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.

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. 
<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="dbb7e3b2-0cfa-4cff-b31b-3a9087bdd83b" />
    <contained>
        <Medication>
            <id value="med1" />
            <code>
                <coding>
                    <system value="http://snomed.info/sct" />
                    <code value="317378005" />
                    <display value="Loperamide 2mg capsules" />
                </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" />
        <additionalInstruction>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="421723005" />
                <display value="Now" />
            </coding>
        </additionalInstruction>
        <doseQuantity>
            <value value="2" />
            <unit value="capsule" />
            <system value="http://snomed.info/sct" />
            <code value="428641000" />
        </doseQuantity>
        <maxDosePerPeriod>
            <numerator>
                <value value="8" />
                <unit value="capsule" />
                <system value="http://snomed.info/sct" />
                <code value="428641000" />
            </numerator>
            <denominator>
                <value value="1" />
                <unit value="day" />
                <system value="http://unitsofmeasure.org/" />
                <code value="d" />
            </denominator>
        </maxDosePerPeriod>
    </dosageInstruction>
    <dosageInstruction>
        <sequence value="2" />
        <asNeededCodeableConcept>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="62315008" />
                <display value="Diarrhea" />
            </coding>
        </asNeededCodeableConcept>
        <doseQuantity>
            <value value="1" />
            <unit value="capsule" />
            <system value="http://snomed.info/sct" />
            <code value="428641000" />
        </doseQuantity>
        <maxDosePerPeriod>
            <numerator>
                <value value="8" />
                <unit value="capsule" />
                <system value="http://snomed.info/sct" />
                <code value="428641000" />
            </numerator>
            <denominator>
                <value value="1" />
                <unit value="day" />
                <system value="http://unitsofmeasure.org/" />
                <code value="d" />
            </denominator>
        </maxDosePerPeriod>
    </dosageInstruction>
</MedicationRequest>

{
    "resourceType": "MedicationRequest",
    "id": "dbb7e3b2-0cfa-4cff-b31b-3a9087bdd83b",
    "contained":  [
        {
            "resourceType": "Medication",
            "id": "med1",
            "code": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "317378005",
                        "display": "Loperamide 2mg capsules"
                    }
                ]
            }
        }
    ],
    "status": "active",
    "intent": "order",
    "medicationReference": {
        "reference": "#med1"
    },
    "subject": {
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9999999999"
        }
    },
    "dosageInstruction":  [
        {
            "sequence": 1,
            "additionalInstruction":  [
                {
                    "coding":  [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "421723005",
                            "display": "Now"
                        }
                    ]
                }
            ],
            "doseQuantity": {
                "value": 2,
                "unit": "capsule",
                "system": "http://snomed.info/sct",
                "code": "428641000"
            },
            "maxDosePerPeriod": {
                "numerator": {
                    "value": 8,
                    "unit": "capsule",
                    "system": "http://snomed.info/sct",
                    "code": "428641000"
                },
                "denominator": {
                    "value": 1,
                    "unit": "day",
                    "system": "http://unitsofmeasure.org/",
                    "code": "d"
                }
            }
        },
        {
            "sequence": 2,
            "asNeededCodeableConcept": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "62315008",
                        "display": "Diarrhea"
                    }
                ]
            },
            "doseQuantity": {
                "value": 1,
                "unit": "capsule",
                "system": "http://snomed.info/sct",
                "code": "428641000"
            },
            "maxDosePerPeriod": {
                "numerator": {
                    "value": 8,
                    "unit": "capsule",
                    "system": "http://snomed.info/sct",
                    "code": "428641000"
                },
                "denominator": {
                    "value": 1,
                    "unit": "day",
                    "system": "http://unitsofmeasure.org/",
                    "code": "d"
                }
            }
        }
    ]
}
MedicationRequest.id[0]dbb7e3b2-0cfa-4cff-b31b-3a9087bdd83b
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]317378005
MedicationRequest.contained[0].code[0].coding[0].display[0]Loperamide 2mg capsules
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].additionalInstruction[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].additionalInstruction[0].coding[0].code[0]421723005
MedicationRequest.dosageInstruction[0].additionalInstruction[0].coding[0].display[0]Now
MedicationRequest.dosageInstruction[0].dose[0].value[0]2
MedicationRequest.dosageInstruction[0].dose[0].unit[0]capsule
MedicationRequest.dosageInstruction[0].dose[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].dose[0].code[0]428641000
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].value[0]8
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].unit[0]capsule
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].code[0]428641000
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.dosageInstruction[1].sequence[0]2
MedicationRequest.dosageInstruction[1].asNeeded[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[1].asNeeded[0].coding[0].code[0]62315008
MedicationRequest.dosageInstruction[1].asNeeded[0].coding[0].display[0]Diarrhea
MedicationRequest.dosageInstruction[1].dose[0].value[0]1
MedicationRequest.dosageInstruction[1].dose[0].unit[0]capsule
MedicationRequest.dosageInstruction[1].dose[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[1].dose[0].code[0]428641000
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].value[0]8
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].unit[0]capsule
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].code[0]428641000
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].denominator[0].value[0]1
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].denominator[0].unit[0]day
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].denominator[0].system[0]http://unitsofmeasure.org/
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].denominator[0].code[0]d
MedicationRequest
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