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.

Coded Additional Instruction Examples

These medicationRequest examples require use of the additionalInstruction using SNOMED-CT coded terms.

Important: Examples are not complete with respect to all required data for a CareConnect implementation but instead highlight the variety of use of the FHIR Dosage structure

Microgynon 30 tablets (Bayer Plc), 63 tablets

Product-based prescription using additional instruction field to convey dosing instructions.

This example includes a dispenseRequest instruction so represents the clinical information that could be shared as part of a FHIR-based primary care prescription between a prescribing and dispensing clinical system.

<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="68ed456c-4fbb-4e7c-b431-321e06a6fdf9" />
    <contained>
        <Medication>
            <id value="med1" />
            <code>
                <coding>
                    <system value="http://snomed.info/sct" />
                    <code value="42111000001107" />
                    <display value="Microgynon 30 tablets (Bayer Plc)" />
                </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>
        <additionalInstruction>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="421769005" />
                <display value="Follow directions" />
            </coding>
        </additionalInstruction>
    </dosageInstruction>
    <dispenseRequest>
        <quantity>
            <value value="63" />
            <unit value="tablet" />
            <system value="http://snomed.info/sct" />
            <code value="428673006" />
        </quantity>
    </dispenseRequest>
</MedicationRequest>

{
    "resourceType": "MedicationRequest",
    "id": "68ed456c-4fbb-4e7c-b431-321e06a6fdf9",
    "contained":  [
        {
            "resourceType": "Medication",
            "id": "med1",
            "code": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "42111000001107",
                        "display": "Microgynon 30 tablets (Bayer Plc)"
                    }
                ]
            }
        }
    ],
    "status": "active",
    "intent": "order",
    "medicationReference": {
        "reference": "#med1"
    },
    "subject": {
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9999999999"
        }
    },
    "dosageInstruction":  [
        {
            "additionalInstruction":  [
                {
                    "coding":  [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "421769005",
                            "display": "Follow directions"
                        }
                    ]
                }
            ]
        }
    ],
    "dispenseRequest": {
        "quantity": {
            "value": 63,
            "unit": "tablet",
            "system": "http://snomed.info/sct",
            "code": "428673006"
        }
    }
}
MedicationRequest.id[0]68ed456c-4fbb-4e7c-b431-321e06a6fdf9
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]42111000001107
MedicationRequest.contained[0].code[0].coding[0].display[0]Microgynon 30 tablets (Bayer Plc)
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].additionalInstruction[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].additionalInstruction[0].coding[0].code[0]421769005
MedicationRequest.dosageInstruction[0].additionalInstruction[0].coding[0].display[0]Follow directions
MedicationRequest.dispenseRequest[0].quantity[0].value[0]63
MedicationRequest.dispenseRequest[0].quantity[0].unit[0]tablet
MedicationRequest.dispenseRequest[0].quantity[0].system[0]http://snomed.info/sct
MedicationRequest.dispenseRequest[0].quantity[0].code[0]428673006
MedicationRequest

Simvastatin, 40mg, oral, once a day

Dose-based VTM prescription with additional instructions. 
<Bundle xmlns="http://hl7.org/fhir">
    <id value="32e2adf8-595b-4b39-b6f1-f0073464c7f9" />
    <type value="message" />
    <!--    Message Header    -->
    <entry>
        <fullUrl value="message-header-167434" />
        <resource>
            <MessageHeader>
                <id value="message-header-167434" />
                <text>
                    <status value="generated" />
                    <div xmlns="http://www.w3.org/1999/xhtml"><p>The quick brown fox jumps over the lazy dog</p></div>
                </text>
                <event>
                    <system value="https://fhir.nhs.uk/STU3/CodeSystem/EventType-1" />
                    <code value="individual-requirements-1" />
                    <display value="Individual Requirements" />
                </event>
                <timestamp value="2021-05-07T16:15:32Z" />
                <source>
                    <endpoint value="nhs-uk:addressing:ods:T48NT" />
                </source>
                <focus>
                    <reference value="medication-request-129456799" />
                </focus>
            </MessageHeader>
        </resource>
    </entry>
    <!-- Patient associated with the encounter. -->
    <entry>
        <fullUrl value="patient-01020304" />
        <resource>
            <Patient>
                <id value="patient-01020304" />
                <identifier>
                    <extension url="https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-NHSNumberVerificationStatus-1">
                        <valueCodeableConcept>
                            <coding>
                                <system value="https://fhir.hl7.org.uk/STU3/CodeSystem/CareConnect-NHSNumberVerificationStatus-1" />
                                <code value="01" />
                                <display value="Number present and verified" />
                            </coding>
                        </valueCodeableConcept>
                    </extension>
                    <system value="https://fhir.nhs.uk/Id/nhs-number" />
                    <value value="2377954310" />
                </identifier>
                <name>
                    <use value="official" />
                    <text value="Mrs Anne Teak" />
                    <family value="Teak" />
                    <given value="Anne" />
                    <prefix value="Mrs" />
                </name>
                <gender value="female" />
                <birthDate value="1956-02-04" />
            </Patient>
        </resource>
    </entry>
    <!-- Prescribing clinician associated with the encounter.  -->
    <entry>
        <fullUrl value="staff-0001" />
        <resource>
            <Practitioner>
                <id value="staff-0001" />
                <name>
                    <text value="Dr Maikeu Well" />
                    <family value="Well" />
                    <given value="Maikeu" />
                    <prefix value="Dr" />
                </name>
                <qualification>
                    <code>
                        <coding>
                            <system value="https://fhir.hl7.org.uk/Id/gmc-number" />
                            <code value="2145879" />
                            <display value="General Medical Council" />
                        </coding>
                    </code>
                </qualification>
            </Practitioner>
        </resource>
    </entry>
    <!-- Medication prescribed  -->
    <entry>
        <fullUrl value="medication-27658006" />
        <resource>
            <Medication>
                <id value="medication-27658006" />
                <code>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="27658006" />
                        <display value="Amoxicillin" />
                    </coding>
                </code>
            </Medication>
        </resource>
    </entry>
    <!--  Medication Request  -->
    <entry>
        <fullUrl value="medication-request-129456799" />
        <resource>
            <MedicationRequest>
                <id value="medication-request-129456799" />
                <status value="active" />
                <intent value="order" />
                <category>
                    <coding>
                        <system value="http://hl7.org/fhir/medication-request-category" />
                        <code value="inpatient" />
                        <display value="inpatient" />
                    </coding>
                </category>
                <medicationReference>
                    <reference value="medication-27658006" />
                    <display value="Amoxicillin" />
                </medicationReference>
                <subject>
                    <reference value="patient-01020304" />
                    <display value="Mrs Anne Teak" />
                </subject>
                <authoredOn value="2020-05-15T15:00:00+01:00" />
                <requester>
                    <agent>
                        <reference value="staff-0001" />
                        <display value="Dr Maikeu Well" />
                    </agent>
                </requester>
                <recorder>
                    <reference value="staff-0001" />
                    <display value="Dr Maikeu Well" />
                </recorder>
                <dosageInstruction>
                    <timing>
                        <repeat>
                            <frequency value="3" />
                            <period value="1" />
                            <periodUnit value="d" />
                        </repeat>
                    </timing>
                    <route>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="26643006" />
                            <display value="oral" />
                        </coding>
                    </route>
                    <doseQuantity>
                        <value value="500" />
                        <unit value="milligram" />
                        <system value="http://unitsofmeasure.org" />
                        <code value="mg" />
                    </doseQuantity>
                </dosageInstruction>
                <substitution>
                    <allowed value="false" />
                </substitution>
                <priorPrescription>
                    <reference value="47fcb89e-46bc-4c64-bfa6-84b0098a2296" />
                </priorPrescription>
            </MedicationRequest>
        </resource>
    </entry>
</Bundle>

{
    "resourceType": "Bundle",
    "id": "32e2adf8-595b-4b39-b6f1-f0073464c7f9",
    "type": "message",
    "entry":  [
        {
            "fullUrl": "message-header-167434",
            "resource": {
                "resourceType": "MessageHeader",
                "id": "message-header-167434",
                "text": {
                    "status": "generated",
                    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>The quick brown fox jumps over the lazy dog</p></div>"
                },
                "event": {
                    "system": "https://fhir.nhs.uk/STU3/CodeSystem/EventType-1",
                    "code": "individual-requirements-1",
                    "display": "Individual Requirements"
                },
                "timestamp": "2021-05-07T16:15:32+00:00",
                "source": {
                    "endpoint": "nhs-uk:addressing:ods:T48NT"
                },
                "focus":  [
                    {
                        "reference": "medication-request-129456799"
                    }
                ]
            }
        },
        {
            "fullUrl": "patient-01020304",
            "resource": {
                "resourceType": "Patient",
                "id": "patient-01020304",
                "identifier":  [
                    {
                        "extension":  [
                            {
                                "url": "https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-NHSNumberVerificationStatus-1",
                                "valueCodeableConcept": {
                                    "coding":  [
                                        {
                                            "system": "https://fhir.hl7.org.uk/STU3/CodeSystem/CareConnect-NHSNumberVerificationStatus-1",
                                            "code": "01",
                                            "display": "Number present and verified"
                                        }
                                    ]
                                }
                            }
                        ],
                        "system": "https://fhir.nhs.uk/Id/nhs-number",
                        "value": "2377954310"
                    }
                ],
                "name":  [
                    {
                        "use": "official",
                        "text": "Mrs Anne Teak",
                        "family": "Teak",
                        "given":  [
                            "Anne"
                        ],
                        "prefix":  [
                            "Mrs"
                        ]
                    }
                ],
                "gender": "female",
                "birthDate": "1956-02-04"
            }
        },
        {
            "fullUrl": "staff-0001",
            "resource": {
                "resourceType": "Practitioner",
                "id": "staff-0001",
                "name":  [
                    {
                        "text": "Dr Maikeu Well",
                        "family": "Well",
                        "given":  [
                            "Maikeu"
                        ],
                        "prefix":  [
                            "Dr"
                        ]
                    }
                ],
                "qualification":  [
                    {
                        "code": {
                            "coding":  [
                                {
                                    "system": "https://fhir.hl7.org.uk/Id/gmc-number",
                                    "code": "2145879",
                                    "display": "General Medical Council"
                                }
                            ]
                        }
                    }
                ]
            }
        },
        {
            "fullUrl": "medication-27658006",
            "resource": {
                "resourceType": "Medication",
                "id": "medication-27658006",
                "code": {
                    "coding":  [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "27658006",
                            "display": "Amoxicillin"
                        }
                    ]
                }
            }
        },
        {
            "fullUrl": "medication-request-129456799",
            "resource": {
                "resourceType": "MedicationRequest",
                "id": "medication-request-129456799",
                "status": "active",
                "intent": "order",
                "category": {
                    "coding":  [
                        {
                            "system": "http://hl7.org/fhir/medication-request-category",
                            "code": "inpatient",
                            "display": "inpatient"
                        }
                    ]
                },
                "medicationReference": {
                    "reference": "medication-27658006",
                    "display": "Amoxicillin"
                },
                "subject": {
                    "reference": "patient-01020304",
                    "display": "Mrs Anne Teak"
                },
                "authoredOn": "2020-05-15T15:00:00+01:00",
                "requester": {
                    "agent": {
                        "reference": "staff-0001",
                        "display": "Dr Maikeu Well"
                    }
                },
                "recorder": {
                    "reference": "staff-0001",
                    "display": "Dr Maikeu Well"
                },
                "dosageInstruction":  [
                    {
                        "timing": {
                            "repeat": {
                                "frequency": 3,
                                "period": 1,
                                "periodUnit": "d"
                            }
                        },
                        "route": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "26643006",
                                    "display": "oral"
                                }
                            ]
                        },
                        "doseQuantity": {
                            "value": 500,
                            "unit": "milligram",
                            "system": "http://unitsofmeasure.org",
                            "code": "mg"
                        }
                    }
                ],
                "substitution": {
                    "allowed": false
                },
                "priorPrescription": {
                    "reference": "47fcb89e-46bc-4c64-bfa6-84b0098a2296"
                }
            }
        }
    ]
}
Bundle.id[0]32e2adf8-595b-4b39-b6f1-f0073464c7f9
Bundle.type[0]message
Bundle.entry[0].fullUrl[0]message-header-167434
Bundle.entry[0].resource[0].id[0]message-header-167434
Bundle.entry[0].resource[0].text[0].status[0]generated
Bundle.entry[0].resource[0].text[0].div[0]<div xmlns="http://www.w3.org/1999/xhtml"><p>The quick brown fox jumps over the lazy dog</p></div>
Bundle.entry[0].resource[0].event[0].system[0]https://fhir.nhs.uk/STU3/CodeSystem/EventType-1
Bundle.entry[0].resource[0].event[0].code[0]individual-requirements-1
Bundle.entry[0].resource[0].event[0].display[0]Individual Requirements
Bundle.entry[0].resource[0].timestamp[0]2021-05-07T16:15:32+00:00
Bundle.entry[0].resource[0].source[0].endpoint[0]nhs-uk:addressing:ods:T48NT
Bundle.entry[0].resource[0].focus[0].reference[0]medication-request-129456799
Bundle.entry[1].fullUrl[0]patient-01020304
Bundle.entry[1].resource[0].id[0]patient-01020304
Bundle.entry[1].resource[0].identifier[0].extension[0].url[0]https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-NHSNumberVerificationStatus-1
Bundle.entry[1].resource[0].identifier[0].extension[0].value[0].coding[0].system[0]https://fhir.hl7.org.uk/STU3/CodeSystem/CareConnect-NHSNumberVerificationStatus-1
Bundle.entry[1].resource[0].identifier[0].extension[0].value[0].coding[0].code[0]01
Bundle.entry[1].resource[0].identifier[0].extension[0].value[0].coding[0].display[0]Number present and verified
Bundle.entry[1].resource[0].identifier[0].system[0]https://fhir.nhs.uk/Id/nhs-number
Bundle.entry[1].resource[0].identifier[0].value[0]2377954310
Bundle.entry[1].resource[0].name[0].use[0]official
Bundle.entry[1].resource[0].name[0].text[0]Mrs Anne Teak
Bundle.entry[1].resource[0].name[0].family[0]Teak
Bundle.entry[1].resource[0].name[0].given[0]Anne
Bundle.entry[1].resource[0].name[0].prefix[0]Mrs
Bundle.entry[1].resource[0].gender[0]female
Bundle.entry[1].resource[0].birthDate[0]1956-02-04
Bundle.entry[2].fullUrl[0]staff-0001
Bundle.entry[2].resource[0].id[0]staff-0001
Bundle.entry[2].resource[0].name[0].text[0]Dr Maikeu Well
Bundle.entry[2].resource[0].name[0].family[0]Well
Bundle.entry[2].resource[0].name[0].given[0]Maikeu
Bundle.entry[2].resource[0].name[0].prefix[0]Dr
Bundle.entry[2].resource[0].qualification[0].code[0].coding[0].system[0]https://fhir.hl7.org.uk/Id/gmc-number
Bundle.entry[2].resource[0].qualification[0].code[0].coding[0].code[0]2145879
Bundle.entry[2].resource[0].qualification[0].code[0].coding[0].display[0]General Medical Council
Bundle.entry[3].fullUrl[0]medication-27658006
Bundle.entry[3].resource[0].id[0]medication-27658006
Bundle.entry[3].resource[0].code[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[3].resource[0].code[0].coding[0].code[0]27658006
Bundle.entry[3].resource[0].code[0].coding[0].display[0]Amoxicillin
Bundle.entry[4].fullUrl[0]medication-request-129456799
Bundle.entry[4].resource[0].id[0]medication-request-129456799
Bundle.entry[4].resource[0].status[0]active
Bundle.entry[4].resource[0].intent[0]order
Bundle.entry[4].resource[0].category[0].coding[0].system[0]http://hl7.org/fhir/medication-request-category
Bundle.entry[4].resource[0].category[0].coding[0].code[0]inpatient
Bundle.entry[4].resource[0].category[0].coding[0].display[0]inpatient
Bundle.entry[4].resource[0].medication[0].reference[0]medication-27658006
Bundle.entry[4].resource[0].medication[0].display[0]Amoxicillin
Bundle.entry[4].resource[0].subject[0].reference[0]patient-01020304
Bundle.entry[4].resource[0].subject[0].display[0]Mrs Anne Teak
Bundle.entry[4].resource[0].authoredOn[0]2020-05-15T15:00:00+01:00
Bundle.entry[4].resource[0].requester[0].agent[0].reference[0]staff-0001
Bundle.entry[4].resource[0].requester[0].agent[0].display[0]Dr Maikeu Well
Bundle.entry[4].resource[0].recorder[0].reference[0]staff-0001
Bundle.entry[4].resource[0].recorder[0].display[0]Dr Maikeu Well
Bundle.entry[4].resource[0].dosageInstruction[0].timing[0].repeat[0].frequency[0]3
Bundle.entry[4].resource[0].dosageInstruction[0].timing[0].repeat[0].period[0]1
Bundle.entry[4].resource[0].dosageInstruction[0].timing[0].repeat[0].periodUnit[0]d
Bundle.entry[4].resource[0].dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[4].resource[0].dosageInstruction[0].route[0].coding[0].code[0]26643006
Bundle.entry[4].resource[0].dosageInstruction[0].route[0].coding[0].display[0]oral
Bundle.entry[4].resource[0].dosageInstruction[0].dose[0].value[0]500
Bundle.entry[4].resource[0].dosageInstruction[0].dose[0].unit[0]milligram
Bundle.entry[4].resource[0].dosageInstruction[0].dose[0].system[0]http://unitsofmeasure.org
Bundle.entry[4].resource[0].dosageInstruction[0].dose[0].code[0]mg
Bundle.entry[4].resource[0].substitution[0].allowed[0]False
Bundle.entry[4].resource[0].priorPrescription[0].reference[0]47fcb89e-46bc-4c64-bfa6-84b0098a2296
Bundle

Aspirin 300mg dispersible tablets, two tablets to be taken four times daily well diluted in water. To be taken with food.

Product-based prescription using additional instruction field to convey dosing instructions. 
<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="329526003" />
                    <display value="Aspirin 300mg dispersible 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>
        <additionalInstruction>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="417995008" />
                <display value="Dissolve or mix with water before taking" />
            </coding>
        </additionalInstruction>
        <timing>
            <repeat>
                <frequency value="4" />
                <period value="1" />
                <periodUnit value="d" />
                <when value="C" />
                <when value="PC" />
            </repeat>
        </timing>
        <doseQuantity>
            <value value="2" />
            <unit value="tablet" />
            <system value="http://snomed.info/sct" />
            <code value="428673006" />
        </doseQuantity>
    </dosageInstruction>
</MedicationRequest>

{
    "resourceType": "MedicationRequest",
    "id": "a8ca980c-72aa-11e7-8cf7-a6006ad3dba0",
    "contained":  [
        {
            "resourceType": "Medication",
            "id": "med1",
            "code": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "329526003",
                        "display": "Aspirin 300mg dispersible tablets"
                    }
                ]
            }
        }
    ],
    "status": "active",
    "intent": "order",
    "medicationReference": {
        "reference": "#med1"
    },
    "subject": {
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9999999999"
        }
    },
    "dosageInstruction":  [
        {
            "additionalInstruction":  [
                {
                    "coding":  [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "417995008",
                            "display": "Dissolve or mix with water before taking"
                        }
                    ]
                }
            ],
            "timing": {
                "repeat": {
                    "frequency": 4,
                    "period": 1,
                    "periodUnit": "d",
                    "when":  [
                        "C",
                        "PC"
                    ]
                }
            },
            "doseQuantity": {
                "value": 2,
                "unit": "tablet",
                "system": "http://snomed.info/sct",
                "code": "428673006"
            }
        }
    ]
}
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]329526003
MedicationRequest.contained[0].code[0].coding[0].display[0]Aspirin 300mg dispersible tablets
MedicationRequest.status[0]active
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MedicationRequest.dosageInstruction[0].additionalInstruction[0].coding[0].display[0]Dissolve or mix with water before taking
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MedicationRequest

Prednisolone 5mg tablets, have 8 tablets a day after food for 7 days then stop

Product-based prescription with course length, when and additional instruction. 
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MedicationRequest

Loperamide 2mg capsules, take two capsules (4 mg) immediately followed by one capsule (2 mg) after each episode of diarrhoea. Daily dose should not exceed eight capsules (16 mg)

Product-based prescription with sequential dosing, when required as additional instruction and maximum daily dose. 
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MedicationRequest
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