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.

Free-text instruction examples

These medicationRequest examples require use of free-text intructions that cannot be represented using the coded elements of the Dosage structure. Therefore these examples cannot be fully machine readable and would require human interpretation to ensure the free-text instructions are adhered to, and they do not contradict the coded instructions.

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), 1 tablet, ONCE a DAY, oral, for 21 days, subsequent courses repeated after 7-day tablet-free interval

Product-based AMP prescription using additional instructions to convery pill free interval.
<MedicationRequest xmlns="http://hl7.org/fhir">
<id value="d4b05cfb-d444-4490-824a-67c55596c610" />
<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>
<text value="subsequent courses repeated after 7-day tablet-free interval" />
</additionalInstruction>
<timing>
<repeat>
<boundsDuration>
<value value="21" />
<unit value="day" />
<system value="http://unitsofmeasure.org" />
<code value="d" />
</boundsDuration>
<frequency value="1" />
<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="1" />
<unit value="tablet" />
<system value="http://snomed.info/sct" />
<code value="428673006" />
</doseQuantity>
</dosageInstruction>
</MedicationRequest>
{
"resourceType": "MedicationRequest",
"id": "d4b05cfb-d444-4490-824a-67c55596c610",
"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": [
{
"text": "subsequent courses repeated after 7-day tablet-free interval"
}
],
"timing": {
"repeat": {
"boundsDuration": {
"value": 21,
"unit": "day",
"system": "http://unitsofmeasure.org",
"code": "d"
},
"frequency": 1,
"period": 1,
"periodUnit": "d"
}
},
"route": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "26643006",
"display": "oral"
}
]
},
"doseQuantity": {
"value": 1,
"unit": "tablet",
"system": "http://snomed.info/sct",
"code": "428673006"
}
}
]
}
MedicationRequest.id[0]d4b05cfb-d444-4490-824a-67c55596c610
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].text[0]subsequent courses repeated after 7-day tablet-free interval
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].bounds[0].value[0]21
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].bounds[0].unit[0]day
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].bounds[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].bounds[0].code[0]d
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].frequency[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].period[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].periodUnit[0]d
MedicationRequest.dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].route[0].coding[0].code[0]26643006
MedicationRequest.dosageInstruction[0].route[0].coding[0].display[0]oral
MedicationRequest.dosageInstruction[0].dose[0].value[0]1
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

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

Eprex 2,000units/0.5ml solution for injection pre-filled syringes (Janssen-Cilag Ltd), to be given by s.c. injection on Mondays and Thursdays with dialysis

Product-based prescription with doses on specific days of the week. Also additional instructions field.
<MedicationRequest xmlns="http://hl7.org/fhir">
<id value="808e7672-cf8d-48d8-885b-694c9bb9a417" />
<contained>
<Medication>
<id value="med1" />
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="2971511000001101" />
<display value="Eprex 2,000units/0.5ml solution for injection pre-filled syringes (Janssen-Cilag Ltd)" />
</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>
<text value="with dialysis" />
</additionalInstruction>
<timing>
<repeat>
<frequency value="1" />
<period value="1" />
<periodUnit value="d" />
<dayOfWeek value="mon" />
<dayOfWeek value="thu" />
</repeat>
</timing>
<route>
<coding>
<system value="http://snomed.info/sct" />
<code value="34206005" />
<display value="subcutaneous route" />
</coding>
</route>
<method>
<coding>
<system value="http://snomed.info/sct" />
<code value="422145002" />
<display value="inject" />
</coding>
</method>
</dosageInstruction>
</MedicationRequest>
{
"resourceType": "MedicationRequest",
"id": "808e7672-cf8d-48d8-885b-694c9bb9a417",
"contained": [
{
"resourceType": "Medication",
"id": "med1",
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "2971511000001101",
"display": "Eprex 2,000units/0.5ml solution for injection pre-filled syringes (Janssen-Cilag Ltd)"
}
]
}
}
],
"status": "active",
"intent": "order",
"medicationReference": {
"reference": "#med1"
},
"subject": {
"identifier": {
"system": "https://fhir.nhs.uk/Id/nhs-number",
"value": "9999999999"
}
},
"dosageInstruction": [
{
"additionalInstruction": [
{
"text": "with dialysis"
}
],
"timing": {
"repeat": {
"frequency": 1,
"period": 1,
"periodUnit": "d",
"dayOfWeek": [
"mon",
"thu"
]
}
},
"route": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "34206005",
"display": "subcutaneous route"
}
]
},
"method": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "422145002",
"display": "inject"
}
]
}
}
]
}
MedicationRequest.id[0]808e7672-cf8d-48d8-885b-694c9bb9a417
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]2971511000001101
MedicationRequest.contained[0].code[0].coding[0].display[0]Eprex 2,000units/0.5ml solution for injection pre-filled syringes (Janssen-Cilag Ltd)
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].text[0]with dialysis
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].frequency[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].period[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].periodUnit[0]d
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].dayOfWeek[0]mon
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].dayOfWeek[1]thu
MedicationRequest.dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].route[0].coding[0].code[0]34206005
MedicationRequest.dosageInstruction[0].route[0].coding[0].display[0]subcutaneous route
MedicationRequest.dosageInstruction[0].method[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].method[0].coding[0].code[0]422145002
MedicationRequest.dosageInstruction[0].method[0].coding[0].display[0]inject
MedicationRequest

Hydrocortisone 0.1% cream, apply 2-3 times daily to area around lips

Product-based prescription (VMP) using patient instruction for site.
<MedicationRequest xmlns="http://hl7.org/fhir">
<id value="da60a842-d755-4fe6-a7eb-4cda52cf17f7" />
<contained>
<Medication>
<id value="med1" />
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="331680008" />
<display value="Hydrocortisone 0.1% cream" />
</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="Apply to area around lips" />
<timing>
<repeat>
<frequency value="2" />
<frequencyMax value="3" />
<period value="1" />
<periodUnit value="d" />
</repeat>
</timing>
<method>
<coding>
<system value="http://snomed.info/sct" />
<code value="417924000" />
<display value="Apply" />
</coding>
</method>
</dosageInstruction>
</MedicationRequest>
{
"resourceType": "MedicationRequest",
"id": "da60a842-d755-4fe6-a7eb-4cda52cf17f7",
"contained": [
{
"resourceType": "Medication",
"id": "med1",
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "331680008",
"display": "Hydrocortisone 0.1% cream"
}
]
}
}
],
"status": "active",
"intent": "order",
"medicationReference": {
"reference": "#med1"
},
"subject": {
"identifier": {
"system": "https://fhir.nhs.uk/Id/nhs-number",
"value": "9999999999"
}
},
"dosageInstruction": [
{
"patientInstruction": "Apply to area around lips",
"timing": {
"repeat": {
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"frequencyMax": 3,
"period": 1,
"periodUnit": "d"
}
},
"method": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "417924000",
"display": "Apply"
}
]
}
}
]
}
MedicationRequest.id[0]da60a842-d755-4fe6-a7eb-4cda52cf17f7
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]331680008
MedicationRequest.contained[0].code[0].coding[0].display[0]Hydrocortisone 0.1% cream
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]Apply to area around lips
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].frequency[0]2
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].frequencyMax[0]3
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].period[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].periodUnit[0]d
MedicationRequest.dosageInstruction[0].method[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].method[0].coding[0].code[0]417924000
MedicationRequest.dosageInstruction[0].method[0].coding[0].display[0]Apply
MedicationRequest

NovoRapid Penfill 100units/ml solution for injection 3ml cartridges (Novo Nordisk Ltd), inject according to insulin requirements

Product-based AMP prescription using patient instructions.
<MedicationRequest xmlns="http://hl7.org/fhir">
<id value="9599bbbd-5fb0-429b-ba24-bca6448f521a" />
<contained>
<Medication>
<id value="med1" />
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="3279211000001105" />
<display value="NovoRapid Penfill 100units/ml solution for injection 3ml cartridges (Novo Nordisk Ltd)" />
</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="according to insulin requirements" />
<asNeededBoolean value="true" />
<method>
<coding>
<system value="http://snomed.info/sct" />
<code value="422145002" />
<display value="inject" />
</coding>
</method>
</dosageInstruction>
</MedicationRequest>
{
"resourceType": "MedicationRequest",
"id": "9599bbbd-5fb0-429b-ba24-bca6448f521a",
"contained": [
{
"resourceType": "Medication",
"id": "med1",
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "3279211000001105",
"display": "NovoRapid Penfill 100units/ml solution for injection 3ml cartridges (Novo Nordisk Ltd)"
}
]
}
}
],
"status": "active",
"intent": "order",
"medicationReference": {
"reference": "#med1"
},
"subject": {
"identifier": {
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"value": "9999999999"
}
},
"dosageInstruction": [
{
"patientInstruction": "according to insulin requirements",
"asNeededBoolean": true,
"method": {
"coding": [
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}
]
}
}
]
}
MedicationRequest.id[0]9599bbbd-5fb0-429b-ba24-bca6448f521a
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]3279211000001105
MedicationRequest.contained[0].code[0].coding[0].display[0]NovoRapid Penfill 100units/ml solution for injection 3ml cartridges (Novo Nordisk Ltd)
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]according to insulin requirements
MedicationRequest.dosageInstruction[0].asNeeded[0]True
MedicationRequest.dosageInstruction[0].method[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].method[0].coding[0].code[0]422145002
MedicationRequest.dosageInstruction[0].method[0].coding[0].display[0]inject
MedicationRequest

Oxygen by inhalation 1 to 2 litres per minute via nasal cannula

Dose-based (VMP) dose expressed as a rate. Device expressed as additional instruction.
<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="375287000" />
<display value="Oxygen" />
</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>
<text value="to be given via nasal cannula" />
</additionalInstruction>
<route>
<coding>
<system value="http://snomed.info/sct" />
<code value="18679011000001101" />
<display value="Inhalation" />
</coding>
</route>
<doseRange>
<low>
<value value="1" />
<unit value="liter per minute" />
<system value="http://unitsofmeasure.org" />
<code value="L/min" />
</low>
<high>
<value value="2" />
<unit value="liter per minute" />
<system value="http://unitsofmeasure.org" />
<code value="L/min" />
</high>
</doseRange>
</dosageInstruction>
</MedicationRequest>
{
"resourceType": "MedicationRequest",
"id": "a8ca980c-72aa-11e7-8cf7-a6006ad3dba0",
"contained": [
{
"resourceType": "Medication",
"id": "med1",
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "375287000",
"display": "Oxygen"
}
]
}
}
],
"status": "active",
"intent": "order",
"medicationReference": {
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},
"subject": {
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"value": "9999999999"
}
},
"dosageInstruction": [
{
"additionalInstruction": [
{
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}
],
"route": {
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"code": "18679011000001101",
"display": "Inhalation"
}
]
},
"doseRange": {
"low": {
"value": 1,
"unit": "liter per minute",
"system": "http://unitsofmeasure.org",
"code": "L/min"
},
"high": {
"value": 2,
"unit": "liter per minute",
"system": "http://unitsofmeasure.org",
"code": "L/min"
}
}
}
]
}
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]375287000
MedicationRequest.contained[0].code[0].coding[0].display[0]Oxygen
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].text[0]to be given via nasal cannula
MedicationRequest.dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].route[0].coding[0].code[0]18679011000001101
MedicationRequest.dosageInstruction[0].route[0].coding[0].display[0]Inhalation
MedicationRequest.dosageInstruction[0].dose[0].low[0].value[0]1
MedicationRequest.dosageInstruction[0].dose[0].low[0].unit[0]liter per minute
MedicationRequest.dosageInstruction[0].dose[0].low[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[0].dose[0].low[0].code[0]L/min
MedicationRequest.dosageInstruction[0].dose[0].high[0].value[0]2
MedicationRequest.dosageInstruction[0].dose[0].high[0].unit[0]liter per minute
MedicationRequest.dosageInstruction[0].dose[0].high[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[0].dose[0].high[0].code[0]L/min
MedicationRequest

Salbutamol, 5mg to be given via a nebuliser. Repeat every 20-30 minutes as required

Dose-based prescription (VTM) using additional instruction for device and dose timing as a range.
<MedicationRequest xmlns="http://hl7.org/fhir">
<id value="c4f1f082-75b2-4642-b1da-df15868467d6" />
<contained>
<Medication>
<id value="med1" />
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="91143003" />
<display value="Salbutamol" />
</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>
<text value="to be given via a nebuliser" />
</additionalInstruction>
<timing>
<repeat>
<frequency value="1" />
<period value="20" />
<periodMax value="30" />
<periodUnit value="min" />
</repeat>
</timing>
<asNeededBoolean value="true" />
<route>
<coding>
<system value="http://snomed.info/sct" />
<code value="18679011000001101" />
<display value="inhalation" />
</coding>
</route>
<doseQuantity>
<value value="5" />
<unit value="milligram" />
<system value="http://unitsofmeasure.org" />
<code value="mg" />
</doseQuantity>
</dosageInstruction>
</MedicationRequest>
{
"resourceType": "MedicationRequest",
"id": "c4f1f082-75b2-4642-b1da-df15868467d6",
"contained": [
{
"resourceType": "Medication",
"id": "med1",
"code": {
"coding": [
{
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"code": "91143003",
"display": "Salbutamol"
}
]
}
}
],
"status": "active",
"intent": "order",
"medicationReference": {
"reference": "#med1"
},
"subject": {
"identifier": {
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"value": "9999999999"
}
},
"dosageInstruction": [
{
"additionalInstruction": [
{
"text": "to be given via a nebuliser"
}
],
"timing": {
"repeat": {
"frequency": 1,
"period": 20,
"periodMax": 30,
"periodUnit": "min"
}
},
"asNeededBoolean": true,
"route": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "18679011000001101",
"display": "inhalation"
}
]
},
"doseQuantity": {
"value": 5,
"unit": "milligram",
"system": "http://unitsofmeasure.org",
"code": "mg"
}
}
]
}
MedicationRequest.id[0]c4f1f082-75b2-4642-b1da-df15868467d6
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]91143003
MedicationRequest.contained[0].code[0].coding[0].display[0]Salbutamol
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].text[0]to be given via a nebuliser
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].frequency[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].period[0]20
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].periodMax[0]30
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].periodUnit[0]min
MedicationRequest.dosageInstruction[0].asNeeded[0]True
MedicationRequest.dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].route[0].coding[0].code[0]18679011000001101
MedicationRequest.dosageInstruction[0].route[0].coding[0].display[0]inhalation
MedicationRequest.dosageInstruction[0].dose[0].value[0]5
MedicationRequest.dosageInstruction[0].dose[0].unit[0]milligram
MedicationRequest.dosageInstruction[0].dose[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[0].dose[0].code[0]mg
MedicationRequest

Salbutamol, 100-200mcg to be inhaled when required up to 4 times daily, using the metered dose device

Dose-based prescription (VTM) using additional instruction for device.
<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="91143003" />
<display value="Salbutamol" />
</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>
<text value="using the metered dose device" />
</additionalInstruction>
<asNeededBoolean value="true" />
<route>
<coding>
<system value="http://snomed.info/sct" />
<code value="18679011000001101" />
<display value="inhalation" />
</coding>
</route>
<doseRange>
<low>
<value value="100" />
<unit value="microgram" />
<system value="http://unitsofmeasure.org" />
<code value="ug" />
</low>
<high>
<value value="200" />
<unit value="microgram" />
<system value="http://unitsofmeasure.org" />
<code value="ug" />
</high>
</doseRange>
<maxDosePerPeriod>
<numerator>
<value value="4" />
<unit value="dose" />
<system value="http://snomed.info/sct" />
<code value="3317411000001100" />
</numerator>
<denominator>
<value value="1" />
<unit value="day" />
<system value="http://unitsofmeasure.org" />
<code value="d" />
</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": "91143003",
"display": "Salbutamol"
}
]
}
}
],
"status": "active",
"intent": "order",
"medicationReference": {
"reference": "#med1"
},
"subject": {
"identifier": {
"system": "https://fhir.nhs.uk/Id/nhs-number",
"value": "9999999999"
}
},
"dosageInstruction": [
{
"additionalInstruction": [
{
"text": "using the metered dose device"
}
],
"asNeededBoolean": true,
"route": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "18679011000001101",
"display": "inhalation"
}
]
},
"doseRange": {
"low": {
"value": 100,
"unit": "microgram",
"system": "http://unitsofmeasure.org",
"code": "ug"
},
"high": {
"value": 200,
"unit": "microgram",
"system": "http://unitsofmeasure.org",
"code": "ug"
}
},
"maxDosePerPeriod": {
"numerator": {
"value": 4,
"unit": "dose",
"system": "http://snomed.info/sct",
"code": "3317411000001100"
},
"denominator": {
"value": 1,
"unit": "day",
"system": "http://unitsofmeasure.org",
"code": "d"
}
}
}
]
}
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]91143003
MedicationRequest.contained[0].code[0].coding[0].display[0]Salbutamol
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].text[0]using the metered dose device
MedicationRequest.dosageInstruction[0].asNeeded[0]True
MedicationRequest.dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].route[0].coding[0].code[0]18679011000001101
MedicationRequest.dosageInstruction[0].route[0].coding[0].display[0]inhalation
MedicationRequest.dosageInstruction[0].dose[0].low[0].value[0]100
MedicationRequest.dosageInstruction[0].dose[0].low[0].unit[0]microgram
MedicationRequest.dosageInstruction[0].dose[0].low[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[0].dose[0].low[0].code[0]ug
MedicationRequest.dosageInstruction[0].dose[0].high[0].value[0]200
MedicationRequest.dosageInstruction[0].dose[0].high[0].unit[0]microgram
MedicationRequest.dosageInstruction[0].dose[0].high[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[0].dose[0].high[0].code[0]ug
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].value[0]4
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]1
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].unit[0]day
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].code[0]d
MedicationRequest

Migraleve tablets (McNeil Products Ltd), initially 2 pink tablets to be taken at onset of attack followed by 2 yellow tablets every 4 hours if required. maximum 2 pink and 6 yellow tablets in 24 hours

Product-based prescription (VMP) using free text additional instruction.

Complex because specific instructions related to combination products is not currently supported within the STU3 Dosage structure.

<MedicationRequest xmlns="http://hl7.org/fhir">
<id value="859e5d8a-391a-4b2a-8f29-15e8c75180bb" />
<contained>
<Medication>
<id value="internalMedicationIdentifer123abc" />
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="3363411000001108" />
<display value="Migraleve tablets (McNeil Products Ltd)" />
</coding>
</code>
</Medication>
</contained>
<status value="active" />
<intent value="order" />
<medicationReference>
<reference value="#internalMedicationIdentifer123abc" />
<display value="Migraleve tablets (McNeil Products Ltd)" />
</medicationReference>
<subject>
<identifier>
<system value="https://fhir.nhs.uk/Id/nhs-number" />
<value value="9999999999" />
</identifier>
</subject>
<dosageInstruction>
<sequence value="1" />
<text value="2 tablets - take once - as required when migraine occurs - Max dose 2 tablets in 24 hours - Pink tablet" />
<additionalInstruction>
<text value="Pink tablets" />
</additionalInstruction>
<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="2" />
<unit value="tablet" />
<system value="http://snomed.info/sct" />
<code value="428673006" />
</numerator>
<denominator>
<value value="24" />
<unit value="hour" />
<system value="http://unitsofmeasure.org" />
<code value="h" />
</denominator>
</maxDosePerPeriod>
</dosageInstruction>
<dosageInstruction>
<sequence value="2" />
<text value="2 tablets - every 4 hours - as required - max dose 6 tablets in 24 hours - Yellow tablets" />
<additionalInstruction>
<text value="Yellow tablets" />
</additionalInstruction>
<timing>
<repeat>
<frequency value="1" />
<period value="4" />
<periodUnit value="h" />
</repeat>
</timing>
<asNeededBoolean value="true" />
<doseQuantity>
<value value="2" />
<unit value="tablet" />
<system value="http://snomed.info/sct" />
<code value="428673006" />
</doseQuantity>
<maxDosePerPeriod>
<numerator>
<value value="6" />
<unit value="tablet" />
<system value="http://snomed.info/sct" />
<code value="428673006" />
</numerator>
<denominator>
<value value="24" />
<unit value="hour" />
<system value="http://unitsofmeasure.org" />
<code value="h" />
</denominator>
</maxDosePerPeriod>
</dosageInstruction>
</MedicationRequest>
{
"resourceType": "MedicationRequest",
"id": "859e5d8a-391a-4b2a-8f29-15e8c75180bb",
"contained": [
{
"resourceType": "Medication",
"id": "internalMedicationIdentifer123abc",
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "3363411000001108",
"display": "Migraleve tablets (McNeil Products Ltd)"
}
]
}
}
],
"status": "active",
"intent": "order",
"medicationReference": {
"reference": "#internalMedicationIdentifer123abc",
"display": "Migraleve tablets (McNeil Products Ltd)"
},
"subject": {
"identifier": {
"system": "https://fhir.nhs.uk/Id/nhs-number",
"value": "9999999999"
}
},
"dosageInstruction": [
{
"sequence": 1,
"text": "2 tablets - take once - as required when migraine occurs - Max dose 2 tablets in 24 hours - Pink tablet",
"additionalInstruction": [
{
"text": "Pink tablets"
}
],
"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": 2,
"unit": "tablet",
"system": "http://snomed.info/sct",
"code": "428673006"
},
"denominator": {
"value": 24,
"unit": "hour",
"system": "http://unitsofmeasure.org",
"code": "h"
}
}
},
{
"sequence": 2,
"text": "2 tablets - every 4 hours - as required - max dose 6 tablets in 24 hours - Yellow tablets",
"additionalInstruction": [
{
"text": "Yellow tablets"
}
],
"timing": {
"repeat": {
"frequency": 1,
"period": 4,
"periodUnit": "h"
}
},
"asNeededBoolean": true,
"doseQuantity": {
"value": 2,
"unit": "tablet",
"system": "http://snomed.info/sct",
"code": "428673006"
},
"maxDosePerPeriod": {
"numerator": {
"value": 6,
"unit": "tablet",
"system": "http://snomed.info/sct",
"code": "428673006"
},
"denominator": {
"value": 24,
"unit": "hour",
"system": "http://unitsofmeasure.org",
"code": "h"
}
}
}
]
}
MedicationRequest.id[0]859e5d8a-391a-4b2a-8f29-15e8c75180bb
MedicationRequest.contained[0].id[0]internalMedicationIdentifer123abc
MedicationRequest.contained[0].code[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.contained[0].code[0].coding[0].code[0]3363411000001108
MedicationRequest.contained[0].code[0].coding[0].display[0]Migraleve tablets (McNeil Products Ltd)
MedicationRequest.status[0]active
MedicationRequest.intent[0]order
MedicationRequest.medication[0].reference[0]#internalMedicationIdentifer123abc
MedicationRequest.medication[0].display[0]Migraleve tablets (McNeil Products Ltd)
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].text[0]2 tablets - take once - as required when migraine occurs - Max dose 2 tablets in 24 hours - Pink tablet
MedicationRequest.dosageInstruction[0].additionalInstruction[0].text[0]Pink tablets
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]2
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].unit[0]tablet
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].code[0]428673006
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].text[0]2 tablets - every 4 hours - as required - max dose 6 tablets in 24 hours - Yellow tablets
MedicationRequest.dosageInstruction[1].additionalInstruction[0].text[0]Yellow tablets
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].asNeeded[0]True
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]tablet
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].code[0]428673006
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
STU3 Dosage current limiation - Specific instructions related to combination products

Phenoxymethylpenicillin 250mg tablets, 2 tablets every 6 hours an hour before food or on an empty stomach, oral

Product -based prescription (VMP) using free text additional instruction.

Complex because “on an empty stomach” is not a coded SNOMED-CT code nor in a FHIR value-set.

To avoid confusion with a coded “before food”, the complete instruction “an hour before food or on an empty stomach” is conveyed as free-text within additionalInstruction.

<MedicationRequest xmlns="http://hl7.org/fhir">
<id value="5dcc8ffd-9838-45ed-8d31-fd20026fde4b" />
<contained>
<Medication>
<id value="med1" />
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="323416001" />
<display value="Phenoxymethylpenicillin 250mg 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>
<text value="an hour before food or on an empty stomach" />
</additionalInstruction>
<timing>
<repeat>
<frequency value="1" />
<period value="6" />
<periodUnit value="h" />
<when value="AC" />
<offset value="60" />
</repeat>
</timing>
<route>
<coding>
<system value="http://snomed.info/sct" />
<code value="26643006" />
<display value="oral" />
</coding>
</route>
<doseQuantity>
<value value="2" />
<unit value="tablet" />
<system value="http://snomed.info/sct" />
<code value="428673006" />
</doseQuantity>
</dosageInstruction>
</MedicationRequest>
{
"resourceType": "MedicationRequest",
"id": "5dcc8ffd-9838-45ed-8d31-fd20026fde4b",
"contained": [
{
"resourceType": "Medication",
"id": "med1",
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "323416001",
"display": "Phenoxymethylpenicillin 250mg tablets"
}
]
}
}
],
"status": "active",
"intent": "order",
"medicationReference": {
"reference": "#med1"
},
"subject": {
"identifier": {
"system": "https://fhir.nhs.uk/Id/nhs-number",
"value": "9999999999"
}
},
"dosageInstruction": [
{
"additionalInstruction": [
{
"text": "an hour before food or on an empty stomach"
}
],
"timing": {
"repeat": {
"frequency": 1,
"period": 6,
"periodUnit": "h",
"when": [
"AC"
],
"offset": 60
}
},
"route": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "26643006",
"display": "oral"
}
]
},
"doseQuantity": {
"value": 2,
"unit": "tablet",
"system": "http://snomed.info/sct",
"code": "428673006"
}
}
]
}
MedicationRequest.id[0]5dcc8ffd-9838-45ed-8d31-fd20026fde4b
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]323416001
MedicationRequest.contained[0].code[0].coding[0].display[0]Phenoxymethylpenicillin 250mg 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].additionalInstruction[0].text[0]an hour before food or on an empty stomach
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].frequency[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].period[0]6
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].periodUnit[0]h
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].when[0]AC
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].offset[0]60
MedicationRequest.dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].route[0].coding[0].code[0]26643006
MedicationRequest.dosageInstruction[0].route[0].coding[0].display[0]oral
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

Avloclor 250mg tablets (Alliance Pharmaceuticals Ltd), two to be taken once a week, start one week before travel and continue until 4 weeks after return

Product-based prescription (AMP) using patient instruction for start and duration.

Complex because the instruction to “start one week before travel and continue until 4 weeks after return” cannot be a coded instruction so is conveyed as free-text within patientlInstruction.

<MedicationRequest xmlns="http://hl7.org/fhir">
<id value="1d0bc824-f2bf-42c8-b7f9-954e7f6bbd98" />
<contained>
<Medication>
<id value="med1" />
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="3727711000001102" />
<display value="Avloclor 250mg tablets (Alliance Pharmaceuticals Ltd)" />
</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="start one week before travel and continue until 4 weeks after return" />
<timing>
<repeat>
<frequency value="1" />
<period value="1" />
<periodUnit value="wk" />
</repeat>
</timing>
<doseQuantity>
<value value="2" />
<unit value="tablet" />
<system value="http://snomed.info/sct" />
<code value="428673006" />
</doseQuantity>
</dosageInstruction>
</MedicationRequest>
{
"resourceType": "MedicationRequest",
"id": "1d0bc824-f2bf-42c8-b7f9-954e7f6bbd98",
"contained": [
{
"resourceType": "Medication",
"id": "med1",
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "3727711000001102",
"display": "Avloclor 250mg tablets (Alliance Pharmaceuticals Ltd)"
}
]
}
}
],
"status": "active",
"intent": "order",
"medicationReference": {
"reference": "#med1"
},
"subject": {
"identifier": {
"system": "https://fhir.nhs.uk/Id/nhs-number",
"value": "9999999999"
}
},
"dosageInstruction": [
{
"patientInstruction": "start one week before travel and continue until 4 weeks after return",
"timing": {
"repeat": {
"frequency": 1,
"period": 1,
"periodUnit": "wk"
}
},
"doseQuantity": {
"value": 2,
"unit": "tablet",
"system": "http://snomed.info/sct",
"code": "428673006"
}
}
]
}
MedicationRequest.id[0]1d0bc824-f2bf-42c8-b7f9-954e7f6bbd98
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]3727711000001102
MedicationRequest.contained[0].code[0].coding[0].display[0]Avloclor 250mg tablets (Alliance Pharmaceuticals Ltd)
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]start one week before travel and continue until 4 weeks after return
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].frequency[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].period[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].periodUnit[0]wk
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

Permitabs 400mg tablets. Add 500ml of warm water to one tablet and dissolve. Make the resulting solution up to 8 litres and use to soak feet.

Product-based prescription with patient instruction for preparation.

Complex because contains a detailed preparation instruction which has to be conveyed as free-text within patientInstruction.

<MedicationRequest xmlns="http://hl7.org/fhir">
<id value="1f4959a1-4a33-4b0e-bfad-f2ea1fccb2fa" />
<contained>
<Medication>
<id value="med1" />
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="4256811000001101" />
<display value="Permitabs 400mg tablets for cutaneous solution (Alliance Pharmaceuticals Ltd)" />
</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="Add 500ml of warm water to one tablet and dissolve. Make the resulting solution up to 8 litres and use to soak feet." />
</dosageInstruction>
</MedicationRequest>
{
"resourceType": "MedicationRequest",
"id": "1f4959a1-4a33-4b0e-bfad-f2ea1fccb2fa",
"contained": [
{
"resourceType": "Medication",
"id": "med1",
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "4256811000001101",
"display": "Permitabs 400mg tablets for cutaneous solution (Alliance Pharmaceuticals Ltd)"
}
]
}
}
],
"status": "active",
"intent": "order",
"medicationReference": {
"reference": "#med1"
},
"subject": {
"identifier": {
"system": "https://fhir.nhs.uk/Id/nhs-number",
"value": "9999999999"
}
},
"dosageInstruction": [
{
"patientInstruction": "Add 500ml of warm water to one tablet and dissolve. Make the resulting solution up to 8 litres and use to soak feet."
}
]
}
MedicationRequest.id[0]1f4959a1-4a33-4b0e-bfad-f2ea1fccb2fa
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]4256811000001101
MedicationRequest.contained[0].code[0].coding[0].display[0]Permitabs 400mg tablets for cutaneous solution (Alliance Pharmaceuticals Ltd)
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]Add 500ml of warm water to one tablet and dissolve. Make the resulting solution up to 8 litres and use to soak feet.
MedicationRequest
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