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.

Levothyroxine 100mcg on one day alternating with 125mcg on another day

The dose should be 100mcg/125mcg, and it the label on the dispensed item for the patient will likely by a VTM such as:

Levothyroxine sodium 100mcg tablets - one to be taken daily and Levothyroxine sodium 25mcg tablets - one to be taken on alternate days

To account for this, the example below shows how to describe a dose instruction containing concurrent sequences.

<MedicationRequest xmlns="http://hl7.org/fhir">
<id value="efaae147-81bb-4abd-b1d4-dd394a7ffc0c" />
<Medication>
<id value="med1" />
<system value="http://snomed.info/sct" />
<code value="126202002" />
<display value="Levothyroxine sodium" />
</coding>
</code>
</Medication>
</contained>
<status value="active" />
<intent value="order" />
<reference value="#med1" />
</medicationReference>
<system value="https://fhir.nhs.uk/Id/nhs-number" />
<value value="4857773456" />
</identifier>
</subject>
<sequence value="1" />
<frequency value="1" />
<period value="1" />
<periodUnit value="d" />
</repeat>
</timing>
<value value="100" />
<unit value="microgram" />
<system value="http://unitsofmeasure.org" />
<code value="ug" />
</doseQuantity>
</dosageInstruction>
<sequence value="1" />
<frequency value="1" />
<period value="2" />
<periodUnit value="d" />
</repeat>
</timing>
<value value="25" />
<unit value="microgram" />
<system value="http://unitsofmeasure.org" />
<code value="ug" />
</doseQuantity>
</dosageInstruction>
</MedicationRequest>
{
"resourceType": "MedicationRequest",
"id": "efaae147-81bb-4abd-b1d4-dd394a7ffc0c",
{
"resourceType": "Medication",
"id": "med1",
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "126202002",
"display": "Levothyroxine sodium"
}
]
}
}
],
"status": "active",
"intent": "order",
"reference": "#med1"
},
"subject": {
"system": "https://fhir.nhs.uk/Id/nhs-number",
"value": "4857773456"
}
},
{
"sequence": 1,
"timing": {
"repeat": {
"frequency": 1,
"period": 1,
"periodUnit": "d"
}
},
"value": 100,
"unit": "microgram",
"system": "http://unitsofmeasure.org",
"code": "ug"
}
},
{
"sequence": 1,
"timing": {
"repeat": {
"frequency": 1,
"period": 2,
"periodUnit": "d"
}
},
"value": 25,
"unit": "microgram",
"system": "http://unitsofmeasure.org",
"code": "ug"
}
}
]
}
MedicationRequest.id[0]efaae147-81bb-4abd-b1d4-dd394a7ffc0c
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]126202002
MedicationRequest.contained[0].code[0].coding[0].display[0]Levothyroxine sodium
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]4857773456
MedicationRequest.dosageInstruction[0].sequence[0]1
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].dose[0].value[0]100
MedicationRequest.dosageInstruction[0].dose[0].unit[0]microgram
MedicationRequest.dosageInstruction[0].dose[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[0].dose[0].code[0]ug
MedicationRequest.dosageInstruction[1].sequence[0]1
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].frequency[0]1
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].period[0]2
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].periodUnit[0]d
MedicationRequest.dosageInstruction[1].dose[0].value[0]25
MedicationRequest.dosageInstruction[1].dose[0].unit[0]microgram
MedicationRequest.dosageInstruction[1].dose[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[1].dose[0].code[0]ug
MedicationRequest
Levothyroxine sodium - 100 microgram - once a day, and 25 microgram - every 2 days
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