Typecode
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                Need to refer to a particular code in the system.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                186. MedicationDispense.statusReason[x].coding.display
                                                Definition

                                                A representation of the meaning of the code in the system, following the rules of the system.

                                                ShortRepresentation defined by the system
                                                Control0..1
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                188. MedicationDispense.statusReason[x].coding.userSelected
                                                Definition

                                                Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                ShortIf this coding was chosen directly by the user
                                                Comments

                                                Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                Control0..1
                                                Typeboolean
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                190. MedicationDispense.statusReason[x].text
                                                Definition

                                                A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                ShortPlain text representation of the concept
                                                Comments

                                                Very often the text is the same as a displayName of one of the codings.

                                                Control0..1
                                                Typestring
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                192. 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)).

                                                ShortType 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.

                                                Control0..0
                                                BindingThe codes SHOULD be taken from MedicationDispense Category Codes
                                                (preferred to http://hl7.org/fhir/ValueSet/medicationdispense-category|4.0.1)

                                                A code describing where the dispensed medication is expected to be consumed or administered.

                                                TypeCodeableConcept
                                                Is Modifierfalse
                                                Summaryfalse
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                194. MedicationDispense.medication[x]
                                                Definition

                                                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.

                                                ShortReference to MedicationListMedication resource
                                                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.

                                                Control1..1
                                                TypeReference(MedicationListMedication)contained
                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                Is Modifierfalse
                                                Summarytrue
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                196. MedicationDispense.subject
                                                Definition

                                                A link to a resource representing the person or the group to whom the medication will be given.

                                                ShortWho the dispense is for
                                                Comments

                                                SubstanceAdministration->subject->Patient.

                                                Control0..0
                                                TypeReference(Patient, Group)
                                                Is Modifierfalse
                                                Summarytrue
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                198. MedicationDispense.context
                                                Definition

                                                The encounter or episode of care that establishes the context for this event.

                                                ShortEncounter / Episode associated with event
                                                Control0..0
                                                TypeReference(Encounter, EpisodeOfCare)
                                                Is Modifierfalse
                                                Summaryfalse
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                200. MedicationDispense.supportingInformation
                                                Definition

                                                Additional information that supports the medication being dispensed.

                                                ShortInformation that supports the dispensing of the medication
                                                Control0..0
                                                TypeReference(Resource)
                                                Is Modifierfalse
                                                Summaryfalse
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                202. MedicationDispense.performer
                                                Definition

                                                Indicates who or what performed the event.

                                                ShortWho performed event
                                                Control0..*
                                                TypeBackboneElement
                                                Is Modifierfalse
                                                Summaryfalse
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                204. 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.

                                                ShortUnique id for inter-element referencing
                                                Control0..1
                                                Typestring
                                                Is Modifierfalse
                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                Summaryfalse
                                                206. 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.

                                                ShortAdditional 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.

                                                Control0..*
                                                TypeExtension
                                                Is Modifierfalse
                                                Summaryfalse
                                                Alternate Namesextensions, user content
                                                Invariantsele-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())
                                                208. 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).

                                                ShortExtensions 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.

                                                Control0..*
                                                TypeExtension
                                                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                Summarytrue
                                                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 Namesextensions, user content, modifiers
                                                Invariantsele-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())
                                                210. MedicationDispense.performer.function
                                                Definition

                                                Distinguishes the type of performer in the dispense. For example, date enterer, packager, final checker.

                                                ShortWho performed the dispense and what they did
                                                Control0..1
                                                BindingFor example codes, see MedicationDispense Performer Function Codes
                                                (example to http://hl7.org/fhir/ValueSet/medicationdispense-performer-function|4.0.1)

                                                A code describing the role an individual played in dispensing a medication.

                                                TypeCodeableConcept
                                                Is Modifierfalse
                                                Summaryfalse
                                                Requirements

                                                Allows disambiguation of the types of involvement of different performers.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                212. 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.

                                                ShortReference to the information of the person who performed the dispensation
                                                Control1..1
                                                TypeReference(MedicationListPractitionerRole)contained
                                                Is Modifierfalse
                                                Summaryfalse
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                214. MedicationDispense.performer.actor.id
                                                Definition

                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                ShortUnique id for inter-element referencing
                                                Control0..1
                                                Typestring
                                                Is Modifierfalse
                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                Summaryfalse
                                                216. MedicationDispense.performer.actor.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.

                                                ShortAdditional 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.

                                                Control0..*
                                                TypeExtension
                                                Is Modifierfalse
                                                Summaryfalse
                                                Alternate Namesextensions, user content
                                                Invariantsele-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())
                                                SlicingThis element introduces a set of slices on MedicationDispense.performer.actor.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                • value @ url
                                                • 218. MedicationDispense.performer.actor.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.

                                                  ShortLiteral 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.

                                                  Control1..1
                                                  This element is affected by the following invariants: ref-1
                                                  Typestring
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  220. MedicationDispense.performer.actor.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).

                                                  ShortType 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.

                                                  Control0..1
                                                  BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                                  (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

                                                  Aa resource (or, for logical models, the URI of the logical model).

                                                  Typeuri
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  222. MedicationDispense.performer.actor.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.

                                                  ShortLogical 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).

                                                  NoteThis is a business identifier, not a resource identifier (see discussion)
                                                  Control0..1
                                                  TypeIdentifier
                                                  Is Modifierfalse
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  224. MedicationDispense.performer.actor.display
                                                  Definition

                                                  Plain text narrative that identifies the resource in addition to the resource reference.

                                                  ShortText 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.

                                                  Control0..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  226. MedicationDispense.location
                                                  Definition

                                                  The principal physical location where the dispense was performed.

                                                  ShortWhere the dispense occurred
                                                  Control0..0
                                                  TypeReference(Location)
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  228. MedicationDispense.authorizingPrescription
                                                  Definition

                                                  Reference to the unique identifier of the MedicationRequest resource to which the MedicationDispense resource is linked (MedicationRequest.id).

                                                  ShortReference to the unique identifier of the MedicationRequest resource to which the MedicationDispense is linked
                                                  Comments

                                                  Maps to basedOn in Event logical model.

                                                  Control1..1
                                                  TypeReference(MedicationRequest)
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  230. 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.

                                                  ShortUnique id for inter-element referencing
                                                  Control0..1
                                                  Typestring
                                                  Is Modifierfalse
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  Summaryfalse
                                                  232. MedicationDispense.authorizingPrescription.extension
                                                  Definition

                                                  An Extension

                                                  ShortExtension
                                                  Control1..*
                                                  TypeExtension
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Invariantsele-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())
                                                  SlicingThis 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
                                                  • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

                                                    234. MedicationDispense.authorizingPrescription.extension:prescriptionSetId
                                                    Slice NameprescriptionSetId
                                                    Definition

                                                    setId, the original identifier of the prescription document, with which the drug dispensation is associated

                                                    ShortsetId, the original identifier of the prescription document, with which the drug dispensation is associated
                                                    Control1..1
                                                    TypeExtension(Extension prescriptionSetId) (Extension Type: Identifier)
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Invariantsele-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())
                                                    236. 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.

                                                    ShortLiteral 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.

                                                    Control0..1
                                                    This element is affected by the following invariants: ref-1
                                                    Typestring
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summarytrue
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    238. 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).

                                                    ShortType 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.

                                                    Control0..1
                                                    BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                                    (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

                                                    Aa resource (or, for logical models, the URI of the logical model).

                                                    Typeuri
                                                    Is Modifierfalse
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summarytrue
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    240. MedicationDispense.authorizingPrescription.identifier
                                                    Definition

                                                    Unique identifier of the MedicationRequest resource to which the MedicationDispense resource is linked

                                                    ShortUnique identifier of the MedicationRequest resource to which the MedicationDispense resource is linked
                                                    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).

                                                    NoteThis is a business identifier, not a resource identifier (see discussion)
                                                    Control1..1
                                                    TypeIdentifier
                                                    Is Modifierfalse
                                                    Summarytrue
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    242. MedicationDispense.authorizingPrescription.identifier.id
                                                    Definition

                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                    ShortUnique id for inter-element referencing
                                                    Control0..1
                                                    Typestring
                                                    Is Modifierfalse
                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                    Summaryfalse
                                                    244. MedicationDispense.authorizingPrescription.identifier.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.

                                                    ShortAdditional 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.

                                                    Control0..*
                                                    TypeExtension
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Alternate Namesextensions, user content
                                                    Invariantsele-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())
                                                    SlicingThis element introduces a set of slices on MedicationDispense.authorizingPrescription.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                    • value @ url
                                                    • 246. MedicationDispense.authorizingPrescription.identifier.use
                                                      Definition

                                                      The purpose of this identifier.

                                                      Shortusual | official | temp | secondary | old (If known)
                                                      Comments

                                                      Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                                                      Control0..1
                                                      BindingThe codes SHALL be taken from IdentifierUse
                                                      (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                                                      Identifies the purpose for this identifier, if known .

                                                      Typecode
                                                      Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      Requirements

                                                      Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      248. MedicationDispense.authorizingPrescription.identifier.type
                                                      Definition

                                                      A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                                                      ShortDescription of identifier
                                                      Comments

                                                      This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                                                      Control0..1
                                                      BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                                                      (extensible to http://hl7.org/fhir/ValueSet/identifier-type|4.0.1)

                                                      A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                                                      TypeCodeableConcept
                                                      Is Modifierfalse
                                                      Summarytrue
                                                      Requirements

                                                      Allows users to make use of identifiers when the identifier system is not known.

                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      250. MedicationDispense.authorizingPrescription.identifier.system
                                                      Definition

                                                      Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                                                      ShortThe namespace for the identifier value
                                                      Comments

                                                      Identifier.system is always case sensitive.

                                                      Control1..1
                                                      Typeuri
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      Requirements

                                                      There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                                                      Fixed Value
                                                      {
                                                        "system" : "http://resepti.kanta.fi/fhir/id/id"
                                                      }
                                                      <system value="http://resepti.kanta.fi/fhir/id/id"/>
                                                      ExampleGeneral: http://www.acme.com/identifiers/patient
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      252. MedicationDispense.authorizingPrescription.identifier.value
                                                      Definition

                                                      The unique OID identifier of the prescription.

                                                      ShortThe unique OID identifier of the prescription
                                                      Comments

                                                      If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                                                      Control1..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      ExampleGeneral: 123456
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      254. MedicationDispense.authorizingPrescription.identifier.period
                                                      Definition

                                                      Time period during which identifier is/was valid for use.

                                                      ShortTime period when id is/was valid for use
                                                      Control0..1
                                                      TypePeriod
                                                      Is Modifierfalse
                                                      Summarytrue
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      256. MedicationDispense.authorizingPrescription.identifier.assigner
                                                      Definition

                                                      Organization that issued/manages the identifier.

                                                      ShortOrganization that issued id (may be just text)
                                                      Comments

                                                      The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                                                      Control0..1
                                                      TypeReference(Organization)
                                                      Is Modifierfalse
                                                      Summarytrue
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      258. MedicationDispense.authorizingPrescription.display
                                                      Definition

                                                      Plain text narrative that identifies the resource in addition to the resource reference.

                                                      ShortText 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.

                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      260. 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.

                                                      ShortTrial fill, partial fill, emergency fill, etc.
                                                      Control0..0
                                                      BindingFor 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.

                                                      TypeCodeableConcept
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      262. MedicationDispense.quantity
                                                      Definition

                                                      The amount of the drug provided by the prescription at that dispensation. The amount of the drug supplied as a numerical value (e.g., 100) and the unit (e.g., tab).

                                                      ShortTotal amount of drug and unit of the amount
                                                      Control1..1
                                                      TypeQuantity(SimpleQuantity)
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      sqty-1: The comparator is not used on a SimpleQuantity (comparator.empty())
                                                      264. 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.

                                                      ShortUnique id for inter-element referencing
                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                      Summaryfalse
                                                      266. MedicationDispense.quantity.extension
                                                      Definition

                                                      An Extension

                                                      ShortExtension
                                                      Control1..*
                                                      TypeExtension
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Invariantsele-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())
                                                      SlicingThis 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
                                                      • Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

                                                        268. MedicationDispense.quantity.extension:amountFormula
                                                        Slice NameamountFormula
                                                        Definition

                                                        The dispensed amount of drug as a calculation formula.

                                                        ShortThe dispensed amount of drug as a calculation formula
                                                        Control0..1
                                                        TypeExtension(Extension amountFormula) (Complex Extension)
                                                        Is Modifierfalse
                                                        Invariantsele-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())
                                                        270. MedicationDispense.quantity.extension:amountText
                                                        Slice NameamountText
                                                        Definition

                                                        The dispensed amount of the drug as text (e.g., 1 suppository + 20 g ointment). The unit is also recorded in the text.

                                                        ShortThe amount of drug as text
                                                        Control0..1
                                                        TypeExtension(Extension amountText) (Extension Type: string)
                                                        Is Modifierfalse
                                                        Summaryfalse
                                                        Invariantsele-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())
                                                        272. MedicationDispense.quantity.extension:totalDispensedAmount
                                                        Slice NametotalDispensedAmount
                                                        Definition

                                                        Kyseisen lääkemääräyksen kaikilla toimituskerroilla yhteensä toimitettu lääkkeen määrä. Jos kyseessä on lääkemääräyksen ensimmäinen toimitus, arvo on sama kuin kyseisellä toimituskerralla toimitettu määrä. Voi palautua yhdellä vaihtoehtoisella tavalla: lääkkeen kokonaismäärä ja määrän yksikkö, lääkkeen määrä laskukaavana tai lääkkeen määrä tekstinä.

                                                        ShortLääkemääräyksellä yhteensä toimitettu määrä
                                                        Control0..1
                                                        TypeExtension(Extension totalDispensedAmount) (Complex Extension)
                                                        Is Modifierfalse
                                                        Invariantsele-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())
                                                        274. MedicationDispense.quantity.extension:remainingAmount
                                                        Slice NameremainingAmount
                                                        Definition

                                                        The amount of the drug remaining (to be dispensed) in the prescription. Can be returned in the following ways: the total amount of the drug and the unit, the amount of the drug as a calculation formula or the amount of the drug as text. This information is not returned by the basic medication list search or in the search for discontinued medications if the dispensation is not related to the latest prescription in the continuum.

                                                        ShortLääkemääräyksellä jäljellä oleva määrä
                                                        Control1..1
                                                        TypeExtension(Extension remainingAmount) (Complex Extension)
                                                        Is Modifierfalse
                                                        Invariantsele-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())
                                                        276. MedicationDispense.quantity.value
                                                        Definition

                                                        The dispensed amount of the medicine as a numerical value (e.g., 100).

                                                        ShortTotal amount of medicine, amount
                                                        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).

                                                        Control0..1
                                                        Typedecimal
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summarytrue
                                                        Requirements

                                                        Precision is handled implicitly in almost all cases of measurement.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        278. MedicationDispense.quantity.comparator
                                                        Definition

                                                        Not allowed to be used in this context

                                                        Short< | <= | >= | > - how to understand the value
                                                        Control0..0
                                                        BindingThe 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.

                                                        Typecode
                                                        Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summarytrue
                                                        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 MissingIf there is no comparator, then there is no modification of the value
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        280. MedicationDispense.quantity.unit
                                                        Definition

                                                        The dispensed amount of drug as a numerical value, unit (e.g., tab).

                                                        ShortThe total amount of medicine, unit
                                                        Control0..1
                                                        Typestring
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summarytrue
                                                        Requirements

                                                        There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        282. MedicationDispense.quantity.system
                                                        Definition

                                                        The identification of the system that provides the coded form of the unit.

                                                        ShortSystem that defines coded unit form
                                                        Control0..1
                                                        This element is affected by the following invariants: qty-3
                                                        Typeuri
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summarytrue
                                                        Requirements

                                                        Need to know the system that defines the coded form of the unit.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        284. MedicationDispense.quantity.code
                                                        Definition

                                                        A computer processable form of the unit in some unit representation system.

                                                        ShortCoded 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.

                                                        Control0..1
                                                        Typecode
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summarytrue
                                                        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.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        286. MedicationDispense.daysSupply
                                                        Definition

                                                        The amount of medication expressed as a timing amount.

                                                        ShortAmount of medication expressed as a timing amount
                                                        Control0..0
                                                        TypeQuantity(SimpleQuantity)
                                                        Is Modifierfalse
                                                        Summaryfalse
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        sqty-1: The comparator is not used on a SimpleQuantity (comparator.empty())
                                                        288. MedicationDispense.whenPrepared
                                                        Definition

                                                        The time when the dispensed product was packaged and reviewed.

                                                        ShortWhen product was packaged and reviewed
                                                        Control0..0
                                                        TypedateTime
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summarytrue
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        290. MedicationDispense.whenHandedOver
                                                        Definition

                                                        Dispensation date of the drug.

                                                        ShortDispensation date
                                                        Control1..1
                                                        TypedateTime
                                                        Is Modifierfalse
                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                        Summaryfalse
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        292. MedicationDispense.destination
                                                        Definition

                                                        Identification of the facility/location where the medication was shipped to, as part of the dispense event.

                                                        ShortWhere the medication was sent
                                                        Control0..0
                                                        TypeReference(Location)
                                                        Is Modifierfalse
                                                        Summaryfalse
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        294. 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.

                                                        ShortWho collected the medication
                                                        Control0..0
                                                        TypeReference(Patient, Practitioner)
                                                        Is Modifierfalse
                                                        Summaryfalse
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        296. MedicationDispense.note
                                                        Definition

                                                        Extra information about the dispense that could not be conveyed in the other attributes.

                                                        ShortInformation about the dispense
                                                        Control0..1
                                                        TypeAnnotation
                                                        Is Modifierfalse
                                                        Summaryfalse
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        298. MedicationDispense.note.id
                                                        Definition

                                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                        ShortUnique id for inter-element referencing
                                                        Control0..1
                                                        Typestring
                                                        Is Modifierfalse
                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                        Summaryfalse
                                                        300. MedicationDispense.note.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.

                                                        ShortAdditional 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.

                                                        Control0..*
                                                        TypeExtension
                                                        Is Modifierfalse
                                                        Summaryfalse
                                                        Alternate Namesextensions, user content
                                                        Invariantsele-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())
                                                        SlicingThis element introduces a set of slices on MedicationDispense.note.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                        • value @ url
                                                        • 302. MedicationDispense.note.author[x]
                                                          Definition

                                                          The individual responsible for making the annotation.

                                                          ShortIndividual responsible for the annotation
                                                          Comments

                                                          Organization is used when there's no need for specific attribution as to who made the comment.

                                                          Control0..1
                                                          TypeChoice of: Reference(Practitioner, Patient, RelatedPerson, Organization), string
                                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summarytrue
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          304. MedicationDispense.note.time
                                                          Definition

                                                          Indicates when this particular annotation was made.

                                                          ShortWhen the annotation was made
                                                          Control0..1
                                                          TypedateTime
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summarytrue
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          306. MedicationDispense.note.text
                                                          Definition

                                                          Pharmacy's note on drug dispensing. The name of the pharmacist who prepared the drug for dispensing is recorded in the field dedicated for notes. This information is mandatory when, in addition to receiving the prescription and dispensing the drug, another pharmacist has been required for the preparation of the drug for dispensing.

                                                          ShortPharmacy's note on drug dispensing
                                                          Control1..1
                                                          Typemarkdown
                                                          Is Modifierfalse
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summarytrue
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          308. MedicationDispense.dosageInstruction
                                                          Definition

                                                          Indicates how the medication is to be used by the patient.

                                                          ShortHow 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.

                                                          Control0..*
                                                          TypeDosage
                                                          Is Modifierfalse
                                                          Summaryfalse
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          310. MedicationDispense.dosageInstruction.id
                                                          Definition

                                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                          ShortUnique id for inter-element referencing
                                                          Control0..1
                                                          Typestring
                                                          Is Modifierfalse
                                                          XML FormatIn the XML format, this property is represented as an attribute.
                                                          Summaryfalse
                                                          312. MedicationDispense.dosageInstruction.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.

                                                          ShortAdditional 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.

                                                          Control0..*
                                                          TypeExtension
                                                          Is Modifierfalse
                                                          Summaryfalse
                                                          Alternate Namesextensions, user content
                                                          Invariantsele-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())
                                                          SlicingThis element introduces a set of slices on MedicationDispense.dosageInstruction.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                          • value @ url
                                                          • 314. MedicationDispense.dosageInstruction.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).

                                                            ShortExtensions 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.

                                                            Control0..*
                                                            TypeExtension
                                                            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                            Summarytrue
                                                            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 Namesextensions, user content, modifiers
                                                            Invariantsele-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())
                                                            316. MedicationDispense.dosageInstruction.sequence
                                                            Definition

                                                            Indicates the order in which the dosage instructions should be applied or interpreted.

                                                            ShortThe order of the dosage instructions
                                                            Control0..1
                                                            Typeinteger
                                                            Is Modifierfalse
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Summarytrue
                                                            Requirements

                                                            If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. If the sequence number is different, then the Dosages are intended to be sequential.

                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            318. MedicationDispense.dosageInstruction.text
                                                            Definition

                                                            The intended use of the drug written during dispensation if the intended use written on the prescription is unclear.

                                                            ShortIntended use of the drug on a dispensation information sticker
                                                            Control0..1
                                                            Typestring
                                                            Is Modifierfalse
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Summarytrue
                                                            Requirements

                                                            Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing. Additional information about administration or preparation of the medication should be included as text.

                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            320. MedicationDispense.dosageInstruction.additionalInstruction
                                                            Definition

                                                            Supplemental instructions to the patient on how to take the medication (e.g. "with meals" or"take half to one hour before food") or warnings for the patient about the medication (e.g. "may cause drowsiness" or "avoid exposure of skin to direct sunlight or sunlamps").

                                                            ShortSupplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
                                                            Comments

                                                            Information about administration or preparation of the medication (e.g. "infuse as rapidly as possibly via intraperitoneal port" or "immediately following drug x") should be populated in dosage.text.

                                                            Control0..*
                                                            BindingFor example codes, see SNOMEDCTAdditionalDosageInstructions
                                                            (example to http://hl7.org/fhir/ValueSet/additional-instruction-codes|4.0.1)

                                                            A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".

                                                            TypeCodeableConcept
                                                            Is Modifierfalse
                                                            Summarytrue
                                                            Requirements

                                                            Additional instruction is intended to be coded, but where no code exists, the element could include text. For example, "Swallow with plenty of water" which might or might not be coded.

                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            322. MedicationDispense.dosageInstruction.patientInstruction
                                                            Definition

                                                            Dispensation instruction printed on a dispensation information sticker if the dosage instructions written on the prescription are unclear. If the dosage information is given in structured format, the dosage instructions provided for the prescription by the system may not be changed.

                                                            ShortDosage instructions on a dispensation information sticker
                                                            Control0..1
                                                            Typestring
                                                            Is Modifierfalse
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Summarytrue
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            324. MedicationDispense.dosageInstruction.timing
                                                            Definition

                                                            When medication should be administered.

                                                            ShortWhen medication should be administered
                                                            Comments

                                                            This attribute might not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.

                                                            Control0..1
                                                            TypeTiming
                                                            Is Modifierfalse
                                                            Summarytrue
                                                            Requirements

                                                            The timing schedule for giving the medication to the patient. This data type allows many different expressions. For example: "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            326. MedicationDispense.dosageInstruction.asNeeded[x]
                                                            Definition

                                                            Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept).

                                                            ShortTake "as needed" (for x)
                                                            Comments

                                                            Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not "prn" or "as needed".

                                                            Control0..1
                                                            BindingFor example codes, see SNOMEDCTMedicationAsNeededReasonCodes
                                                            (example to http://hl7.org/fhir/ValueSet/medication-as-needed-reason|4.0.1)

                                                            A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc.

                                                            TypeChoice of: boolean, CodeableConcept
                                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                            Is Modifierfalse
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Summarytrue
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            328. MedicationDispense.dosageInstruction.site
                                                            Definition

                                                            Body site to administer to.

                                                            ShortBody site to administer to
                                                            Comments

                                                            If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.

                                                            Control0..1
                                                            BindingFor example codes, see SNOMEDCTAnatomicalStructureForAdministrationSiteCodes
                                                            (example to http://hl7.org/fhir/ValueSet/approach-site-codes|4.0.1)

                                                            A coded concept describing the site location the medicine enters into or onto the body.

                                                            TypeCodeableConcept
                                                            Is Modifierfalse
                                                            Summarytrue
                                                            Requirements

                                                            A coded specification of the anatomic site where the medication first enters the body.

                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            330. MedicationDispense.dosageInstruction.route
                                                            Definition

                                                            How drug should enter body.

                                                            ShortHow drug should enter body
                                                            Control0..1
                                                            BindingFor example codes, see SNOMEDCTRouteCodes
                                                            (example to http://hl7.org/fhir/ValueSet/route-codes|4.0.1)

                                                            A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

                                                            TypeCodeableConcept
                                                            Is Modifierfalse
                                                            Summarytrue
                                                            Requirements

                                                            A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.

                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            332. MedicationDispense.dosageInstruction.method
                                                            Definition

                                                            Technique for administering medication.

                                                            ShortTechnique for administering medication
                                                            Comments

                                                            Terminologies used often pre-coordinate this term with the route and or form of administration.

                                                            Control0..1
                                                            BindingFor example codes, see SNOMEDCTAdministrationMethodCodes
                                                            (example to http://hl7.org/fhir/ValueSet/administration-method-codes|4.0.1)

                                                            A coded concept describing the technique by which the medicine is administered.

                                                            TypeCodeableConcept
                                                            Is Modifierfalse
                                                            Summarytrue
                                                            Requirements

                                                            A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV.

                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            334. MedicationDispense.dosageInstruction.doseAndRate
                                                            Definition

                                                            The amount of medication administered.

                                                            ShortAmount of medication administered
                                                            Control0..*
                                                            TypeElement
                                                            Is Modifierfalse
                                                            Summarytrue
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            336. MedicationDispense.dosageInstruction.doseAndRate.id
                                                            Definition

                                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                            ShortUnique id for inter-element referencing
                                                            Control0..1
                                                            Typestring
                                                            Is Modifierfalse
                                                            XML FormatIn the XML format, this property is represented as an attribute.
                                                            Summaryfalse
                                                            338. MedicationDispense.dosageInstruction.doseAndRate.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.

                                                            ShortAdditional 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.

                                                            Control0..*
                                                            TypeExtension
                                                            Is Modifierfalse
                                                            Summaryfalse
                                                            Alternate Namesextensions, user content
                                                            Invariantsele-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())
                                                            SlicingThis element introduces a set of slices on MedicationDispense.dosageInstruction.doseAndRate.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                            • value @ url
                                                            • 340. MedicationDispense.dosageInstruction.doseAndRate.type
                                                              Definition

                                                              The kind of dose or rate specified, for example, ordered or calculated.

                                                              ShortThe kind of dose or rate specified
                                                              Control0..1
                                                              BindingFor example codes, see DoseAndRateType
                                                              (example to http://hl7.org/fhir/ValueSet/dose-rate-type|4.0.1)

                                                              The kind of dose or rate specified.

                                                              TypeCodeableConcept
                                                              Is Modifierfalse
                                                              Summarytrue
                                                              Requirements

                                                              If the type is not populated, assume to be "ordered".

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              342. MedicationDispense.dosageInstruction.doseAndRate.dose[x]
                                                              Definition

                                                              Amount of medication per dose.

                                                              ShortAmount of medication per dose
                                                              Comments

                                                              Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.

                                                              Control0..1
                                                              TypeChoice of: Range, Quantity(SimpleQuantity The snapshot does not say whether the constraints on the root of this type profile have been applied to this element, so assume they have not. Check the type profile directly as well)
                                                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                              Is Modifierfalse
                                                              Summarytrue
                                                              Requirements

                                                              The amount of therapeutic or other substance given at one administration event.

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              344. MedicationDispense.dosageInstruction.doseAndRate.rate[x]
                                                              Definition

                                                              Amount of medication per unit of time.

                                                              ShortAmount of medication per unit of time
                                                              Comments

                                                              It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate.

                                                              It is possible to specify a rate over time (for example, 100 ml/hour) using either the rateRatio and rateQuantity. The rateQuantity approach requires systems to have the capability to parse UCUM grammer where ml/hour is included rather than a specific ratio where the time is specified as the denominator. Where a rate such as 500ml over 2 hours is specified, the use of rateRatio may be more semantically correct than specifying using a rateQuantity of 250 mg/hour.

                                                              Control0..1
                                                              TypeChoice of: Ratio, Range, Quantity(SimpleQuantity The snapshot does not say whether the constraints on the root of this type profile have been applied to this element, so assume they have not. Check the type profile directly as well)
                                                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                              Is Modifierfalse
                                                              Summarytrue
                                                              Requirements

                                                              Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              346. MedicationDispense.dosageInstruction.maxDosePerPeriod
                                                              Definition

                                                              Upper limit on medication per unit of time.

                                                              ShortUpper limit on medication per unit of time
                                                              Comments

                                                              This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".

                                                              Control0..1
                                                              TypeRatio
                                                              Is Modifierfalse
                                                              Summarytrue
                                                              Requirements

                                                              The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours.

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              348. MedicationDispense.dosageInstruction.maxDosePerAdministration
                                                              Definition

                                                              Upper limit on medication per administration.

                                                              ShortUpper limit on medication per administration
                                                              Comments

                                                              This is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg.

                                                              Control0..1
                                                              TypeQuantity(SimpleQuantity)
                                                              Is Modifierfalse
                                                              Summarytrue
                                                              Requirements

                                                              The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              sqty-1: The comparator is not used on a SimpleQuantity (comparator.empty())
                                                              350. MedicationDispense.dosageInstruction.maxDosePerLifetime
                                                              Definition

                                                              Upper limit on medication per lifetime of the patient.

                                                              ShortUpper limit on medication per lifetime of the patient
                                                              Control0..1
                                                              TypeQuantity(SimpleQuantity)
                                                              Is Modifierfalse
                                                              Summarytrue
                                                              Requirements

                                                              The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              sqty-1: The comparator is not used on a SimpleQuantity (comparator.empty())
                                                              352. 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.

                                                              ShortWhether a substitution was performed on the dispense
                                                              Control1..1
                                                              TypeBackboneElement
                                                              Is Modifierfalse
                                                              Summaryfalse
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              354. 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.

                                                              ShortUnique id for inter-element referencing
                                                              Control0..1
                                                              Typestring
                                                              Is Modifierfalse
                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                              Summaryfalse
                                                              356. 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.

                                                              ShortAdditional 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.

                                                              Control0..*
                                                              TypeExtension
                                                              Is Modifierfalse
                                                              Summaryfalse
                                                              Alternate Namesextensions, user content
                                                              Invariantsele-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())
                                                              358. 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).

                                                              ShortExtensions 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.

                                                              Control0..*
                                                              TypeExtension
                                                              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                              Summarytrue
                                                              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 Namesextensions, user content, modifiers
                                                              Invariantsele-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())
                                                              360. MedicationDispense.substitution.wasSubstituted
                                                              Definition

                                                              Information about whether the drug has been substituted in dispensing.

                                                              ShortDrug substituted in dispensing
                                                              Control1..1
                                                              Typeboolean
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Summaryfalse
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              362. MedicationDispense.substitution.type
                                                              Definition

                                                              A code signifying whether a different drug was dispensed from what was prescribed.

                                                              ShortCode signifying whether a different drug was dispensed from what was prescribed
                                                              Control0..1
                                                              BindingFor 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.

                                                              TypeCodeableConcept
                                                              Is Modifierfalse
                                                              Summaryfalse
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              364. MedicationDispense.substitution.reason
                                                              Definition

                                                              Information of a forbidden drug change or the reason for dispensing a drug outside the reference pricing system. According to the Kanta code system 'Sähköinen lääkemääräys - Lääkevaihtokielto tai lääkevaihdon syy'. Also, provide the additional information for dispensing a drug outside the reference pricing system.

                                                              ShortThe reason and additional information for dispensing a drug outside the reference pricing system
                                                              Control0..1
                                                              BindingFor 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.

                                                              TypeCodeableConcept
                                                              Is Modifierfalse
                                                              Summaryfalse
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              366. MedicationDispense.substitution.reason.id
                                                              Definition

                                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                              ShortUnique id for inter-element referencing
                                                              Control0..1
                                                              Typestring
                                                              Is Modifierfalse
                                                              XML FormatIn the XML format, this property is represented as an attribute.
                                                              Summaryfalse
                                                              368. MedicationDispense.substitution.reason.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.

                                                              ShortAdditional 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.

                                                              Control0..*
                                                              TypeExtension
                                                              Is Modifierfalse
                                                              Summaryfalse
                                                              Alternate Namesextensions, user content
                                                              Invariantsele-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())
                                                              SlicingThis element introduces a set of slices on MedicationDispense.substitution.reason.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                              • value @ url
                                                              • 370. MedicationDispense.substitution.reason.coding
                                                                Definition

                                                                Information of a forbidden drug change or the reason for dispensing a drug outside the reference pricing system. According to the Kanta code system 'Sähköinen lääkemääräys - Lääkevaihtokielto tai lääkevaihdon syy'.

                                                                ShortReason for dispensing a drug outside the reference pricing system
                                                                Comments

                                                                Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                                Control1..1
                                                                TypeCoding
                                                                Is Modifierfalse
                                                                Summarytrue
                                                                Requirements

                                                                Allows for alternative encodings within a code system, and translations to other code systems.

                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                372. MedicationDispense.substitution.reason.coding.id
                                                                Definition

                                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                                ShortUnique id for inter-element referencing
                                                                Control0..1
                                                                Typestring
                                                                Is Modifierfalse
                                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                                Summaryfalse
                                                                374. MedicationDispense.substitution.reason.coding.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.

                                                                ShortAdditional 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.

                                                                Control0..*
                                                                TypeExtension
                                                                Is Modifierfalse
                                                                Summaryfalse
                                                                Alternate Namesextensions, user content
                                                                Invariantsele-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())
                                                                SlicingThis element introduces a set of slices on MedicationDispense.substitution.reason.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                • value @ url
                                                                • 376. MedicationDispense.substitution.reason.coding.system
                                                                  Definition

                                                                  OID of the Kanta code system 'Sähköinen lääkemääräys - Lääkevaihtokielto tai lääkevaihdon syy'.

                                                                  ShortOID of the Kanta code system 'Sähköinen lääkemääräys - Lääkevaihtokielto tai lääkevaihdon syy'
                                                                  Comments

                                                                  The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                                                                  Control1..1
                                                                  Typeuri
                                                                  Is Modifierfalse
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Summarytrue
                                                                  Requirements

                                                                  Need to be unambiguous about the source of the definition of the symbol.

                                                                  Fixed Value
                                                                  {
                                                                    "system" : "urn:oid:1.2.246.537.5.40183.2009"
                                                                  }
                                                                  <system value="urn:oid:1.2.246.537.5.40183.2009"/>
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  378. MedicationDispense.substitution.reason.coding.version
                                                                  Definition

                                                                  The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                                                  ShortVersion of the system - if relevant
                                                                  Comments

                                                                  Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                                                  NoteThis is a business version Id, not a resource version Id (see discussion)
                                                                  Control0..1
                                                                  Typestring
                                                                  Is Modifierfalse
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Summarytrue
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  380. MedicationDispense.substitution.reason.coding.code
                                                                  Definition

                                                                  Code of the Kanta code system 'Sähköinen lääkemääräys - Lääkevaihtokielto tai lääkevaihdon syy'.

                                                                  ShortCode of the Kanta code system 'Sähköinen lääkemääräys - Lääkevaihtokielto tai lääkevaihdon syy'
                                                                  Control1..1
                                                                  Typecode
                                                                  Is Modifierfalse
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Summarytrue
                                                                  Requirements

                                                                  Need to refer to a particular code in the system.

                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  382. MedicationDispense.substitution.reason.coding.display
                                                                  Definition

                                                                  A representation of the meaning of the code in the system, following the rules of the system.

                                                                  ShortRepresentation defined by the system
                                                                  Control0..1
                                                                  Typestring
                                                                  Is Modifierfalse
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Summarytrue
                                                                  Requirements

                                                                  Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  384. MedicationDispense.substitution.reason.coding.userSelected
                                                                  Definition

                                                                  Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                                                                  ShortIf this coding was chosen directly by the user
                                                                  Comments

                                                                  Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                                                  Control0..1
                                                                  Typeboolean
                                                                  Is Modifierfalse
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Summarytrue
                                                                  Requirements

                                                                  This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  386. MedicationDispense.substitution.reason.text
                                                                  Definition

                                                                  Further clarification on the dispensing of a drug outside of the reference pricing system. Always returned if the reason for the dispensation outside of the reference pricing system is M (other reason).

                                                                  ShortAdditional information for dispensing a drug outside the reference pricing system
                                                                  Comments

                                                                  Very often the text is the same as a displayName of one of the codings.

                                                                  Control0..1
                                                                  Typestring
                                                                  Is Modifierfalse
                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                  Summarytrue
                                                                  Requirements

                                                                  The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  388. MedicationDispense.substitution.responsibleParty
                                                                  Definition

                                                                  The person or organization that has primary responsibility for the substitution.

                                                                  ShortWho is responsible for the substitution
                                                                  Control0..*
                                                                  TypeReference(Practitioner, PractitionerRole)
                                                                  Is Modifierfalse
                                                                  Summaryfalse
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  390. 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.

                                                                  ShortClinical 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.

                                                                  Control0..0
                                                                  TypeReference(DetectedIssue)
                                                                  Is Modifierfalse
                                                                  Summaryfalse
                                                                  Alternate NamesContraindication, Drug Utilization Review (DUR), Alert
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  392. MedicationDispense.eventHistory
                                                                  Definition

                                                                  A summary of the events of interest that have occurred, such as when the dispense was verified.

                                                                  ShortA 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.).

                                                                  Control0..0
                                                                  TypeReference(Provenance)
                                                                  Is Modifierfalse
                                                                  Summaryfalse
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))