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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