調劑單張-調劑內容(MedicationDispense) - 電子病歷交換單張實作指引(EMR-IG) v0.1.0

This page is part of the 電子病歷交換單張實作指引(EMR-IG) (v0.1.0: Releases) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Resource Profile: 調劑單張-調劑內容(MedicationDispense)

Official URL: https://twcore.mohw.gov.tw/ig/emr/StructureDefinition/MedicationDispense-DS				Version: 0.1.0
Draft as of 2024-01-13				Computable Name: MedicationDispenseDS

此Profiles用於描述調劑單張的調劑內容。

Usage:

Use this Resource Profile: 調劑單張-Bundle
Refer to this Resource Profile: 調劑單張-Composition
Examples for this Resource Profile: MedicationDispense/med-dis-01-ds

Formal Views of Profile Content

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

Differential Table
Key Elements Table
Snapshot Table
Statistics/References
All

This structure is derived from TWCoreMedicationDispense

Name	Flags	Card.	Type	Description & Constraints
MedicationDispense		0..*	TWCoreMedicationDispense	為指定病人配藥/調劑藥品
identifier		1..*	Identifier	External identifier.[應填入項次 Item/藥品批號]。至少需填入項次 Item
value	S	0..1	string	The value that is unique
category		0..1	CodeableConceptTW	Type of medication dispense.[應填入醫令類別]
medication[x]		1..1		所提供的藥品
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(調劑單張-藥物處方內容(Medication))
Slices for medication[x]				Content/Rules for all slices
medication[x]:medicationCodeableConcept		0..1	CodeableConceptTW	所提供的藥品。此資料項目為可擴充綁定預設國際標準值集，但實作者可視實務專案需求只綁定以下slices中的任一值集。目前未只限定綁定預設值集是因為尚無slice值集與預設國際標準值集的代碼對應表，待後續有相對的代碼對應表後將建議採用國際標準值集作為唯一綁定值集並針對該值集進行擴充與管理，以利進行跨國與跨系統之資料交換。[應填入健保代碼與藥品商品名稱Brand Name]。健保代碼(code)；藥品商品名稱Brand Name(display)，至少需填入藥品商品名稱Brand Name。
text		1..1	string	Plain text representation of the concept.[應填入學名Generic Name]
quantity		1..1	SimpleQuantity	配藥/調劑藥品的量
value	S	1..1	decimal	Numerical value (with implicit precision).[應填入給藥總量 Total Amount]
unit	S	1..1	string	Unit representation.[應填入給藥總量單位 Total Units]。如：顆、CC、瓶等
daysSupply		1..1	SimpleQuantity	Amount of medication expressed as a timing amount.[應填入給藥日數 Medication Days]
value	S	1..1	decimal	Numerical value (with implicit precision)
unit	S	0..1	string	Unit representation
note	S	1..*	Annotation	Information about the dispense.[應填入調劑之核種名稱/調劑之放射活度/完成調劑之放射活度/完成調劑之核醫放射性藥品數量/處方疑義樣態註記]。至少需填入處方疑義樣態註記
text	S	1..1	markdown	The annotation - text content (as markdown)
dosageInstruction		1..*	Dosage	病人如何使用藥品或者照護者如何給藥
timing		1..1	Timing	應該何時給藥；時間的寫法請參照Timimg datatype。
repeat		1..1	Element	事件定期重複發生的時間
frequency		1..1	positiveInt	Event occurs frequency times per period.[應填入頻率 Frequency]
code		0..1	CodeableConcept	BID \| TID \| QID \| AM \| PM \| QD \| QOD \| +[應填入使用時間]。如：飯前後
coding	S	0..*	CodingTW	由專門術語系統（terminology system）定義的代碼。此資料項目為可擴充綁定預設國際標準值集，但實作者可視實務專案需求只綁定以下slices中的任一值集。目前未只限定綁定預設值集是因為尚無slice值集與預設國際標準值集的代碼對應表，待後續有相對的代碼對應表後將建議採用國際標準值集作為唯一綁定值集並針對該值集進行擴充與管理，以利進行跨國與跨系統之資料交換。
route		1..1	CodeableConceptTW	How drug should enter body.[應填入給藥途徑 Route of Administration]
doseAndRate		1..*	Element	用藥量
Slices for dose[x]		1..1	SimpleQuantity	每一劑量的藥量 Slice: Unordered, Open by type:$this
dose[x]:doseQuantity		1..1	Quantity	每一劑量的藥量
value	S	1..1	decimal	Numerical value (with implicit precision).[應填入劑量]
unit	S	1..1	string	Unit representation.[應填入劑量單位 Dose Units]。如：顆、CC等
substitution	S	0..1	BackboneElement	配藥/調劑藥品時是否進行了藥品替代
wasSubstituted	S	1..1	boolean	Whether a substitution was or was not performed on the dispense.[應填入有更換藥品註記]
reason	S	0..*	CodeableConceptTW	Why was substitution made.[應填入不得以其他廠牌藥品替代之理由]。填寫說明：有特殊情況時才填寫不可替代時始需註明
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
MedicationDispense	C	0..*	TWCoreMedicationDispense	為指定病人配藥/調劑藥品 mdd-1: whenHandedOver cannot be before whenPrepared
implicitRules	?!Σ	0..1	uri	創建此內容所依據的一組規則
modifierExtension	?!	0..*	Extension	此擴充的資料項目可能會完全修正或改變其他資料項目的意涵，需特別留意。
identifier	S	1..*	Identifier	External identifier.[應填入項次 Item/藥品批號]。至少需填入項次 Item
use	?!Σ	0..1	code	usual \| official \| temp \| secondary \| old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
value	SΣ	0..1	string	The value that is unique Example General: 123456
status	?!SΣ	1..1	code	preparation \| in-progress \| cancelled \| on-hold \| completed + Binding: MedicationDispense Status Codes (required): 一個編碼概念，用以具體說明配藥/藥品調劑事件的狀態；應填入所綁定值集中的其中一個代碼
category	S	0..1	CodeableConceptTW	Type of medication dispense.[應填入醫令類別] Binding: MedicationDispense Category Codes (preferred): 鼓勵使用所綁定值集中的代碼，但不強制一定要使用此值集，你也可使用其他值集的代碼或單純以文字表示。
Slices for medication[x]	SΣ	1..1		所提供的藥品 Slice: Unordered, Closed by type:$this Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying which substance or product can be dispensed.
medicationCodeableConcept			CodeableConcept
medicationReference			Reference(調劑單張-藥物處方內容(Medication))
medication[x]:medicationCodeableConcept		0..1	CodeableConceptTW	所提供的藥品。此資料項目為可擴充綁定預設國際標準值集，但實作者可視實務專案需求只綁定以下slices中的任一值集。目前未只限定綁定預設值集是因為尚無slice值集與預設國際標準值集的代碼對應表，待後續有相對的代碼對應表後將建議採用國際標準值集作為唯一綁定值集並針對該值集進行擴充與管理，以利進行跨國與跨系統之資料交換。[應填入健保代碼與藥品商品名稱Brand Name]。健保代碼(code)；藥品商品名稱Brand Name(display)，至少需填入藥品商品名稱Brand Name。 Binding: SNOMEDCTMedicationCodes (example): A coded concept identifying which substance or product can be dispensed.
Slices for coding	S	0..*	CodingTW	由專門術語系統（terminology system）定義的代碼 Slice: Unordered, Open by pattern:$this
coding:fda-medication-tw	S	0..1	CodingTW	此為臺灣食品藥物管理署(TFDA)維護之藥品代碼，涵蓋範圍相對完整，可免費使用，可優先選用此代碼。 Binding: 臺灣食藥署藥品及醫療器材代碼值集 (required): 應填入所綁定值集中的其中一個代碼。
coding:nhi-medication-tw	S	0..1	CodingTW	此為中央健康保險署(NHI)維護之藥品代碼，主要針對申報使用，更新頻率相對頻繁，可免費使用，可依情境選用此代碼。 Binding: 臺灣健保署健保用藥品項代碼值集 (required): 應填入所綁定值集中的其中一個代碼。
coding:rxnorm-medication-us-core	S	0..1	CodingTW	RxNorm為美國Unified Medical Language System®中的藥品代碼，取得UMLS®授權即可免費使用，可依情境選用此代碼。 Binding: RxNorm藥品代碼值集 (required): 應填入所綁定值集中的其中一個代碼。
coding:atc-medication-code	S	0..1	CodingTW	ATC代碼的版權為世界衛生組織（WHO）Collaborating Centre for Drug Statistics Methodology，可免費使用，可依情境選用此代碼。 Binding: 臺灣食藥署藥品藥理治療分類ATC碼值集 (required): 應填入所綁定值集中的其中一個代碼。
coding:snomedct-medication-codes	S	0..1	CodingTW	此為SNOMED CT代碼，若機構已有購買相關授權，亦可使用。 Binding: SNOMEDCTMedicationCodes (required): 可參考所綁定值集，但此值集只是針對這個欄位的一個可能值的範例，不預期也不鼓勵使用者一定要使用此值集的代碼。
text	SΣ	1..1	string	Plain text representation of the concept.[應填入學名Generic Name]
medication[x]:medicationReference	Σ	0..1	Reference(TW Core Medication)	What medication was supplied
subject	SΣ	1..1	Reference(TW Core Patient \| Group)	配藥/調劑藥品的對象，意即為誰配藥/調劑藥品。
context	S	0..1	Reference(TW Core Encounter)	與此配藥/調劑藥品相關的就醫事件(Encounter/Episode)
performer	S	0..*	BackboneElement	執行此配藥/藥品調劑的人員。
modifierExtension	?!Σ	0..*	Extension	此擴充的資料項目可能會完全修正或改變其他資料項目的意涵，需特別留意。
actor	S	1..1	Reference(TW Core Practitioner \| TW Core PractitionerRole \| TW Core Organization \| TW Core Patient \| Device \| RelatedPerson)	執行此操作的個人
authorizingPrescription	S	0..*	Reference(TW Core MedicationRequest)	授權此配藥/調劑藥品的處方
type	S	0..1	CodeableConceptTW	配藥/調劑藥品類型。例如：試用分裝、部分分裝、緊急分裝等 Binding: ActPharmacySupplyType (example): 可參考所綁定值集，但此值集只是針對這個欄位的一個可能值的範例，不預期也不鼓勵使用者一定要使用此值集的代碼。
quantity	S	1..1	SimpleQuantity	配藥/調劑藥品的量
value	SΣ	1..1	decimal	Numerical value (with implicit precision).[應填入給藥總量 Total Amount]
unit	SΣ	1..1	string	Unit representation.[應填入給藥總量單位 Total Units]。如：顆、CC、瓶等
daysSupply	S	1..1	SimpleQuantity	Amount of medication expressed as a timing amount.[應填入給藥日數 Medication Days]
value	SΣ	1..1	decimal	Numerical value (with implicit precision)
unit	SΣ	0..1	string	Unit representation
whenHandedOver	S	0..1	dateTime	藥品發放的時間
note	S	1..*	Annotation	Information about the dispense.[應填入調劑之核種名稱/調劑之放射活度/完成調劑之放射活度/完成調劑之核醫放射性藥品數量/處方疑義樣態註記]。至少需填入處方疑義樣態註記
text	SΣ	1..1	markdown	The annotation - text content (as markdown)
dosageInstruction	S	1..*	Dosage	病人如何使用藥品或者照護者如何給藥
modifierExtension	?!Σ	0..*	Extension	此擴充的資料項目可能會完全修正或改變其他資料項目的意涵，需特別留意。
sequence	SΣ	0..1	integer	劑量指示的順序
text	SΣ	0..1	string	純文字表述的劑量指示，例如：SIG。
patientInstruction	SΣ	0..1	string	以病人或消費者為導向的指示
timing	SΣ	1..1	Timing	應該何時給藥；時間的寫法請參照Timimg datatype。
modifierExtension	?!Σ	0..*	Extension	此擴充的資料項目可能會完全修正或改變其他資料項目的意涵，需特別留意。
repeat	SΣC	1..1	Element	事件定期重複發生的時間 tim-1: if there's a duration, there needs to be duration units tim-2: if there's a period, there needs to be period units tim-4: duration SHALL be a non-negative value tim-5: period SHALL be a non-negative value tim-6: If there's a periodMax, there must be a period tim-7: If there's a durationMax, there must be a duration tim-8: If there's a countMax, there must be a count tim-9: If there's an offset, there must be a when (and not C, CM, CD, CV) tim-10: If there's a timeOfDay, there cannot be a when, or vice versa
count	SΣ	0..1	positiveInt	重複的次數
duration	SΣ	0..1	decimal	此事件持續多久時間
durationUnit	SΣ	0..1	code	s ｜ min ｜ h ｜ d ｜ wk ｜ mo ｜ a - 單位時間（unit of time，UCUM） Binding: UnitsOfTime (required): 時間的單位（單位來自UCUM）；應填入UnitsOfTime值集中的其中一個代碼
frequency	SΣ	1..1	positiveInt	Event occurs frequency times per period.[應填入頻率 Frequency]
period	SΣ	0..1	decimal	此事件於特定時間區間所發生的頻率
periodUnit	SΣ	0..1	code	s ｜ min ｜ h ｜ d ｜ wk ｜ mo ｜ a - 單位時間（unit of time，UCUM） Binding: UnitsOfTime (required): 時間的單位（單位來自UCUM）；應填入UnitsOfTime值集中的其中一個代碼
dayOfWeek	SΣ	0..*	code	mon ｜ tue ｜ wed ｜ thu ｜ fri ｜ sat ｜ sun Binding: DaysOfWeek (required): 應填入DaysOfWeek值集中的其中一個代碼
timeOfDay	SΣ	0..*	time	一天中的活動時間
code	SΣ	0..1	CodeableConcept	BID \| TID \| QID \| AM \| PM \| QD \| QOD \| +[應填入使用時間]。如：飯前後 Binding: TimingAbbreviation (preferred): 已知／確定的時間模式之代碼；鼓勵使用TimingAbbreviation值集中的代碼，但不強制一定要使用此值集，你也可使用其他值集的代碼或單純以文字表示。
coding	S	0..*	CodingTW	由專門術語系統（terminology system）定義的代碼。此資料項目為可擴充綁定預設國際標準值集，但實作者可視實務專案需求只綁定以下slices中的任一值集。目前未只限定綁定預設值集是因為尚無slice值集與預設國際標準值集的代碼對應表，待後續有相對的代碼對應表後將建議採用國際標準值集作為唯一綁定值集並針對該值集進行擴充與管理，以利進行跨國與跨系統之資料交換。 Binding: HL7 TimingAbbreviation + 臺灣衛福部統計處藥品使用頻率值集 (extensible): 應填入所綁定值集中適合的代碼，確定無適合的代碼才可以使用其他值集的代碼來表示。
text	SΣ	0..1	string	概念的文字標記法
route	S	1..1	CodeableConceptTW	How drug should enter body.[應填入給藥途徑 Route of Administration] Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
coding	S	0..*	CodingTW	由專門術語系統（terminology system）定義的代碼。此資料項目為可擴充綁定預設國際標準值集，但實作者可視實務專案需求只綁定以下slices中的任一值集。目前未只限定綁定預設值集是因為尚無slice值集與預設國際標準值集的代碼對應表，待後續有相對的代碼對應表後將建議採用國際標準值集作為唯一綁定值集並針對該值集進行擴充與管理，以利進行跨國與跨系統之資料交換。 Binding: SNOMED CT + 臺灣衛福部統計處給藥途徑值集 (extensible): 應填入所綁定值集中適合的代碼，確定無適合的代碼才可以使用其他值集的代碼來表示。
text	SΣ	0..1	string	概念的文字標記法
doseAndRate	SΣ	1..*	Element	用藥量
Slices for dose[x]	SΣ	1..1	SimpleQuantity	每一劑量的藥量 Slice: Unordered, Closed by type:$this
dose[x]:doseQuantity	SΣ	1..1	Quantity	每一劑量的藥量
value	SΣ	1..1	decimal	Numerical value (with implicit precision).[應填入劑量]
comparator	?!Σ	0..1	code	< \| <= \| >= \| > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented.
unit	SΣ	1..1	string	Unit representation.[應填入劑量單位 Dose Units]。如：顆、CC等
rate[x]	SΣ	0..1		每時間單位內的用藥量
rateRatio			Ratio
rateRange			Range
rateQuantity			Quantity(SimpleQuantity)
substitution	S	0..1	BackboneElement	配藥/調劑藥品時是否進行了藥品替代
modifierExtension	?!Σ	0..*	Extension	此擴充的資料項目可能會完全修正或改變其他資料項目的意涵，需特別留意。
wasSubstituted	S	1..1	boolean	Whether a substitution was or was not performed on the dispense.[應填入有更換藥品註記]
reason	S	0..*	CodeableConceptTW	Why was substitution made.[應填入不得以其他廠牌藥品替代之理由]。填寫說明：有特殊情況時才填寫不可替代時始需註明 Binding: SubstanceAdminSubstitutionReason (example): 可參考所綁定值集，但此值集只是針對這個欄位的一個可能值的範例，不預期也不鼓勵使用者一定要使用此值集的代碼。
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
MedicationDispense.identifier.use	required	IdentifierUse `http://hl7.org/fhir/ValueSet/identifier-use\|4.0.1` from the FHIR Standard
MedicationDispense.status	required	MedicationDispense Status Codes `http://hl7.org/fhir/ValueSet/medicationdispense-status\|4.0.1` from the FHIR Standard
MedicationDispense.category	preferred	MedicationDispense Category Codes `http://hl7.org/fhir/ValueSet/medicationdispense-category` from the FHIR Standard
MedicationDispense.medication[x]	example	SNOMEDCTMedicationCodes `http://hl7.org/fhir/ValueSet/medication-codes` from the FHIR Standard
MedicationDispense.medication[x]:medicationCodeableConcept	example	SNOMEDCTMedicationCodes `http://hl7.org/fhir/ValueSet/medication-codes` from the FHIR Standard
MedicationDispense.medication[x]:medicationCodeableConcept.coding:fda-medication-tw	required	TWMedicationFDA `https://twcore.mohw.gov.tw/ig/twcore/ValueSet/medication-fda-tw`
MedicationDispense.medication[x]:medicationCodeableConcept.coding:nhi-medication-tw	required	TWMedicationNHI `https://twcore.mohw.gov.tw/ig/twcore/ValueSet/medication-nhi-tw`
MedicationDispense.medication[x]:medicationCodeableConcept.coding:rxnorm-medication-us-core	required	TWMedicationRXNORM `https://twcore.mohw.gov.tw/ig/twcore/ValueSet/medication-rxnorm-tw`
MedicationDispense.medication[x]:medicationCodeableConcept.coding:atc-medication-code	required	TWMedcationATC `https://twcore.mohw.gov.tw/ig/twcore/ValueSet/medcation-atc-tw`
MedicationDispense.medication[x]:medicationCodeableConcept.coding:snomedct-medication-codes	required	SNOMEDCTMedicationCodes `http://hl7.org/fhir/ValueSet/medication-codes` from the FHIR Standard
MedicationDispense.type	example	ActPharmacySupplyType `http://terminology.hl7.org/ValueSet/v3-ActPharmacySupplyType`
MedicationDispense.dosageInstruction.timing.repeat.durationUnit	required	UnitsOfTime `http://hl7.org/fhir/ValueSet/units-of-time\|4.0.1` from the FHIR Standard
MedicationDispense.dosageInstruction.timing.repeat.periodUnit	required	UnitsOfTime `http://hl7.org/fhir/ValueSet/units-of-time\|4.0.1` from the FHIR Standard
MedicationDispense.dosageInstruction.timing.repeat.dayOfWeek	required	DaysOfWeek `http://hl7.org/fhir/ValueSet/days-of-week\|4.0.1` from the FHIR Standard
MedicationDispense.dosageInstruction.timing.code	preferred	TimingAbbreviation `http://hl7.org/fhir/ValueSet/timing-abbreviation` from the FHIR Standard
MedicationDispense.dosageInstruction.timing.code.coding	extensible	TWMedicationFrequencyHL7 `https://twcore.mohw.gov.tw/ig/twcore/ValueSet/medication-frequency-hl7-tw`
MedicationDispense.dosageInstruction.route	example	SNOMEDCTRouteCodes `http://hl7.org/fhir/ValueSet/route-codes` from the FHIR Standard
MedicationDispense.dosageInstruction.route.coding	extensible	TWMedicationPathSCT `https://twcore.mohw.gov.tw/ig/twcore/ValueSet/medication-path-sct-tw`
MedicationDispense.dosageInstruction.doseAndRate.dose[x]:doseQuantity.comparator	required	QuantityComparator `http://hl7.org/fhir/ValueSet/quantity-comparator\|4.0.1` from the FHIR Standard
MedicationDispense.substitution.reason	example	SubstanceAdminSubstitutionReason `http://terminology.hl7.org/ValueSet/v3-SubstanceAdminSubstitutionReason`

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	MedicationDispense	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	MedicationDispense	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	MedicationDispense	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	MedicationDispense	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	MedicationDispense	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	ALL elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	ALL extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
mdd-1	error	MedicationDispense	whenHandedOver cannot be before whenPrepared : whenHandedOver.empty() or whenPrepared.empty() or whenHandedOver >= whenPrepared
tim-1	error	MedicationDispense.dosageInstruction.timing.repeat	if there's a duration, there needs to be duration units : duration.empty() or durationUnit.exists()
tim-2	error	MedicationDispense.dosageInstruction.timing.repeat	if there's a period, there needs to be period units : period.empty() or periodUnit.exists()
tim-4	error	MedicationDispense.dosageInstruction.timing.repeat	duration SHALL be a non-negative value : duration.exists() implies duration >= 0
tim-5	error	MedicationDispense.dosageInstruction.timing.repeat	period SHALL be a non-negative value : period.exists() implies period >= 0
tim-6	error	MedicationDispense.dosageInstruction.timing.repeat	If there's a periodMax, there must be a period : periodMax.empty() or period.exists()
tim-7	error	MedicationDispense.dosageInstruction.timing.repeat	If there's a durationMax, there must be a duration : durationMax.empty() or duration.exists()
tim-8	error	MedicationDispense.dosageInstruction.timing.repeat	If there's a countMax, there must be a count : countMax.empty() or count.exists()
tim-9	error	MedicationDispense.dosageInstruction.timing.repeat	If there's an offset, there must be a when (and not C, CM, CD, CV) : offset.empty() or (when.exists() and ((when in ('C' \| 'CM' \| 'CD' \| 'CV')).not()))
tim-10	error	MedicationDispense.dosageInstruction.timing.repeat	If there's a timeOfDay, there cannot be a when, or vice versa : timeOfDay.empty() or when.empty()