# description
Indicates that a medication product is to be or has been dispensed for a named person/patient.

# copyright
Copyright © 2016 HL7 UK  Licensed under the Apache License, Version 2.0 (the "License"); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0  Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an "AS IS" BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License.  HL7® FHIR® standard Copyright © 2011+ HL7  The HL7® FHIR® standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html

# snapshot.element[].short
Dispensing a medication to a named patient

# snapshot.element[].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.

# snapshot.element[].comment
The WG will be updating the MedicationDispense resource  to adjust each affected resource to align with the workflow pattern (see workflow.html).

# snapshot.element[].constraint[].human
If the resource is contained in another resource, it SHALL NOT contain nested Resources

# snapshot.element[].constraint[].human
If the resource is contained in another resource, it SHALL NOT contain any narrative

# snapshot.element[].constraint[].human
If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated

# snapshot.element[].constraint[].human
If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource

# snapshot.element[].constraint[].human
whenHandedOver cannot be before whenPrepared

# snapshot.element[].definition
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

# snapshot.element[].comment
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].short
A set of rules under which this content was created

# snapshot.element[].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.

# snapshot.element[].comment
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.   This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].definition
The base language in which the resource is written.

# snapshot.element[].comment
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).

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].short
Text summary of the resource, for human interpretation

# snapshot.element[].definition
A human-readable narrative that contains a summary of the resource, and may 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.

# snapshot.element[].comment
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 in formation is added later.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].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.

# snapshot.element[].comment
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.

# snapshot.element[].slicing.description
Extensions are always sliced by (at least) url

# snapshot.element[].short
Additional Content defined by implementations

# snapshot.element[].definition
May be used to represent additional information that is not part of the basic definition of the resource. In order 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.

# snapshot.element[].comment
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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
Must have either extensions or value[x], not both

# snapshot.element[].slicing.description
Extensions are always sliced by (at least) url

# snapshot.element[].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. Usually modifier elements provide negation or qualification. In order 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.

# snapshot.element[].comment
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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
Must have either extensions or value[x], not both

# snapshot.element[].definition
Identifier assigned by the dispensing facility - this is an identifier assigned outside FHIR.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].mapping[].map
CX / EI (occasionally, more often EI maps to a resource id or a URL)

# snapshot.element[].mapping[].map
II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]

# snapshot.element[].definition
unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

# snapshot.element[].comment
Note that FHIR strings may not exceed 1MB in size

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].slicing.description
Extensions are always sliced by (at least) url

# snapshot.element[].short
Additional Content defined by implementations

# snapshot.element[].definition
May be used to represent additional information that is not part of the basic definition of the element. In order 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.

# snapshot.element[].comment
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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
Must have either extensions or value[x], not both

# snapshot.element[].short
usual | official | temp | secondary (If known)

# snapshot.element[].comment
This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

# snapshot.element[].requirements
Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].binding.description
Identifies the purpose for this identifier, if known .

# snapshot.element[].definition
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

# snapshot.element[].comment
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.

# snapshot.element[].requirements
Allows users to make use of identifiers when the identifier system is not known.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].binding.description
A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

# snapshot.element[].definition
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

# snapshot.element[].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.

# snapshot.element[].example[].valueUri
http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].definition
The portion of the identifier typically relevant to the user and which is unique within the context of the system.

# snapshot.element[].comment
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](extension-rendered-value.html).

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].mapping[].map
II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)

# snapshot.element[].short
Time period when id is/was valid for use

# snapshot.element[].definition
Time period during which identifier is/was valid for use.

# snapshot.element[].comment
This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval|Duration.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
If present, start SHALL have a lower value than end

# snapshot.element[].constraint[].expression
start.empty() or end.empty() or (start <= end)

# snapshot.element[].mapping[].map
IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]

# snapshot.element[].mapping[].map
Role.effectiveTime or implied by context

# snapshot.element[].short
Organization that issued id (may be just text)

# snapshot.element[].definition
Organization that issued/manages the identifier.

# snapshot.element[].comment
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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
SHALL have a contained resource if a local reference is provided

# snapshot.element[].mapping[].map
The target of a resource reference is a RIM entry point (Act, Role, or Entity)

# snapshot.element[].mapping[].map
II.assigningAuthorityName but note that this is an improper use by the definition of the field.  Also Role.scoper

# snapshot.element[].definition
The procedure that the dispense is done because of.

# snapshot.element[].comment
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
SHALL have a contained resource if a local reference is provided

# snapshot.element[].mapping[].map
The target of a resource reference is a RIM entry point (Act, Role, or Entity)

# snapshot.element[].short
preparation | in-progress | on-hold | completed | entered-in-error | stopped

# snapshot.element[].definition
A code specifying the state of the set of dispense events.

# snapshot.element[].comment
This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].binding.description
A coded concept specifying the state of the dispense event.

# snapshot.element[].definition
Indicates type of medication dispense and where the medication is expected to be consumed or administered.

# snapshot.element[].comment
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].binding.description
A code describing where the dispensed medication is expected to be consumed or administered

# snapshot.element[].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.

# snapshot.element[].comment
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. .

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].binding.description
A coded concept identifying which substance or product can be dispensed

# snapshot.element[].definition
A link to a resource representing the person or the group to whom the medication will be given.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
SHALL have a contained resource if a local reference is provided

# snapshot.element[].mapping[].map
The target of a resource reference is a RIM entry point (Act, Role, or Entity)

# snapshot.element[].short
Encounter / Episode associated with event

# snapshot.element[].definition
The encounter or episode of care that establishes the context for this event.

# snapshot.element[].comment
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
SHALL have a contained resource if a local reference is provided

# snapshot.element[].mapping[].map
The target of a resource reference is a RIM entry point (Act, Role, or Entity)

# snapshot.element[].short
Information that supports the dispensing of the medication

# snapshot.element[].definition
Additional information that supports the medication being dispensed.

# snapshot.element[].comment
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
SHALL have a contained resource if a local reference is provided

# snapshot.element[].mapping[].map
The target of a resource reference is a RIM entry point (Act, Role, or Entity)

# snapshot.element[].mapping[].map
.outboundRelationship[typeCode=PERT].target[A_SupportingClinicalStatement CMET minimal with many different choices of classCodes(ORG, ENC, PROC, SPLY, SBADM, OBS) and each of the act class codes draws from one or more of the following moodCodes (EVN, DEF, INT PRMS, RQO, PRP, APT, ARQ, GOL)]

# snapshot.element[].definition
Indicates who or what performed the event.  It should be assumed that the performer is the dispenser of the medication.

# snapshot.element[].comment
The performer will be reviewed as part of STU4.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].definition
unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

# snapshot.element[].comment
Note that FHIR strings may not exceed 1MB in size

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].slicing.description
Extensions are always sliced by (at least) url

# snapshot.element[].short
Additional Content defined by implementations

# snapshot.element[].definition
May be used to represent additional information that is not part of the basic definition of the element. In order 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.

# snapshot.element[].comment
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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
Must have either extensions or value[x], not both

# snapshot.element[].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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

# snapshot.element[].comment
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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
Must have either extensions or value[x], not both

# snapshot.element[].definition
The device, practitioner, etc. who performed the action.  It should be assumed that the actor is the dispenser of the medication.

# snapshot.element[].comment
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
SHALL have a contained resource if a local reference is provided

# snapshot.element[].mapping[].map
The target of a resource reference is a RIM entry point (Act, Role, or Entity)

# snapshot.element[].short
Organization organization was acting for

# snapshot.element[].definition
The organization the device or practitioner was acting on behalf of.

# snapshot.element[].comment
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
SHALL have a contained resource if a local reference is provided

# snapshot.element[].mapping[].map
The target of a resource reference is a RIM entry point (Act, Role, or Entity)

# snapshot.element[].short
Medication order that authorizes the dispense

# snapshot.element[].definition
Indicates the medication order that is being dispensed against.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
SHALL have a contained resource if a local reference is provided

# snapshot.element[].mapping[].map
The target of a resource reference is a RIM entry point (Act, Role, or Entity)

# snapshot.element[].short
To identify the type of medication supply.

# snapshot.element[].definition
Indicates the type of dispensing event that is performed. For example, Trial Fill, Completion of Trial, Partial Fill, Emergency Fill, Samples, etc.

# snapshot.element[].comment
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].binding.description
A ValueSet to identify the type of medication supply.

# snapshot.element[].definition
The amount of medication that has been dispensed. Includes unit of measure.

# snapshot.element[].comment
The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
If a code for the unit is present, the system SHALL also be present

# snapshot.element[].constraint[].human
The comparator is not used on a SimpleQuantity

# snapshot.element[].mapping[].map
PQ, IVL<PQ>, MO, CO, depending on the values

# snapshot.element[].mapping[].map
RXD-4-Actual Dispense Amount / RXD-5.1-Actual Dispense Units.code / RXD-5.3-Actual Dispense Units.name of coding system

# snapshot.element[].definition
unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

# snapshot.element[].comment
Note that FHIR strings may not exceed 1MB in size

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].slicing.description
Extensions are always sliced by (at least) url

# snapshot.element[].short
Additional Content defined by implementations

# snapshot.element[].definition
May be used to represent additional information that is not part of the basic definition of the element. In order 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.

# snapshot.element[].comment
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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
Must have either extensions or value[x], not both

# snapshot.element[].comment
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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
Must have either extensions or value[x], not both

# snapshot.element[].short
Numerical value (with implicit precision)

# snapshot.element[].definition
The value of the measured amount. The value includes an implicit precision in the presentation of the value.

# snapshot.element[].comment
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).

# snapshot.element[].requirements
Precision is handled implicitly in almost all cases of measurement.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].mapping[].map
PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value

# snapshot.element[].short
< | <= | >= | > - how to understand the value

# snapshot.element[].comment
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.

# snapshot.element[].requirements
Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

# snapshot.element[].meaningWhenMissing
If there is no comparator, then there is no modification of the value

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].binding.description
How the Quantity should be understood and represented.

# snapshot.element[].comment
Note that FHIR strings may not exceed 1MB in size

# snapshot.element[].requirements
There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].definition
The identification of the system that provides the coded form of the unit.

# snapshot.element[].requirements
Need to know the system that defines the coded form of the unit.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].definition
A computer processable form of the unit in some unit representation system.

# snapshot.element[].comment
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.

# snapshot.element[].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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].short
Amount of medication expressed as a timing amount

# snapshot.element[].definition
The amount of medication expressed as a timing amount.

# snapshot.element[].comment
The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
If a code for the unit is present, the system SHALL also be present

# snapshot.element[].constraint[].human
The comparator is not used on a SimpleQuantity

# snapshot.element[].mapping[].map
PQ, IVL<PQ>, MO, CO, depending on the values

# snapshot.element[].mapping[].map
TQ1.6 Timing/Quantity Segment Service Duration. Prior to v2.5, ORC.7.3 Common Order Segment / Quantity/Timing / Duration component.  This is a formatted string, first character for the time unit (e.g., D=days), followed by the value.  For example, “D14” represents “14 days supply” From v2.5 on, TQ1.6 Timing/Quantity Segment / Service Duration.  This is a CQ data type (<Quantity (NM)> ^ <Units (CWE)>), thus for days supply, assuming the unit of measure is “days”, the numeric value is TQ1.6.1 (…|14^ For backwards compatibility, ORC.7 was permitted through v2.6.  Both forms (field and segment) may be present in v2.5, v2.5.1, and v2.6

# snapshot.element[].definition
The time when the dispensed product was packaged and reviewed.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].definition
The time the dispensed product was provided to the patient or their representative.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].definition
Identification of the facility/location where the medication was shipped to, as part of the dispense event.

# snapshot.element[].comment
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
SHALL have a contained resource if a local reference is provided

# snapshot.element[].mapping[].map
The target of a resource reference is a RIM entry point (Act, Role, or Entity)

# snapshot.element[].mapping[].map
RXD-13 Dispense-to Location; RXD-30 Dispense to Pharmacy; RXD-31 Dispense to Pharmacy Address

# snapshot.element[].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.

# snapshot.element[].comment
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
SHALL have a contained resource if a local reference is provided

# snapshot.element[].mapping[].map
The target of a resource reference is a RIM entry point (Act, Role, or Entity)

# snapshot.element[].definition
Extra information about the dispense that could not be conveyed in the other attributes.

# snapshot.element[].comment
For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time.  This element may need to be included in narrative because of the potential for modifying information.  *Annotations SHOULD NOT* be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].definition
unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

# snapshot.element[].comment
Note that FHIR strings may not exceed 1MB in size

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].slicing.description
Extensions are always sliced by (at least) url

# snapshot.element[].short
Additional Content defined by implementations

# snapshot.element[].definition
May be used to represent additional information that is not part of the basic definition of the element. In order 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.

# snapshot.element[].comment
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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
Must have either extensions or value[x], not both

# snapshot.element[].short
Individual responsible for the annotation

# snapshot.element[].definition
The individual responsible for making the annotation.

# snapshot.element[].comment
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
SHALL have a contained resource if a local reference is provided

# snapshot.element[].mapping[].map
The target of a resource reference is a RIM entry point (Act, Role, or Entity)

# snapshot.element[].definition
Indicates when this particular annotation was made.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].comment
Note that FHIR strings may not exceed 1MB in size

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].short
How the medication is to be used by the patient or administered by the caregiver

# snapshot.element[].definition
Indicates how the medication is to be used by the patient.

# snapshot.element[].comment
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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].definition
unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

# snapshot.element[].comment
Note that FHIR strings may not exceed 1MB in size

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].slicing.description
Extensions are always sliced by (at least) url

# snapshot.element[].short
Additional Content defined by implementations

# snapshot.element[].definition
May be used to represent additional information that is not part of the basic definition of the element. In order 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.

# snapshot.element[].comment
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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
Must have either extensions or value[x], not both

# snapshot.element[].definition
Indicates the order in which the dosage instructions should be applied or interpreted.

# snapshot.element[].comment
32 bit number; for values larger than this, use decimal

# snapshot.element[].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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].comment
Note that FHIR strings may not exceed 1MB in size

# snapshot.element[].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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].short
Supplemental instruction - e.g. "with meals"

# snapshot.element[].definition
Supplemental instruction - e.g. "with meals".

# snapshot.element[].comment
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

# snapshot.element[].requirements
Additional instruction such as "Swallow with plenty of water" which may or may not be coded.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].binding.description
A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery".

# snapshot.element[].short
Patient or consumer oriented instructions

# snapshot.element[].definition
Instructions in terms that are understood by the patient or consumer.

# snapshot.element[].comment
Note that FHIR strings may not exceed 1MB in size

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].comment
This attribute may 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.

# snapshot.element[].requirements
The timing schedule for giving the medication to the patient. The Schedule 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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].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).

# snapshot.element[].comment
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".

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].binding.description
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.

# snapshot.element[].comment
If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [body-site-instance](extension-body-site-instance.html).  May be a summary code, or a reference to a very precise definition of the location, or both.

# snapshot.element[].requirements
A coded specification of the anatomic site where the medication first enters the body.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].binding.description
A coded concept describing the site location the medicine enters into or onto the body.

# snapshot.element[].comment
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

# snapshot.element[].requirements
A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].binding.description
A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

# snapshot.element[].comment
Terminologies used often pre-coordinate this term with the route and or form of administration.

# snapshot.element[].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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].binding.description
A coded concept describing the technique by which the medicine is administered.

# snapshot.element[].comment
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.

# snapshot.element[].requirements
The amount of therapeutic or other substance given at one administration event.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
If present, low SHALL have a lower value than high

# snapshot.element[].constraint[].expression
low.empty() or high.empty() or (low <= high)

# snapshot.element[].mapping[].map
NR and also possibly SN (but see also quantity)

# snapshot.element[].short
Upper limit on medication per unit of time

# snapshot.element[].definition
Upper limit on medication per unit of time.

# snapshot.element[].comment
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".

# snapshot.element[].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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
Numerator and denominator SHALL both be present, or both are absent. If both are absent, there SHALL be some extension present

# snapshot.element[].constraint[].xpath
(count(f:numerator) = count(f:denominator)) and ((count(f:numerator) > 0) or (count(f:extension) > 0))

# snapshot.element[].short
Upper limit on medication per administration

# snapshot.element[].definition
Upper limit on medication per administration.

# snapshot.element[].comment
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.

# snapshot.element[].requirements
The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
If a code for the unit is present, the system SHALL also be present

# snapshot.element[].constraint[].human
The comparator is not used on a SimpleQuantity

# snapshot.element[].mapping[].map
PQ, IVL<PQ>, MO, CO, depending on the values

# snapshot.element[].short
Upper limit on medication per lifetime of the patient

# snapshot.element[].definition
Upper limit on medication per lifetime of the patient.

# snapshot.element[].comment
The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

# snapshot.element[].requirements
The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
If a code for the unit is present, the system SHALL also be present

# snapshot.element[].constraint[].human
The comparator is not used on a SimpleQuantity

# snapshot.element[].mapping[].map
PQ, IVL<PQ>, MO, CO, depending on the values

# snapshot.element[].comment
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.

# snapshot.element[].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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
Numerator and denominator SHALL both be present, or both are absent. If both are absent, there SHALL be some extension present

# snapshot.element[].constraint[].xpath
(count(f:numerator) = count(f:denominator)) and ((count(f:numerator) > 0) or (count(f:extension) > 0))

# snapshot.element[].short
Whether a substitution was performed on the dispense

# snapshot.element[].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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].definition
unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

# snapshot.element[].comment
Note that FHIR strings may not exceed 1MB in size

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].slicing.description
Extensions are always sliced by (at least) url

# snapshot.element[].short
Additional Content defined by implementations

# snapshot.element[].definition
May be used to represent additional information that is not part of the basic definition of the element. In order 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.

# snapshot.element[].comment
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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
Must have either extensions or value[x], not both

# snapshot.element[].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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

# snapshot.element[].comment
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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
Must have either extensions or value[x], not both

# snapshot.element[].short
Whether a substitution was or was not performed on the dispense

# snapshot.element[].definition
True if the dispenser dispensed a different drug or product from what was prescribed.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].short
Code signifying whether a different drug was dispensed from what was prescribed

# snapshot.element[].definition
A code signifying whether a different drug was dispensed from what was prescribed.

# snapshot.element[].comment
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].binding.description
A coded concept describing whether a different medicinal product may be dispensed other than the product as specified exactly in the prescription

# snapshot.element[].definition
Indicates the reason for the substitution of (or lack of substitution) from what was prescribed.

# snapshot.element[].comment
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].binding.description
A coded concept describing the reason that a different medication should (or should not) be substituted from what was prescribed

# snapshot.element[].definition
The person or organization that has primary responsibility for the substitution.

# snapshot.element[].comment
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
SHALL have a contained resource if a local reference is provided

# snapshot.element[].mapping[].map
The target of a resource reference is a RIM entry point (Act, Role, or Entity)

# snapshot.element[].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.

# snapshot.element[].comment
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
SHALL have a contained resource if a local reference is provided

# snapshot.element[].mapping[].map
The target of a resource reference is a RIM entry point (Act, Role, or Entity)

# snapshot.element[].short
Whether the dispense was or was not performed

# snapshot.element[].definition
True if the dispense was not performed for some reason.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].definition
Indicates the reason why a dispense was not performed.

# snapshot.element[].comment
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].definition
A summary of the events of interest that have occurred, such as when the dispense was verified.

# snapshot.element[].comment
This may 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.).

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() | (children().count() > id.count())

# snapshot.element[].constraint[].human
SHALL have a contained resource if a local reference is provided

# snapshot.element[].mapping[].map
The target of a resource reference is a RIM entry point (Act, Role, or Entity)

# differential.element[].short
To identify the type of medication supply.

# differential.element[].binding.description
A ValueSet to identify the type of medication supply.