SMIS API Guide

SMIS Medication Statement profile

Logical URI: http://smis.ch/fhir/StructureDefinition/MedicationStatement

Base Profile

The profile builds on MedicationStatement

MedicationStatement	I		http://hl7.org/fhir/StructureDefinition/DomainResource	Element id MedicationStatement Short description Record of medication being taken by a patient Definition A record of a medication that is being consumed by a patient. A MedicationStatement may indicate that the patient may be taking the medication now, or has taken the medication in the past or will be taking the medication in the future. The source of this information can be the patient, significant other (such as a family member or spouse), or a clinician. A common scenario where this information is captured is during the history taking process during a patient visit or stay. The medication information may come from sources such as the patient's memory, from a prescription bottle, or from a list of medications the patient, clinician or other party maintains The primary difference between a medication statement and a medication administration is that the medication administration has complete administration information and is based on actual administration information from the person who administered the medication. A medication statement is often, if not always, less specific. There is no required date/time when the medication was administered, in fact we only know that a source has reported the patient is taking this medication, where details such as time, quantity, or rate or even medication product may be incomplete or missing or less precise. As stated earlier, the medication statement information may come from the patient's memory, from a prescription bottle or from a list of medications the patient, clinician or other party maintains. Medication administration is more formal and is not missing detailed information. Comments When interpreting a medicationStatement, the value of the status and NotTaken needed to be considered: MedicationStatement.status + MedicationStatement.wasNotTaken Status=Active + NotTaken=T = Not currently taking Status=Completed + NotTaken=T = Not taken in the past Status=Intended + NotTaken=T = No intention of taking Status=Active + NotTaken=F = Taking, but not as prescribed Status=Active + NotTaken=F = Taking Status=Intended +NotTaken= F = Will be taking (not started) Status=Completed + NotTaken=F = Taken in past Status=In Error + NotTaken=N/A = In Error. Data type http://hl7.org/fhir/StructureDefinition/DomainResource Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative `contained.text.empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource `contained.where(('#'+id in %resource.descendants().reference).not()).empty()` mst-1: Reason not taken is only permitted if Taken is No `reasonNotTaken.exists().not() or (taken = 'n')` Mappings rim: Entity. Role, or Act workflow: ..Event rim: SubstanceAdministration w5: clinical.medication
id	Σ	0..1	id	There are no (further) constraints on this element Element id MedicationStatement.id Short description Logical id of this artifact Definition The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type id
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id MedicationStatement.meta Short description Metadata about the resource Definition The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource. Data type Meta
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id MedicationStatement.implicitRules Short description A set of rules under which this content was created Definition A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Comments Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation. Data type uri
language		0..1	codeBinding	There are no (further) constraints on this element Element id MedicationStatement.language Short description Language of the resource content Definition The base language in which the resource is written. Comments Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). Data type code Binding A human language. ?? (extensible)
text	I	0..1	Narrative	There are no (further) constraints on this element Element id MedicationStatement.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display Definition A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Comments Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later. Data type Narrative Mappings rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id MedicationStatement.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. Comments This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Data type Resource Mappings rim: Entity. Role, or Act rim: N/A
extension		0..*	Extension	There are no (further) constraints on this element Element id MedicationStatement.extension Short description Additional Content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Mappings rim: N/A
modifierExtension	?!	0..*	Extension	There are no (further) constraints on this element Element id MedicationStatement.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Mappings rim: N/A
identifier	Σ	0..*	Identifier	There are no (further) constraints on this element Element id MedicationStatement.identifier Short description External identifier Definition External identifier - FHIR will generate its own internal identifiers (probably URLs) which do not need to be explicitly managed by the resource. The identifier here is one that would be used by another non-FHIR system - for example an automated medication pump would provide a record each time it operated; an administration while the patient was off the ward might be made with a different system and entered after the event. Particularly important if these records have to be updated. Data type Identifier Mappings workflow: …identifer rim: .id w5: id
basedOn	Σ	0..*	Reference(http://hl7.org/fhir/StructureDefinition/MedicationRequest \| http://hl7.org/fhir/StructureDefinition/CarePlan \| http://hl7.org/fhir/StructureDefinition/ProcedureRequest \| http://hl7.org/fhir/StructureDefinition/ReferralRequest)	There are no (further) constraints on this element Element id MedicationStatement.basedOn Short description Fulfils plan, proposal or order Definition A plan, proposal or order that is fulfilled in whole or in part by this event. Requirements Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon. Data type Reference(http://hl7.org/fhir/StructureDefinition/MedicationRequest \| http://hl7.org/fhir/StructureDefinition/CarePlan \| http://hl7.org/fhir/StructureDefinition/ProcedureRequest \| http://hl7.org/fhir/StructureDefinition/ReferralRequest) Mappings workflow: …basedOn rim: .outboundRelationship[typeCode=FLFS].target[classCode=SBADM or PROC or PCPR or OBS, moodCode=RQO orPLAN or PRP]
partOf	Σ	0..*	Reference(http://hl7.org/fhir/StructureDefinition/MedicationAdministration \| http://hl7.org/fhir/StructureDefinition/MedicationDispense \| http://hl7.org/fhir/StructureDefinition/MedicationStatement \| http://hl7.org/fhir/StructureDefinition/Procedure \| http://hl7.org/fhir/StructureDefinition/Observation)	There are no (further) constraints on this element Element id MedicationStatement.partOf Short description Part of referenced event Definition A larger event of which this particular event is a component or step. Requirements This should not be used when indicating which resource a MedicationStatement has been derived from. If that is the use case, then MedicationStatement.derivedFrom should be used. Data type Reference(http://hl7.org/fhir/StructureDefinition/MedicationAdministration \| http://hl7.org/fhir/StructureDefinition/MedicationDispense \| http://hl7.org/fhir/StructureDefinition/MedicationStatement \| http://hl7.org/fhir/StructureDefinition/Procedure \| http://hl7.org/fhir/StructureDefinition/Observation) Mappings workflow: …part of rim: .outboundRelationship[typeCode=COMP]/target[classCode=SPLY or SBADM or PROC or OBS,moodCode=EVN]
context	Σ	0..1	Reference(http://hl7.org/fhir/StructureDefinition/Encounter \| http://hl7.org/fhir/StructureDefinition/EpisodeOfCare)	There are no (further) constraints on this element Element id MedicationStatement.context Short description Encounter / Episode associated with MedicationStatement Definition The encounter or episode of care that establishes the context for this MedicationStatement. Data type Reference(http://hl7.org/fhir/StructureDefinition/Encounter \| http://hl7.org/fhir/StructureDefinition/EpisodeOfCare) Mappings workflow: …context rim: .inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN, code="type of encounter or episode"]
status	Σ ?!	1..1	codeBinding	There are no (further) constraints on this element Element id MedicationStatement.status Short description active \| completed \| entered-in-error \| intended \| stopped \| on-hold Definition A code representing the patient or other source's judgment about the state of the medication used that this statement is about. Generally this will be active or completed. Comments MedicationStatement is a statement at a point in time. The status is only representative at the point when it was asserted. The value set for MedicationStatement.status contains codes that assert the status of the use of the medication by the patient (for example, stopped or on hold) as well as codes that assert the status of the medication statement itself (for example, entered in error). This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. Data type code Binding A coded concept indicating the current status of a MedicationStatement. ?? (required) Mappings workflow: …status rim: .statusCode w5: status
category	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id MedicationStatement.category Short description Type of medication usage Definition Indicates where type of medication statement and where the medication is expected to be consumed or administered. Data type CodeableConcept Binding A coded concept identifying where the medication included in the medicationstatement is expected to be consumed or administered ?? (preferred) Mappings rim: .inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="type of medication usage"].value w5: class
medication[x]	Σ	1..1		There are no (further) constraints on this element Element id MedicationStatement.medication[x] Short description What medication was taken Definition Identifies the medication being administered. This is either a link to a resource representing the details of the medication or a simple attribute carrying a code that identifies the medication from a known list of medications. Comments If only a code is specified, then it needs to be a code for a specific product. If more information is required, then the use of the medication resource is recommended. For example if you require form or lot number, then you must reference the Medication resource. . Binding A coded concept identifying the substance or product being taken. ?? (example) Mappings workflow: …code rim: .participation[typeCode=CSM].role[classCode=ADMM or MANU] w5: what
medicationCodeableConcept			CodeableConcept	There are no (further) constraints on this element Data type CodeableConcept
medicationReference			Reference(http://hl7.org/fhir/StructureDefinition/Medication)	There are no (further) constraints on this element Data type Reference(http://hl7.org/fhir/StructureDefinition/Medication)
effective[x]	Σ	0..1		There are no (further) constraints on this element Element id MedicationStatement.effective[x] Short description The date/time or interval when the medication was taken Definition The interval of time during which it is being asserted that the patient was taking the medication (or was not taking, when the wasNotGiven element is true). Comments This attribute reflects the period over which the patient consumed the medication and is expected to be populated on the majority of Medication Statements. If the medication is still being taken at the time the statement is recorded, the "end" date will be omitted. Mappings workflow: …occurrence[x] rim: .effectiveTime w5: when.done
effectiveDateTime			dateTime	There are no (further) constraints on this element Data type dateTime
effectivePeriod			Period	There are no (further) constraints on this element Data type Period
dateAsserted	Σ	0..1	dateTime	There are no (further) constraints on this element Element id MedicationStatement.dateAsserted Short description When the statement was asserted? Definition The date when the medication statement was asserted by the information source. Data type dateTime Mappings rim: .participation[typeCode=AUT].time w5: when.recorded
informationSource		0..1	Reference(http://hl7.org/fhir/StructureDefinition/Patient \| http://hl7.org/fhir/StructureDefinition/Practitioner \| http://hl7.org/fhir/StructureDefinition/RelatedPerson \| http://hl7.org/fhir/StructureDefinition/Organization)	There are no (further) constraints on this element Element id MedicationStatement.informationSource Short description Person or organization that provided the information about the taking of this medication Definition The person or organization that provided the information about the taking of this medication. Note: Use derivedFrom when a MedicationStatement is derived from other resources, e.g Claim or MedicationRequest. Data type Reference(http://hl7.org/fhir/StructureDefinition/Patient \| http://hl7.org/fhir/StructureDefinition/Practitioner \| http://hl7.org/fhir/StructureDefinition/RelatedPerson \| http://hl7.org/fhir/StructureDefinition/Organization) Mappings rim: .participation[typeCode=INF].role[classCode=PAT, or codes for Practioner or Related Person (if PAT is the informer, then syntax for self-reported =true) w5: who.source
subject	Σ	1..1	Reference(http://hl7.org/fhir/StructureDefinition/Patient \| http://hl7.org/fhir/StructureDefinition/Group)	There are no (further) constraints on this element Element id MedicationStatement.subject Short description Who is/was taking the medication Definition The person, animal or group who is/was taking the medication. Data type Reference(http://hl7.org/fhir/StructureDefinition/Patient \| http://hl7.org/fhir/StructureDefinition/Group) Mappings workflow: …subject v2: PID-3-Patient ID List rim: .participation[typeCode=SBJ].role[classCode=PAT] w5: who
derivedFrom		0..*	Reference(http://hl7.org/fhir/StructureDefinition/Resource)	There are no (further) constraints on this element Element id MedicationStatement.derivedFrom Short description Additional supporting information Definition Allows linking the MedicationStatement to the underlying MedicationRequest, or to other information that supports or is used to derive the MedicationStatement. Comments Likely references would be to MedicationRequest, MedicationDispense, Claim, Observation or QuestionnaireAnswers. The most common use cases for deriving a MedicationStatement comes from creating a MedicationStatement from a MedicationRequest or from a lab observation or a claim. it should be noted that the amount of information that is available varies from the type resource that you derive the MedicationStatement from. Data type Reference(http://hl7.org/fhir/StructureDefinition/Resource) Mappings rim: .outboundRelationship[typeCode=SPRT]/target[classCode=ACT,moodCode=EVN]
taken	Σ ?!	1..1	codeBinding	There are no (further) constraints on this element Element id MedicationStatement.taken Short description y \| n \| unk \| na Definition Indicator of the certainty of whether the medication was taken by the patient. Comments This element is labeled as a modifier because it indicates that the medication was not taken. Data type code Binding A coded concept identifying level of certainty if patient has taken or has not taken the medication ?? (required) Mappings workflow: …notDone rim: .actionNegationInd
reasonNotTaken	I	0..*	CodeableConcept	There are no (further) constraints on this element Element id MedicationStatement.reasonNotTaken Short description True if asserting medication was not given Definition A code indicating why the medication was not taken. Data type CodeableConcept Binding A coded concept indicating the reason why the medication was not taken ?? (example) Mappings rim: .outboundRelationship[typeCode=RSON]/target[classCode=OBS,moodCode=EVN, code="reason not taken"].value
reasonCode		0..*	CodeableConcept	There are no (further) constraints on this element Element id MedicationStatement.reasonCode Short description Reason for why the medication is being/was taken Definition A reason for why the medication is being/was taken. Comments This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonForUseReference. Data type CodeableConcept Binding A coded concept identifying why the medication is being taken. ?? (example) Mappings workflow: …reasoneCodeableConcept rim: .reasonCode w5: why
reasonReference		0..*	Reference(http://hl7.org/fhir/StructureDefinition/Condition \| http://hl7.org/fhir/StructureDefinition/Observation)	There are no (further) constraints on this element Element id MedicationStatement.reasonReference Short description Condition or observation that supports why the medication is being/was taken Definition Condition or observation that supports why the medication is being/was taken. Comments This is a reference to a condition that is the reason why the medication is being/was taken. If only a code exists, use reasonForUseCode. Data type Reference(http://hl7.org/fhir/StructureDefinition/Condition \| http://hl7.org/fhir/StructureDefinition/Observation) Mappings workflow: …reasonReference rim: .outboundRelationship[typeCode=RSON]/target[classCode=OBS,moodCode=EVN, code="reason for use"].value w5: why
note		0..*	Annotation	There are no (further) constraints on this element Element id MedicationStatement.note Short description Further information about the statement Definition Provides extra information about the medication statement that is not conveyed by the other attributes. Data type Annotation Mappings workflow: …note rim: .inboundRelationship[typeCode=SUBJ]/source[classCode=OBS,moodCode=EVN,code="annotation"].value
dosage		0..*	Dosage	There are no (further) constraints on this element Element id MedicationStatement.dosage Short description Details of how medication is/was taken or should be taken Definition Indicates how the medication is/was or should be taken by the patient. Comments The dates included in the dosage on a Medication Statement reflect the dates for a given dose. For example, "from November 1, 2016 to November 3, 2016, take one tablet daily and from November 4, 2016 to November 7, 2016, take two tablets daily." It is expected that this specificity may only be populated where the patient brings in their labeled container or where the Medication Statement is derived from a MedicationRequest. Data type Dosage Mappings rim: refer dosageInstruction mapping

Differential table

MedicationStatement	http://hl7.org/fhir/StructureDefinition/MedicationStatement	There are no (further) constraints on this element Data type http://hl7.org/fhir/StructureDefinition/MedicationStatement
medicationReference	Reference(Smis Medication Profile)	There are no (further) constraints on this element Element id MedicationStatement.medication[x]:medicationReference Data type Reference(Smis Medication Profile) Allowed aggregation: contained
effectiveDateTime	dateTime	There are no (further) constraints on this element Element id MedicationStatement.effective[x]:effectiveDateTime Data type dateTime
subject	Reference(SMIS Patient Profile)	There are no (further) constraints on this element Element id MedicationStatement.subject Data type Reference(SMIS Patient Profile) Allowed aggregation: referenced

Structure Definition

<StructureDefinition xmlns="http://hl7.org/fhir">
    <id value="MedicationStatement" />
    <meta>
        <lastUpdated value="2018-09-12T21:06:52.587+00:00" />
    </meta>
    <url value="http://smis.ch/fhir/StructureDefinition/MedicationStatement" />
    <version value="1.0" />
    <name value="MedicationStatement" />
    <title value="SMIS Medication Statement Profile" />
    <status value="draft" />
    <date value="2018-09-12T21:06:51.276+00:00" />
    <publisher value="Arpage AG" />
    <contact>
        <name value="Patrick Husi" />
        <telecom>
            <system value="email" />
        </telecom>
    </contact>
    <description value="SMIS Medication Statement Profile" />
    <fhirVersion value="3.0.1" />
    <kind value="resource" />
    <abstract value="false" />
    <type value="MedicationStatement" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/MedicationStatement" />
    <derivation value="constraint" />
    <differential>
        <element id="MedicationStatement.medication[x]:medicationReference">
            <path value="MedicationStatement.medicationReference" />
            <sliceName value="medicationReference" />
            <type>
                <code value="Reference" />
                <targetProfile value="http://smis.ch/fhir/StructureDefinition/Medication" />
                <aggregation value="contained" />
            </type>
        </element>
        <element id="MedicationStatement.effective[x]:effectiveDateTime">
            <path value="MedicationStatement.effectiveDateTime" />
            <sliceName value="effectiveDateTime" />
            <type>
                <code value="dateTime" />
            </type>
        </element>
        <element id="MedicationStatement.subject">
            <path value="MedicationStatement.subject" />
            <type>
                <code value="Reference" />
                <targetProfile value="http://smis.ch/fhir/StructureDefinition/Patient" />
                <aggregation value="referenced" />
            </type>
        </element>
    </differential>
</StructureDefinition>

MedicationStatement example

{
    "resourceType": "MedicationStatement",
    "id": "1536163214130075",
    "meta": {
        "lastUpdated": "2018-09-12T15:10:56.000+02:00",
        "profile":  [
            "http://smis.ch/fhir/StructureDefinition/MedicationStatement"
        ]
    },
    "contained":  [
        {
            "resourceType": "Medication",
            "id": "1",
            "meta": {
                "profile":  [
                    "http://chmed16af.emediplan.ch/fhir/StructureDefinition/chmed16af-medication"
                ]
            },
            "code": {
                "coding":  [
                    {
                        "system": "urn:oid:2.16.756.5.30.2.6.1",
                        "code": "00589857",
                        "display": "ASPIRIN C Brausetabl 11 Stk"
                    }
                ]
            },
            "status": "active",
            "package": {
                "content":  [
                    {
                        "itemCodeableConcept": {
                            "coding":  [
                                {
                                    "system": "http://chmed16af.emediplan.ch/fhir/CodeSystem/chmed16af-codesystem-cdtyp9",
                                    "code": "U",
                                    "display": "Stk"
                                }
                            ]
                        },
                        "amount": {
                            "value": 3,
                            "unit": "Stk",
                            "system": "http://chmed16af.emediplan.ch/fhir/CodeSystem/chmed16af-codesystem-cdtyp9",
                            "code": "Stk"
                        }
                    }
                ]
            }
        }
    ],
    "identifier":  [
        {
            "use": "usual",
            "system": "http://smis.ch/fhir/element/internal_id",
            "value": "1536163214130075"
        },
        {
            "use": "usual",
            "system": "http://smis.ch/fhir/element/external_id",
            "value": "9E4EFB5B-020B-4682-8B20-B8E86A52C5AC"
        }
    ],
    "status": "completed",
    "medicationReference": {
        "reference": "#1"
    },
    "effectiveDateTime": "2008-01-17T00:00:00+01:00",
    "subject": {
        "reference": "Patient/1489161154728048"
    },
    "taken": "unk",
    "reasonCode":  [
        {
            "coding":  [
                {
                    "system": "http://snomed.info/sct",
                    "code": "3219008",
                    "display": "Disease type AND/OR category unknown"
                }
            ]
        }
    ],
    "note":  [
        {
            "text": "Ab der dritten Woche nach Bedarf"
        }
    ],
    "dosage":  [
        {
            "patientInstruction": "Jeweils vor dem Essen",
            "timing": {
                "repeat": {
                    "boundsPeriod": {
                        "start": "2008-02-15T00:00:00+01:00",
                        "end": "2008-03-16T00:00:00+01:00"
                    },
                    "when":  [
                        "ACM"
                    ]
                }
            },
            "asNeededBoolean": true,
            "doseQuantity": {
                "value": 3,
                "unit": "Stk",
                "system": "http://chmed16af.emediplan.ch/fhir/CodeSystem/chmed16af-codesystem-cdtyp9",
                "code": "Stk"
            }
        },
        {
            "patientInstruction": "Jeweils vor dem Essen",
            "timing": {
                "repeat": {
                    "boundsPeriod": {
                        "start": "2008-02-15T00:00:00+01:00",
                        "end": "2008-03-16T00:00:00+01:00"
                    },
                    "when":  [
                        "ACD"
                    ]
                }
            },
            "asNeededBoolean": true,
            "doseQuantity": {
                "value": 4,
                "unit": "Stk",
                "system": "http://chmed16af.emediplan.ch/fhir/CodeSystem/chmed16af-codesystem-cdtyp9",
                "code": "Stk"
            }
        },
        {
            "patientInstruction": "Jeweils vor dem Essen",
            "timing": {
                "repeat": {
                    "boundsPeriod": {
                        "start": "2008-02-15T00:00:00+01:00",
                        "end": "2008-03-16T00:00:00+01:00"
                    },
                    "when":  [
                        "ACV"
                    ]
                }
            },
            "asNeededBoolean": true,
            "doseQuantity": {
                "value": 5,
                "unit": "Stk",
                "system": "http://chmed16af.emediplan.ch/fhir/CodeSystem/chmed16af-codesystem-cdtyp9",
                "code": "Stk"
            }
        },
        {
            "patientInstruction": "Jeweils vor dem Essen",
            "timing": {
                "repeat": {
                    "boundsPeriod": {
                        "start": "2008-02-15T00:00:00+01:00",
                        "end": "2008-03-16T00:00:00+01:00"
                    },
                    "when":  [
                        "NIGHT"
                    ]
                }
            },
            "asNeededBoolean": true,
            "doseQuantity": {
                "value": 6,
                "unit": "Stk",
                "system": "http://chmed16af.emediplan.ch/fhir/CodeSystem/chmed16af-codesystem-cdtyp9",
                "code": "Stk"
            }
        }
    ]
}