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.

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
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