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.

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
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