Dose syntax implementation guidance for FHIR STU3

This guidance is under active development by NHS Digital and content may be added or updated on a regular basis.

Co-codamol 8mg/500mg tablets, 2 tablets when required when first symptoms of migraine appear. Dose may be repeated after 4 hours if migraine recurs. Oral. Maximum dose 6 tablets every 24 hours

Product based prescription (VMP) maximum daily dose. Complex because could be modelled in two ways. Both have been provided as examples. 
<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="a8ca980c-72aa-11e7-8cf7-a6006ad3dba0" />
    <contained>
        <Medication>
            <id value="med1" />
            <code>
                <coding>
                    <system value="http://snomed.info/sct" />
                    <code value="322307006" />
                    <display value="Co-codamol 8mg/500mg tablets" />
                </coding>
            </code>
        </Medication>
    </contained>
    <status value="active" />
    <intent value="order" />
    <medicationReference>
        <reference value="#med1" />
    </medicationReference>
    <subject>
        <identifier>
            <system value="https://fhir.nhs.uk/Id/nhs-number" />
            <value value="9999999999" />
        </identifier>
    </subject>
    <dosageInstruction>
        <patientInstruction value="Additional doses only to be taken after migraine recurrence" />
        <timing>
            <repeat>
                <frequency value="1" />
                <period value="4" />
                <periodUnit value="h" />
            </repeat>
        </timing>
        <asNeededCodeableConcept>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="37796009" />
                <display value="Migraine" />
            </coding>
        </asNeededCodeableConcept>
        <doseQuantity>
            <value value="2" />
            <unit value="tablet" />
            <system value="http://snomed.info/sct" />
            <code value="428673006" />
        </doseQuantity>
        <maxDosePerPeriod>
            <numerator>
                <value value="6" />
                <unit value="dose" />
                <system value="http://snomed.info/sct" />
                <code value="3317411000001100" />
            </numerator>
            <denominator>
                <value value="24" />
                <unit value="hour" />
                <system value="http://unitsofmeasure.org/" />
                <code value="h" />
            </denominator>
        </maxDosePerPeriod>
    </dosageInstruction>
</MedicationRequest>

{
    "resourceType": "MedicationRequest",
    "id": "a8ca980c-72aa-11e7-8cf7-a6006ad3dba0",
    "contained":  [
        {
            "resourceType": "Medication",
            "id": "med1",
            "code": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "322307006",
                        "display": "Co-codamol 8mg/500mg tablets"
                    }
                ]
            }
        }
    ],
    "status": "active",
    "intent": "order",
    "medicationReference": {
        "reference": "#med1"
    },
    "subject": {
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9999999999"
        }
    },
    "dosageInstruction":  [
        {
            "patientInstruction": "Additional doses only to be taken after migraine recurrence",
            "timing": {
                "repeat": {
                    "frequency": 1,
                    "period": 4,
                    "periodUnit": "h"
                }
            },
            "asNeededCodeableConcept": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "37796009",
                        "display": "Migraine"
                    }
                ]
            },
            "doseQuantity": {
                "value": 2,
                "unit": "tablet",
                "system": "http://snomed.info/sct",
                "code": "428673006"
            },
            "maxDosePerPeriod": {
                "numerator": {
                    "value": 6,
                    "unit": "dose",
                    "system": "http://snomed.info/sct",
                    "code": "3317411000001100"
                },
                "denominator": {
                    "value": 24,
                    "unit": "hour",
                    "system": "http://unitsofmeasure.org/",
                    "code": "h"
                }
            }
        }
    ]
}
MedicationRequest.id[0]a8ca980c-72aa-11e7-8cf7-a6006ad3dba0
MedicationRequest.contained[0].id[0]med1
MedicationRequest.contained[0].code[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.contained[0].code[0].coding[0].code[0]322307006
MedicationRequest.contained[0].code[0].coding[0].display[0]Co-codamol 8mg/500mg tablets
MedicationRequest.status[0]active
MedicationRequest.intent[0]order
MedicationRequest.medication[0].reference[0]#med1
MedicationRequest.subject[0].identifier[0].system[0]https://fhir.nhs.uk/Id/nhs-number
MedicationRequest.subject[0].identifier[0].value[0]9999999999
MedicationRequest.dosageInstruction[0].patientInstruction[0]Additional doses only to be taken after migraine recurrence
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].frequency[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].period[0]4
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].periodUnit[0]h
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].code[0]37796009
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].display[0]Migraine
MedicationRequest.dosageInstruction[0].dose[0].value[0]2
MedicationRequest.dosageInstruction[0].dose[0].unit[0]tablet
MedicationRequest.dosageInstruction[0].dose[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].dose[0].code[0]428673006
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].value[0]6
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].unit[0]dose
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].code[0]3317411000001100
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].value[0]24
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].unit[0]hour
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].system[0]http://unitsofmeasure.org/
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].code[0]h
MedicationRequest

Alternative Representation

<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="c1ea9b0b-f157-4ee2-9771-84c6cbae5cad" />
    <contained>
        <Medication>
            <id value="med1" />
            <code>
                <coding>
                    <system value="http://snomed.info/sct" />
                    <code value="322307006" />
                    <display value="Co-codamol 8mg/500mg tablets" />
                </coding>
            </code>
        </Medication>
    </contained>
    <status value="active" />
    <intent value="order" />
    <medicationReference>
        <reference value="#med1" />
    </medicationReference>
    <subject>
        <identifier>
            <system value="https://fhir.nhs.uk/Id/nhs-number" />
            <value value="9999999999" />
        </identifier>
    </subject>
    <dosageInstruction>
        <sequence value="1" />
        <timing>
            <repeat>
                <count value="1" />
            </repeat>
        </timing>
        <asNeededCodeableConcept>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="37796009" />
                <display value="Migraine" />
            </coding>
        </asNeededCodeableConcept>
        <doseQuantity>
            <value value="2" />
            <unit value="tablet" />
            <system value="http://snomed.info/sct" />
            <code value="428673006" />
        </doseQuantity>
        <maxDosePerPeriod>
            <numerator>
                <value value="6" />
                <unit value="dose" />
                <system value="http://snomed.info/sct" />
                <code value="3317411000001100" />
            </numerator>
            <denominator>
                <value value="24" />
                <unit value="hour" />
                <system value="http://unitsofmeasure.org/" />
                <code value="h" />
            </denominator>
        </maxDosePerPeriod>
    </dosageInstruction>
    <dosageInstruction>
        <sequence value="2" />
        <patientInstruction value="when migraine recurs" />
        <timing>
            <repeat>
                <frequency value="1" />
                <period value="4" />
                <periodUnit value="h" />
            </repeat>
        </timing>
        <doseQuantity>
            <value value="2" />
            <unit value="tablet" />
            <system value="http://snomed.info/sct" />
            <code value="428673006" />
        </doseQuantity>
        <maxDosePerPeriod>
            <numerator>
                <value value="6" />
                <unit value="dose" />
                <system value="http://snomed.info/sct" />
                <code value="3317411000001100" />
            </numerator>
            <denominator>
                <value value="24" />
                <unit value="hour" />
                <system value="http://unitsofmeasure.org/" />
                <code value="h" />
            </denominator>
        </maxDosePerPeriod>
    </dosageInstruction>
</MedicationRequest>

{
    "resourceType": "MedicationRequest",
    "id": "c1ea9b0b-f157-4ee2-9771-84c6cbae5cad",
    "contained":  [
        {
            "resourceType": "Medication",
            "id": "med1",
            "code": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "322307006",
                        "display": "Co-codamol 8mg/500mg tablets"
                    }
                ]
            }
        }
    ],
    "status": "active",
    "intent": "order",
    "medicationReference": {
        "reference": "#med1"
    },
    "subject": {
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9999999999"
        }
    },
    "dosageInstruction":  [
        {
            "sequence": 1,
            "timing": {
                "repeat": {
                    "count": 1
                }
            },
            "asNeededCodeableConcept": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "37796009",
                        "display": "Migraine"
                    }
                ]
            },
            "doseQuantity": {
                "value": 2,
                "unit": "tablet",
                "system": "http://snomed.info/sct",
                "code": "428673006"
            },
            "maxDosePerPeriod": {
                "numerator": {
                    "value": 6,
                    "unit": "dose",
                    "system": "http://snomed.info/sct",
                    "code": "3317411000001100"
                },
                "denominator": {
                    "value": 24,
                    "unit": "hour",
                    "system": "http://unitsofmeasure.org/",
                    "code": "h"
                }
            }
        },
        {
            "sequence": 2,
            "patientInstruction": "when migraine recurs",
            "timing": {
                "repeat": {
                    "frequency": 1,
                    "period": 4,
                    "periodUnit": "h"
                }
            },
            "doseQuantity": {
                "value": 2,
                "unit": "tablet",
                "system": "http://snomed.info/sct",
                "code": "428673006"
            },
            "maxDosePerPeriod": {
                "numerator": {
                    "value": 6,
                    "unit": "dose",
                    "system": "http://snomed.info/sct",
                    "code": "3317411000001100"
                },
                "denominator": {
                    "value": 24,
                    "unit": "hour",
                    "system": "http://unitsofmeasure.org/",
                    "code": "h"
                }
            }
        }
    ]
}
MedicationRequest.id[0]c1ea9b0b-f157-4ee2-9771-84c6cbae5cad
MedicationRequest.contained[0].id[0]med1
MedicationRequest.contained[0].code[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.contained[0].code[0].coding[0].code[0]322307006
MedicationRequest.contained[0].code[0].coding[0].display[0]Co-codamol 8mg/500mg tablets
MedicationRequest.status[0]active
MedicationRequest.intent[0]order
MedicationRequest.medication[0].reference[0]#med1
MedicationRequest.subject[0].identifier[0].system[0]https://fhir.nhs.uk/Id/nhs-number
MedicationRequest.subject[0].identifier[0].value[0]9999999999
MedicationRequest.dosageInstruction[0].sequence[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].count[0]1
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].code[0]37796009
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].display[0]Migraine
MedicationRequest.dosageInstruction[0].dose[0].value[0]2
MedicationRequest.dosageInstruction[0].dose[0].unit[0]tablet
MedicationRequest.dosageInstruction[0].dose[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].dose[0].code[0]428673006
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].value[0]6
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].unit[0]dose
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].code[0]3317411000001100
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].value[0]24
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].unit[0]hour
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].system[0]http://unitsofmeasure.org/
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].code[0]h
MedicationRequest.dosageInstruction[1].sequence[0]2
MedicationRequest.dosageInstruction[1].patientInstruction[0]when migraine recurs
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].frequency[0]1
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].period[0]4
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].periodUnit[0]h
MedicationRequest.dosageInstruction[1].dose[0].value[0]2
MedicationRequest.dosageInstruction[1].dose[0].unit[0]tablet
MedicationRequest.dosageInstruction[1].dose[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[1].dose[0].code[0]428673006
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].value[0]6
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].unit[0]dose
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].code[0]3317411000001100
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].denominator[0].value[0]24
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].denominator[0].unit[0]hour
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].denominator[0].system[0]http://unitsofmeasure.org/
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].denominator[0].code[0]h
MedicationRequest
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