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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