ePMA 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.
Please note: This guidance has been superseded by the Implementation guide for digitial medicines, which contains up-to-date information.

Scenario: Inpatient Re-supply

Patient Anne Teak is admitted as an inpatient is prescribed Amoxicillin 500mg orally three times daily for a suspected chest infection. A re-supply of this medication is requested.

MedicationRequest

<Bundle xmlns="http://hl7.org/fhir">
    <id value="32e2adf8-595b-4b39-b6f1-f0073464c7f9" />
    <type value="message" />
    <!--    Message Header    -->
    <entry>
        <fullUrl value="message-header-167434" />
        <resource>
            <MessageHeader>
                <id value="message-header-167434" />
                <text>
                    <status value="generated" />
                    <div xmlns="http://www.w3.org/1999/xhtml"><p>The quick brown fox jumps over the lazy dog</p></div>
                </text>
                <event>
                    <system value="https://fhir.nhs.uk/STU3/CodeSystem/EventType-1" />
                    <code value="individual-requirements-1" />
                    <display value="Individual Requirements" />
                </event>
                <timestamp value="2021-05-07T16:15:32Z" />
                <source>
                    <endpoint value="nhs-uk:addressing:ods:T48NT" />
                </source>
                <focus>
                    <reference value="med-req-843920" />
                </focus>
            </MessageHeader>
        </resource>
    </entry>
    <!--  Patient associated with the encounter.  -->
    <entry>
        <fullUrl value="patient-011223344" />
        <resource>
            <Patient>
                <id value="patient-011223344" />
                <identifier>
                    <extension url="https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-NHSNumberVerificationStatus-1">
                        <valueCodeableConcept>
                            <coding>
                                <system value="https://fhir.hl7.org.uk/STU3/CodeSystem/CareConnect-NHSNumberVerificationStatus-1" />
                                <code value="01" />
                                <display value="Number present and verified" />
                            </coding>
                        </valueCodeableConcept>
                    </extension>
                    <system value="https://fhir.nhs.uk/Id/nhs-number" />
                    <value value="2377954310" />
                </identifier>
                <name>
                    <use value="official" />
                    <text value="Mrs Anne Teak" />
                    <family value="Teak" />
                    <given value="Anne" />
                    <prefix value="Mrs" />
                </name>
                <gender value="female" />
                <birthDate value="1956-02-04" />
            </Patient>
        </resource>
    </entry>
    <!--  Prescribing clinician associated with the encounter.   -->
    <entry>
        <fullUrl value="staff-1112" />
        <resource>
            <Practitioner>
                <id value="staff-1112" />
                <name>
                    <text value="Dr Maikeu Well" />
                    <family value="Well" />
                    <given value="Maikeu" />
                    <prefix value="Dr" />
                </name>
                <qualification>
                    <code>
                        <coding>
                            <system value="https://fhir.hl7.org.uk/Id/gmc-number" />
                            <code value="2145879" />
                            <display value="General Medical Council" />
                        </coding>
                    </code>
                </qualification>
            </Practitioner>
        </resource>
    </entry>
    <!--  Medication prescribed   -->
    <entry>
        <fullUrl value="medication-38769117" />
        <resource>
            <Medication>
                <id value="medication-38769117" />
                <code>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="27658006" />
                        <display value="Amoxicillin" />
                    </coding>
                </code>
            </Medication>
        </resource>
    </entry>
    <!--   Medication Request   -->
    <entry>
        <fullUrl value="med-req-1023938" />
        <resource>
            <MedicationRequest>
                <id value="med-req-1023938" />
                <status value="active" />
                <intent value="order" />
                <category>
                    <coding>
                        <system value="http://hl7.org/fhir/medication-request-category" />
                        <code value="inpatient" />
                        <display value="inpatient" />
                    </coding>
                </category>
                <priority value="routine" />
                <medicationReference>
                    <reference value="medication-38769117" />
                    <display value="Amoxicillin" />
                </medicationReference>
                <subject>
                    <reference value="patient-011223344" />
                    <display value="Mrs Anne Teak" />
                </subject>
                <authoredOn value="2020-05-15T15:00:00+01:00" />
                <requester>
                    <agent>
                        <reference value="staff-1112" />
                        <display value="Dr Maikeu Well" />
                    </agent>
                </requester>
                <recorder>
                    <reference value="staff-1112" />
                    <display value="Dr Maikeu Well" />
                </recorder>
                <dosageInstruction>
                    <timing>
                        <repeat>
                            <frequency value="3" />
                            <period value="1" />
                            <periodUnit value="d" />
                        </repeat>
                    </timing>
                    <route>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="26643006" />
                            <display value="oral" />
                        </coding>
                    </route>
                    <doseQuantity>
                        <value value="500" />
                        <unit value="milligram" />
                        <system value="http://unitsofmeasure.org" />
                        <code value="mg" />
                    </doseQuantity>
                </dosageInstruction>
                <substitution>
                    <allowed value="false" />
                </substitution>
                <priorPrescription>
                    <reference value="47fcb89e-46bc-4c64-bfa6-84b0098a2296" />
                </priorPrescription>
            </MedicationRequest>
        </resource>
    </entry>
</Bundle>

{
    "resourceType": "Bundle",
    "type": "message",
    "id": "32e2adf8-595b-4b39-b6f1-f0073464c7f9",
    "entry":  [
        {
            "fullUrl": "message-header-167434",
            "resource": {
                "resourceType": "MessageHeader",
                "id": "message-header-167434",
                "text": {
                    "status": "generated",
                    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>The quick brown fox jumps over the lazy dog</p></div>"
                },
                "timestamp": "2021-05-07T16:15:32Z",
                "event": {
                    "system": "https://fhir.nhs.uk/STU3/CodeSystem/EventType-1",
                    "code": "individual-requirements-1",
                    "display": "Individual Requirements"
                },
                "source": {
                    "endpoint": "nhs-uk:addressing:ods:T48NT"
                },
                "focus":  [
                    {
                        "reference": "med-req-843920"
                    }
                ]
            }
        },
        {
            "fullUrl": "patient-011223344",
            "resource": {
                "resourceType": "Patient",
                "id": "patient-011223344",
                "identifier":  [
                    {
                        "extension":  [
                            {
                                "url": "https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-NHSNumberVerificationStatus-1",
                                "valueCodeableConcept": {
                                    "coding":  [
                                        {
                                            "system": "https://fhir.hl7.org.uk/STU3/CodeSystem/CareConnect-NHSNumberVerificationStatus-1",
                                            "code": "01",
                                            "display": "Number present and verified"
                                        }
                                    ]
                                }
                            }
                        ],
                        "system": "https://fhir.nhs.uk/Id/nhs-number",
                        "value": "2377954310"
                    }
                ],
                "name":  [
                    {
                        "use": "official",
                        "text": "Mrs Anne Teak",
                        "family": "Teak",
                        "given":  [
                            "Anne"
                        ],
                        "prefix":  [
                            "Mrs"
                        ]
                    }
                ],
                "gender": "female",
                "birthDate": "1956-02-04"
            }
        },
        {
            "fullUrl": "staff-1112",
            "resource": {
                "resourceType": "Practitioner",
                "id": "staff-1112",
                "name":  [
                    {
                        "text": "Dr Maikeu Well",
                        "family": "Well",
                        "given":  [
                            "Maikeu"
                        ],
                        "prefix":  [
                            "Dr"
                        ]
                    }
                ],
                "qualification":  [
                    {
                        "code": {
                            "coding":  [
                                {
                                    "system": "https://fhir.hl7.org.uk/Id/gmc-number",
                                    "code": "2145879",
                                    "display": "General Medical Council"
                                }
                            ]
                        }
                    }
                ]
            }
        },
        {
            "fullUrl": "medication-38769117",
            "resource": {
                "resourceType": "Medication",
                "id": "medication-38769117",
                "code": {
                    "coding":  [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "27658006",
                            "display": "Amoxicillin"
                        }
                    ]
                }
            }
        },
        {
            "fullUrl": "med-req-1023938",
            "resource": {
                "resourceType": "MedicationRequest",
                "id": "med-req-1023938",
                "status": "active",
                "intent": "order",
                "category": {
                    "coding":  [
                        {
                            "system": "http://hl7.org/fhir/medication-request-category",
                            "code": "inpatient",
                            "display": "inpatient"
                        }
                    ]
                },
                "priority": "routine",
                "medicationReference": {
                    "reference": "medication-38769117",
                    "display": "Amoxicillin"
                },
                "subject": {
                    "reference": "patient-011223344",
                    "display": "Mrs Anne Teak"
                },
                "authoredOn": "2020-05-15T15:00:00+01:00",
                "requester": {
                    "agent": {
                        "reference": "staff-1112",
                        "display": "Dr Maikeu Well"
                    }
                },
                "recorder": {
                    "reference": "staff-1112",
                    "display": "Dr Maikeu Well"
                },
                "dosageInstruction":  [
                    {
                        "timing": {
                            "repeat": {
                                "frequency": 3,
                                "period": 1,
                                "periodUnit": "d"
                            }
                        },
                        "route": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "26643006",
                                    "display": "oral"
                                }
                            ]
                        },
                        "doseQuantity": {
                            "value": 500,
                            "unit": "milligram",
                            "system": "http://unitsofmeasure.org",
                            "code": "mg"
                        }
                    }
                ],
                "substitution": {
                    "allowed": false
                },
                "priorPrescription": {
                    "reference": "47fcb89e-46bc-4c64-bfa6-84b0098a2296"
                }
            }
        }
    ]
}
Bundle.id[0]32e2adf8-595b-4b39-b6f1-f0073464c7f9
Bundle.type[0]message
Bundle.entry[0].fullUrl[0]message-header-167434
Bundle.entry[0].resource[0].id[0]message-header-167434
Bundle.entry[0].resource[0].text[0].status[0]generated
Bundle.entry[0].resource[0].text[0].div[0]<div xmlns="http://www.w3.org/1999/xhtml"><p>The quick brown fox jumps over the lazy dog</p></div>
Bundle.entry[0].resource[0].event[0].system[0]https://fhir.nhs.uk/STU3/CodeSystem/EventType-1
Bundle.entry[0].resource[0].event[0].code[0]individual-requirements-1
Bundle.entry[0].resource[0].event[0].display[0]Individual Requirements
Bundle.entry[0].resource[0].timestamp[0]2021-05-07T16:15:32+00:00
Bundle.entry[0].resource[0].source[0].endpoint[0]nhs-uk:addressing:ods:T48NT
Bundle.entry[0].resource[0].focus[0].reference[0]med-req-843920
Bundle.entry[1].fullUrl[0]patient-011223344
Bundle.entry[1].resource[0].id[0]patient-011223344
Bundle.entry[1].resource[0].identifier[0].extension[0].url[0]https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-NHSNumberVerificationStatus-1
Bundle.entry[1].resource[0].identifier[0].extension[0].value[0].coding[0].system[0]https://fhir.hl7.org.uk/STU3/CodeSystem/CareConnect-NHSNumberVerificationStatus-1
Bundle.entry[1].resource[0].identifier[0].extension[0].value[0].coding[0].code[0]01
Bundle.entry[1].resource[0].identifier[0].extension[0].value[0].coding[0].display[0]Number present and verified
Bundle.entry[1].resource[0].identifier[0].system[0]https://fhir.nhs.uk/Id/nhs-number
Bundle.entry[1].resource[0].identifier[0].value[0]2377954310
Bundle.entry[1].resource[0].name[0].use[0]official
Bundle.entry[1].resource[0].name[0].text[0]Mrs Anne Teak
Bundle.entry[1].resource[0].name[0].family[0]Teak
Bundle.entry[1].resource[0].name[0].given[0]Anne
Bundle.entry[1].resource[0].name[0].prefix[0]Mrs
Bundle.entry[1].resource[0].gender[0]female
Bundle.entry[1].resource[0].birthDate[0]1956-02-04
Bundle.entry[2].fullUrl[0]staff-1112
Bundle.entry[2].resource[0].id[0]staff-1112
Bundle.entry[2].resource[0].name[0].text[0]Dr Maikeu Well
Bundle.entry[2].resource[0].name[0].family[0]Well
Bundle.entry[2].resource[0].name[0].given[0]Maikeu
Bundle.entry[2].resource[0].name[0].prefix[0]Dr
Bundle.entry[2].resource[0].qualification[0].code[0].coding[0].system[0]https://fhir.hl7.org.uk/Id/gmc-number
Bundle.entry[2].resource[0].qualification[0].code[0].coding[0].code[0]2145879
Bundle.entry[2].resource[0].qualification[0].code[0].coding[0].display[0]General Medical Council
Bundle.entry[3].fullUrl[0]medication-38769117
Bundle.entry[3].resource[0].id[0]medication-38769117
Bundle.entry[3].resource[0].code[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[3].resource[0].code[0].coding[0].code[0]27658006
Bundle.entry[3].resource[0].code[0].coding[0].display[0]Amoxicillin
Bundle.entry[4].fullUrl[0]med-req-1023938
Bundle.entry[4].resource[0].id[0]med-req-1023938
Bundle.entry[4].resource[0].status[0]active
Bundle.entry[4].resource[0].intent[0]order
Bundle.entry[4].resource[0].category[0].coding[0].system[0]http://hl7.org/fhir/medication-request-category
Bundle.entry[4].resource[0].category[0].coding[0].code[0]inpatient
Bundle.entry[4].resource[0].category[0].coding[0].display[0]inpatient
Bundle.entry[4].resource[0].priority[0]routine
Bundle.entry[4].resource[0].medication[0].reference[0]medication-38769117
Bundle.entry[4].resource[0].medication[0].display[0]Amoxicillin
Bundle.entry[4].resource[0].subject[0].reference[0]patient-011223344
Bundle.entry[4].resource[0].subject[0].display[0]Mrs Anne Teak
Bundle.entry[4].resource[0].authoredOn[0]2020-05-15T15:00:00+01:00
Bundle.entry[4].resource[0].requester[0].agent[0].reference[0]staff-1112
Bundle.entry[4].resource[0].requester[0].agent[0].display[0]Dr Maikeu Well
Bundle.entry[4].resource[0].recorder[0].reference[0]staff-1112
Bundle.entry[4].resource[0].recorder[0].display[0]Dr Maikeu Well
Bundle.entry[4].resource[0].dosageInstruction[0].timing[0].repeat[0].frequency[0]3
Bundle.entry[4].resource[0].dosageInstruction[0].timing[0].repeat[0].period[0]1
Bundle.entry[4].resource[0].dosageInstruction[0].timing[0].repeat[0].periodUnit[0]d
Bundle.entry[4].resource[0].dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[4].resource[0].dosageInstruction[0].route[0].coding[0].code[0]26643006
Bundle.entry[4].resource[0].dosageInstruction[0].route[0].coding[0].display[0]oral
Bundle.entry[4].resource[0].dosageInstruction[0].dose[0].value[0]500
Bundle.entry[4].resource[0].dosageInstruction[0].dose[0].unit[0]milligram
Bundle.entry[4].resource[0].dosageInstruction[0].dose[0].system[0]http://unitsofmeasure.org
Bundle.entry[4].resource[0].dosageInstruction[0].dose[0].code[0]mg
Bundle.entry[4].resource[0].substitution[0].allowed[0]False
Bundle.entry[4].resource[0].priorPrescription[0].reference[0]47fcb89e-46bc-4c64-bfa6-84b0098a2296
Bundle

MedicationDispense

Note: This example below is a draft and requires clinical verification.
<!-- This xml example is for illustrative purposes only and has not been clinically verified. -->
<Bundle xmlns="http://hl7.org/fhir">
    <id value="baa46293-7f5b-4253-945d-9b723b7a9cae" />
    <identifier>
        <system value="[organisation_name]:[system_name]" />
        <value value="8cd8108d-8c72-4fe9-a284-cd28b127fcfa" />
    </identifier>
    <type value="message" />
    <!--  Message Header  -->
    <entry>
        <fullUrl value="message-header-2123123" />
        <resource>
            <MessageHeader>
                <id value="message-header-2123123" />
                <text>
                    <status value="generated" />
                    <div xmlns="http://www.w3.org/1999/xhtml"><p>The quick brown fox jumps over the lazy dog</p></div>
                </text>
                <event>
                    <system value="https://fhir.nhs.uk/STU3/CodeSystem/EventType-1" />
                    <code value="individual-requirements-1" />
                    <display value="Individual Requirements" />
                </event>
                <timestamp value="2021-05-07T16:15:32Z" />
                <source>
                    <endpoint value="nhs-uk:addressing:ods:T48NT" />
                </source>
                <focus>
                    <reference value="med-disp-1023938" />
                </focus>
            </MessageHeader>
        </resource>
    </entry>
    <!-- Patient associated with the encounter. -->
    <entry>
        <fullUrl value="patient-011223344" />
        <resource>
            <Patient>
                <id value="patient-011223344" />
                <identifier>
                    <extension url="https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-NHSNumberVerificationStatus-1">
                        <valueCodeableConcept>
                            <coding>
                                <system value="https://fhir.hl7.org.uk/STU3/CodeSystem/CareConnect-NHSNumberVerificationStatus-1" />
                                <code value="01" />
                                <display value="Number present and verified" />
                            </coding>
                        </valueCodeableConcept>
                    </extension>
                    <system value="https://fhir.nhs.uk/Id/nhs-number" />
                    <value value="2377954310" />
                </identifier>
                <name>
                    <use value="official" />
                    <text value="Mrs Anne Teak" />
                    <family value="Teak" />
                    <given value="Anne" />
                    <prefix value="Mrs" />
                </name>
                <gender value="female" />
                <birthDate value="1956-02-04" />
            </Patient>
        </resource>
    </entry>
    <!--  Performer associated with the encounter.  -->
    <entry>
        <fullUrl value="staff-0002" />
        <resource>
            <Practitioner>
                <id value="staff-0002" />
                <name>
                    <text value="Dr Allo Kate" />
                    <family value="Kate" />
                    <given value="Allo" />
                    <prefix value="Dr" />
                </name>
                <qualification>
                    <code>
                        <coding>
                            <system value="https://fhir.hl7.org.uk/Id/gpc-number" />
                            <code value="123543" />
                            <display value="General Pharmaceutical Council" />
                        </coding>
                    </code>
                </qualification>
            </Practitioner>
        </resource>
    </entry>
    <!-- Medication prescribed  -->
    <entry>
        <fullUrl value="medication-930411000001106" />
        <resource>
            <Medication>
                <id value="medication-930411000001106" />
                <code>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="930411000001106" />
                        <display value="Amoxicillin 500mg capsules (A A H Pharmaceuticals Ltd)" />
                    </coding>
                </code>
            </Medication>
        </resource>
    </entry>
    <!--  Medication Dispense  -->
    <entry>
        <fullUrl value="med-disp-1023938" />
        <resource>
            <MedicationDispense>
                <id value="med-disp-1023938" />
                <status value="in-progress" />
                <category>
                    <coding>
                        <system value="http://hl7.org/fhir/medication-request-category" />
                        <code value="inpatient" />
                        <display value="inpatient" />
                    </coding>
                </category>
                <medicationReference>
                    <reference value="medication-930411000001106" />
                    <display value="Amoxicillin 500mg capsules (A A H Pharmaceuticals Ltd)" />
                </medicationReference>
                <subject>
                    <reference value="patient-011223344" />
                    <display value="Mrs Anne Teak" />
                </subject>
                <performer>
                    <actor>
                        <reference value="staff-0002" />
                        <display value="Dr Allo Kate" />
                    </actor>
                </performer>
                <whenPrepared value="2021-05-07T13:00:25Z" />
                <whenHandedOver value="2021-05-07T18:12:19Z" />
                <dosageInstruction>
                    <timing>
                        <repeat>
                            <frequency value="3" />
                            <period value="1" />
                            <periodUnit value="d" />
                        </repeat>
                    </timing>
                    <route>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="26643006" />
                            <display value="oral" />
                        </coding>
                    </route>
                    <doseQuantity>
                        <value value="1" />
                        <unit value="capsule" />
                        <system value="http://snomed.info/sct" />
                        <code value="428641000" />
                    </doseQuantity>
                </dosageInstruction>
            </MedicationDispense>
        </resource>
    </entry>
</Bundle>

{
    "resourceType": "Bundle",
    "id": "baa46293-7f5b-4253-945d-9b723b7a9cae",
    "identifier": {
        "system": "[organisation_name]:[system_name]",
        "value": "8cd8108d-8c72-4fe9-a284-cd28b127fcfa"
    },
    "type": "message",
    "entry":  [
        {
            "fullUrl": "message-header-2123123",
            "resource": {
                "resourceType": "MessageHeader",
                "id": "message-header-2123123",
                "text": {
                    "status": "generated",
                    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>The quick brown fox jumps over the lazy dog</p></div>"
                },
                "timestamp": "2021-05-07T16:15:32Z",
                "event": {
                    "system": "https://fhir.nhs.uk/STU3/CodeSystem/EventType-1",
                    "code": "individual-requirements-1",
                    "display": "Individual Requirements"
                },
                "source": {
                    "endpoint": "nhs-uk:addressing:ods:T48NT"
                },
                "focus":  [
                    {
                        "reference": "med-disp-1023938"
                    }
                ]
            }
        },
        {
            "fullUrl": "patient-011223344",
            "resource": {
                "resourceType": "Patient",
                "id": "patient-011223344",
                "identifier":  [
                    {
                        "extension":  [
                            {
                                "url": "https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-NHSNumberVerificationStatus-1",
                                "valueCodeableConcept": {
                                    "coding":  [
                                        {
                                            "system": "https://fhir.hl7.org.uk/STU3/CodeSystem/CareConnect-NHSNumberVerificationStatus-1",
                                            "code": "01",
                                            "display": "Number present and verified"
                                        }
                                    ]
                                }
                            }
                        ],
                        "system": "https://fhir.nhs.uk/Id/nhs-number",
                        "value": "2377954310"
                    }
                ],
                "name":  [
                    {
                        "use": "official",
                        "text": "Mrs Anne Teak",
                        "family": "Teak",
                        "given":  [
                            "Anne"
                        ],
                        "prefix":  [
                            "Mrs"
                        ]
                    }
                ],
                "gender": "female",
                "birthDate": "1956-02-04"
            }
        },
        {
            "fullUrl": "staff-0002",
            "resource": {
                "resourceType": "Practitioner",
                "id": "staff-0002",
                "name":  [
                    {
                        "text": "Dr Allo Kate",
                        "family": "Kate",
                        "given":  [
                            "Allo"
                        ],
                        "prefix":  [
                            "Dr"
                        ]
                    }
                ],
                "qualification":  [
                    {
                        "code": {
                            "coding":  [
                                {
                                    "system": "https://fhir.hl7.org.uk/Id/gpc-number",
                                    "code": "123543",
                                    "display": "General Pharmaceutical Council"
                                }
                            ]
                        }
                    }
                ]
            }
        },
        {
            "fullUrl": "medication-930411000001106",
            "resource": {
                "resourceType": "Medication",
                "id": "medication-930411000001106",
                "code": {
                    "coding":  [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "930411000001106",
                            "display": "Amoxicillin 500mg capsules (A A H Pharmaceuticals Ltd)"
                        }
                    ]
                }
            }
        },
        {
            "fullUrl": "med-disp-1023938",
            "resource": {
                "resourceType": "MedicationDispense",
                "id": "med-disp-1023938",
                "status": "in-progress",
                "category": {
                    "coding":  [
                        {
                            "system": "http://hl7.org/fhir/medication-request-category",
                            "code": "inpatient",
                            "display": "inpatient"
                        }
                    ]
                },
                "medicationReference": {
                    "reference": "medication-930411000001106",
                    "display": "Amoxicillin 500mg capsules (A A H Pharmaceuticals Ltd)"
                },
                "subject": {
                    "reference": "patient-011223344",
                    "display": "Mrs Anne Teak"
                },
                "whenPrepared": "2021-05-07T13:00:25Z",
                "whenHandedOver": "2021-05-07T18:12:19Z",
                "performer":  [
                    {
                        "actor": {
                            "reference": "staff-0002",
                            "display": "Dr Allo Kate"
                        }
                    }
                ],
                "dosageInstruction":  [
                    {
                        "timing": {
                            "repeat": {
                                "frequency": 3,
                                "period": 1,
                                "periodUnit": "d"
                            }
                        },
                        "route": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "26643006",
                                    "display": "oral"
                                }
                            ]
                        },
                        "doseQuantity": {
                            "value": 1,
                            "unit": "capsule",
                            "system": "http://snomed.info/sct",
                            "code": "428641000"
                        }
                    }
                ]
            }
        }
    ]
}
Bundle.id[0]baa46293-7f5b-4253-945d-9b723b7a9cae
Bundle.identifier[0].system[0][organisation_name]:[system_name]
Bundle.identifier[0].value[0]8cd8108d-8c72-4fe9-a284-cd28b127fcfa
Bundle.type[0]message
Bundle.entry[0].fullUrl[0]message-header-2123123
Bundle.entry[0].resource[0].id[0]message-header-2123123
Bundle.entry[0].resource[0].text[0].status[0]generated
Bundle.entry[0].resource[0].text[0].div[0]<div xmlns="http://www.w3.org/1999/xhtml"><p>The quick brown fox jumps over the lazy dog</p></div>
Bundle.entry[0].resource[0].event[0].system[0]https://fhir.nhs.uk/STU3/CodeSystem/EventType-1
Bundle.entry[0].resource[0].event[0].code[0]individual-requirements-1
Bundle.entry[0].resource[0].event[0].display[0]Individual Requirements
Bundle.entry[0].resource[0].timestamp[0]2021-05-07T16:15:32+00:00
Bundle.entry[0].resource[0].source[0].endpoint[0]nhs-uk:addressing:ods:T48NT
Bundle.entry[0].resource[0].focus[0].reference[0]med-disp-1023938
Bundle.entry[1].fullUrl[0]patient-011223344
Bundle.entry[1].resource[0].id[0]patient-011223344
Bundle.entry[1].resource[0].identifier[0].extension[0].url[0]https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-NHSNumberVerificationStatus-1
Bundle.entry[1].resource[0].identifier[0].extension[0].value[0].coding[0].system[0]https://fhir.hl7.org.uk/STU3/CodeSystem/CareConnect-NHSNumberVerificationStatus-1
Bundle.entry[1].resource[0].identifier[0].extension[0].value[0].coding[0].code[0]01
Bundle.entry[1].resource[0].identifier[0].extension[0].value[0].coding[0].display[0]Number present and verified
Bundle.entry[1].resource[0].identifier[0].system[0]https://fhir.nhs.uk/Id/nhs-number
Bundle.entry[1].resource[0].identifier[0].value[0]2377954310
Bundle.entry[1].resource[0].name[0].use[0]official
Bundle.entry[1].resource[0].name[0].text[0]Mrs Anne Teak
Bundle.entry[1].resource[0].name[0].family[0]Teak
Bundle.entry[1].resource[0].name[0].given[0]Anne
Bundle.entry[1].resource[0].name[0].prefix[0]Mrs
Bundle.entry[1].resource[0].gender[0]female
Bundle.entry[1].resource[0].birthDate[0]1956-02-04
Bundle.entry[2].fullUrl[0]staff-0002
Bundle.entry[2].resource[0].id[0]staff-0002
Bundle.entry[2].resource[0].name[0].text[0]Dr Allo Kate
Bundle.entry[2].resource[0].name[0].family[0]Kate
Bundle.entry[2].resource[0].name[0].given[0]Allo
Bundle.entry[2].resource[0].name[0].prefix[0]Dr
Bundle.entry[2].resource[0].qualification[0].code[0].coding[0].system[0]https://fhir.hl7.org.uk/Id/gpc-number
Bundle.entry[2].resource[0].qualification[0].code[0].coding[0].code[0]123543
Bundle.entry[2].resource[0].qualification[0].code[0].coding[0].display[0]General Pharmaceutical Council
Bundle.entry[3].fullUrl[0]medication-930411000001106
Bundle.entry[3].resource[0].id[0]medication-930411000001106
Bundle.entry[3].resource[0].code[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[3].resource[0].code[0].coding[0].code[0]930411000001106
Bundle.entry[3].resource[0].code[0].coding[0].display[0]Amoxicillin 500mg capsules (A A H Pharmaceuticals Ltd)
Bundle.entry[4].fullUrl[0]med-disp-1023938
Bundle.entry[4].resource[0].id[0]med-disp-1023938
Bundle.entry[4].resource[0].status[0]in-progress
Bundle.entry[4].resource[0].category[0].coding[0].system[0]http://hl7.org/fhir/medication-request-category
Bundle.entry[4].resource[0].category[0].coding[0].code[0]inpatient
Bundle.entry[4].resource[0].category[0].coding[0].display[0]inpatient
Bundle.entry[4].resource[0].medication[0].reference[0]medication-930411000001106
Bundle.entry[4].resource[0].medication[0].display[0]Amoxicillin 500mg capsules (A A H Pharmaceuticals Ltd)
Bundle.entry[4].resource[0].subject[0].reference[0]patient-011223344
Bundle.entry[4].resource[0].subject[0].display[0]Mrs Anne Teak
Bundle.entry[4].resource[0].performer[0].actor[0].reference[0]staff-0002
Bundle.entry[4].resource[0].performer[0].actor[0].display[0]Dr Allo Kate
Bundle.entry[4].resource[0].whenPrepared[0]2021-05-07T13:00:25Z
Bundle.entry[4].resource[0].whenHandedOver[0]2021-05-07T18:12:19Z
Bundle.entry[4].resource[0].dosageInstruction[0].timing[0].repeat[0].frequency[0]3
Bundle.entry[4].resource[0].dosageInstruction[0].timing[0].repeat[0].period[0]1
Bundle.entry[4].resource[0].dosageInstruction[0].timing[0].repeat[0].periodUnit[0]d
Bundle.entry[4].resource[0].dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[4].resource[0].dosageInstruction[0].route[0].coding[0].code[0]26643006
Bundle.entry[4].resource[0].dosageInstruction[0].route[0].coding[0].display[0]oral
Bundle.entry[4].resource[0].dosageInstruction[0].dose[0].value[0]1
Bundle.entry[4].resource[0].dosageInstruction[0].dose[0].unit[0]capsule
Bundle.entry[4].resource[0].dosageInstruction[0].dose[0].system[0]http://snomed.info/sct
Bundle.entry[4].resource[0].dosageInstruction[0].dose[0].code[0]428641000
Bundle

MedicationStatement

Note: This example below is a draft and requires clinical verification.
Note: The complication here is at what point the MedicationStatement is created? This example would be relevant BEFORE the medication dispensing event.
<!-- This xml example is for illustrative purposes only and has not been clinically verified. -->
<Bundle xmlns="http://hl7.org/fhir">
    <id value="74b0087c-89ba-46c1-84ce-570334d87421" />
    <type value="message" />
    <!--        Message Header        -->
    <entry>
        <fullUrl value="message-header-167434" />
        <resource>
            <MessageHeader>
                <id value="message-header-167434" />
                <text>
                    <status value="generated" />
                    <div xmlns="http://www.w3.org/1999/xhtml"><p>The quick brown fox jumps over the lazy dog</p></div>
                </text>
                <event>
                    <system value="https://fhir.nhs.uk/STU3/CodeSystem/EventType-1" />
                    <code value="individual-requirements-1" />
                    <display value="Individual Requirements" />
                </event>
                <timestamp value="2021-05-07T16:15:32Z" />
                <source>
                    <endpoint value="nhs-uk:addressing:ods:T48NT" />
                </source>
                <focus>
                    <reference value="medication-statement-27658006" />
                </focus>
            </MessageHeader>
        </resource>
    </entry>
    <!-- Patient associated with the encounter. -->
    <entry>
        <fullUrl value="patient-01020304" />
        <resource>
            <Patient>
                <id value="patient-01020304" />
                <identifier>
                    <extension url="https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-NHSNumberVerificationStatus-1">
                        <valueCodeableConcept>
                            <coding>
                                <system value="https://fhir.hl7.org.uk/STU3/CodeSystem/CareConnect-NHSNumberVerificationStatus-1" />
                                <code value="01" />
                                <display value="Number present and verified" />
                            </coding>
                        </valueCodeableConcept>
                    </extension>
                    <system value="https://fhir.nhs.uk/Id/nhs-number" />
                    <value value="2377954310" />
                </identifier>
                <name>
                    <use value="official" />
                    <text value="Mrs Anne Teak" />
                    <family value="Teak" />
                    <given value="Anne" />
                    <prefix value="Mrs" />
                </name>
                <gender value="female" />
                <birthDate value="1956-02-04" />
            </Patient>
        </resource>
    </entry>
    <!-- Prescribing clinician associated with the encounter.  -->
    <entry>
        <fullUrl value="staff-0001" />
        <resource>
            <Practitioner>
                <id value="staff-0001" />
                <name>
                    <text value="Dr Maikeu Well" />
                    <family value="Well" />
                    <given value="Maikeu" />
                    <prefix value="Dr" />
                </name>
                <qualification>
                    <code>
                        <coding>
                            <system value="https://fhir.hl7.org.uk/Id/gmc-number" />
                            <code value="2145879" />
                            <display value="General Medical Council" />
                        </coding>
                    </code>
                </qualification>
            </Practitioner>
        </resource>
    </entry>
    <!-- Medication   -->
    <entry>
        <fullUrl value="medication-27658006" />
        <resource>
            <Medication>
                <id value="medication-27658006" />
                <code>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="27658006" />
                        <display value="Amoxicillin" />
                    </coding>
                </code>
            </Medication>
        </resource>
    </entry>
    <!--  Medication Statement  -->
    <entry>
        <fullUrl value="medication-statement-27658006" />
        <resource>
            <MedicationStatement>
                <id value="medication-statement-27658006" />
                <status value="active" />
                <category>
                    <coding>
                        <system value="http://hl7.org/fhir/medication-request-category" />
                        <code value="inpatient" />
                        <display value="inpatient" />
                    </coding>
                </category>
                <medicationReference>
                    <reference value="medication-27658006" />
                    <display value="Amoxicillin" />
                </medicationReference>
                <subject>
                    <reference value="patient-01020304" />
                    <display value="Mrs Anne Teak" />
                </subject>
                <taken value="unk" />
                <dosage>
                    <timing>
                        <repeat>
                            <frequency value="3" />
                            <period value="1" />
                            <periodUnit value="d" />
                        </repeat>
                    </timing>
                    <route>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="26643006" />
                            <display value="oral" />
                        </coding>
                    </route>
                    <doseQuantity>
                        <value value="500" />
                        <unit value="milligram" />
                        <system value="http://unitsofmeasure.org" />
                        <code value="mg" />
                    </doseQuantity>
                </dosage>
            </MedicationStatement>
        </resource>
    </entry>
</Bundle>

{
    "resourceType": "Bundle",
    "id": "74b0087c-89ba-46c1-84ce-570334d87421",
    "type": "message",
    "entry":  [
        {
            "fullUrl": "message-header-167434",
            "resource": {
                "resourceType": "MessageHeader",
                "id": "message-header-167434",
                "text": {
                    "status": "generated",
                    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>The quick brown fox jumps over the lazy dog</p></div>"
                },
                "event": {
                    "system": "https://fhir.nhs.uk/STU3/CodeSystem/EventType-1",
                    "code": "individual-requirements-1",
                    "display": "Individual Requirements"
                },
                "timestamp": "2021-05-07T16:15:32Z",
                "source": {
                    "endpoint": "nhs-uk:addressing:ods:T48NT"
                },
                "focus":  [
                    {
                        "reference": "medication-statement-27658006"
                    }
                ]
            }
        },
        {
            "fullUrl": "patient-01020304",
            "resource": {
                "resourceType": "Patient",
                "id": "patient-01020304",
                "identifier":  [
                    {
                        "extension":  [
                            {
                                "url": "https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-NHSNumberVerificationStatus-1",
                                "valueCodeableConcept": {
                                    "coding":  [
                                        {
                                            "system": "https://fhir.hl7.org.uk/STU3/CodeSystem/CareConnect-NHSNumberVerificationStatus-1",
                                            "code": "01",
                                            "display": "Number present and verified"
                                        }
                                    ]
                                }
                            }
                        ],
                        "system": "https://fhir.nhs.uk/Id/nhs-number",
                        "value": "2377954310"
                    }
                ],
                "name":  [
                    {
                        "use": "official",
                        "text": "Mrs Anne Teak",
                        "family": "Teak",
                        "given":  [
                            "Anne"
                        ],
                        "prefix":  [
                            "Mrs"
                        ]
                    }
                ],
                "gender": "female",
                "birthDate": "1956-02-04"
            }
        },
        {
            "fullUrl": "staff-0001",
            "resource": {
                "resourceType": "Practitioner",
                "id": "staff-0001",
                "name":  [
                    {
                        "text": "Dr Maikeu Well",
                        "family": "Well",
                        "given":  [
                            "Maikeu"
                        ],
                        "prefix":  [
                            "Dr"
                        ]
                    }
                ],
                "qualification":  [
                    {
                        "code": {
                            "coding":  [
                                {
                                    "system": "https://fhir.hl7.org.uk/Id/gmc-number",
                                    "code": "2145879",
                                    "display": "General Medical Council"
                                }
                            ]
                        }
                    }
                ]
            }
        },
        {
            "fullUrl": "medication-27658006",
            "resource": {
                "resourceType": "Medication",
                "id": "medication-27658006",
                "code": {
                    "coding":  [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "27658006",
                            "display": "Amoxicillin"
                        }
                    ]
                }
            }
        },
        {
            "fullUrl": "medication-statement-27658006",
            "resource": {
                "resourceType": "MedicationStatement",
                "id": "medication-statement-27658006",
                "status": "active",
                "medicationReference": {
                    "reference": "medication-27658006",
                    "display": "Amoxicillin"
                },
                "subject": {
                    "reference": "patient-01020304",
                    "display": "Mrs Anne Teak"
                },
                "category": {
                    "coding":  [
                        {
                            "system": "http://hl7.org/fhir/medication-request-category",
                            "code": "inpatient",
                            "display": "inpatient"
                        }
                    ]
                },
                "dosage":  [
                    {
                        "timing": {
                            "repeat": {
                                "frequency": 3,
                                "period": 1,
                                "periodUnit": "d"
                            }
                        },
                        "route": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "26643006",
                                    "display": "oral"
                                }
                            ]
                        },
                        "doseQuantity": {
                            "value": 500,
                            "unit": "milligram",
                            "system": "http://unitsofmeasure.org",
                            "code": "mg"
                        }
                    }
                ],
                "taken": "unk"
            }
        }
    ]
}
Bundle.id[0]74b0087c-89ba-46c1-84ce-570334d87421
Bundle.type[0]message
Bundle.entry[0].fullUrl[0]message-header-167434
Bundle.entry[0].resource[0].id[0]message-header-167434
Bundle.entry[0].resource[0].text[0].status[0]generated
Bundle.entry[0].resource[0].text[0].div[0]<div xmlns="http://www.w3.org/1999/xhtml"><p>The quick brown fox jumps over the lazy dog</p></div>
Bundle.entry[0].resource[0].event[0].system[0]https://fhir.nhs.uk/STU3/CodeSystem/EventType-1
Bundle.entry[0].resource[0].event[0].code[0]individual-requirements-1
Bundle.entry[0].resource[0].event[0].display[0]Individual Requirements
Bundle.entry[0].resource[0].timestamp[0]2021-05-07T16:15:32+00:00
Bundle.entry[0].resource[0].source[0].endpoint[0]nhs-uk:addressing:ods:T48NT
Bundle.entry[0].resource[0].focus[0].reference[0]medication-statement-27658006
Bundle.entry[1].fullUrl[0]patient-01020304
Bundle.entry[1].resource[0].id[0]patient-01020304
Bundle.entry[1].resource[0].identifier[0].extension[0].url[0]https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-NHSNumberVerificationStatus-1
Bundle.entry[1].resource[0].identifier[0].extension[0].value[0].coding[0].system[0]https://fhir.hl7.org.uk/STU3/CodeSystem/CareConnect-NHSNumberVerificationStatus-1
Bundle.entry[1].resource[0].identifier[0].extension[0].value[0].coding[0].code[0]01
Bundle.entry[1].resource[0].identifier[0].extension[0].value[0].coding[0].display[0]Number present and verified
Bundle.entry[1].resource[0].identifier[0].system[0]https://fhir.nhs.uk/Id/nhs-number
Bundle.entry[1].resource[0].identifier[0].value[0]2377954310
Bundle.entry[1].resource[0].name[0].use[0]official
Bundle.entry[1].resource[0].name[0].text[0]Mrs Anne Teak
Bundle.entry[1].resource[0].name[0].family[0]Teak
Bundle.entry[1].resource[0].name[0].given[0]Anne
Bundle.entry[1].resource[0].name[0].prefix[0]Mrs
Bundle.entry[1].resource[0].gender[0]female
Bundle.entry[1].resource[0].birthDate[0]1956-02-04
Bundle.entry[2].fullUrl[0]staff-0001
Bundle.entry[2].resource[0].id[0]staff-0001
Bundle.entry[2].resource[0].name[0].text[0]Dr Maikeu Well
Bundle.entry[2].resource[0].name[0].family[0]Well
Bundle.entry[2].resource[0].name[0].given[0]Maikeu
Bundle.entry[2].resource[0].name[0].prefix[0]Dr
Bundle.entry[2].resource[0].qualification[0].code[0].coding[0].system[0]https://fhir.hl7.org.uk/Id/gmc-number
Bundle.entry[2].resource[0].qualification[0].code[0].coding[0].code[0]2145879
Bundle.entry[2].resource[0].qualification[0].code[0].coding[0].display[0]General Medical Council
Bundle.entry[3].fullUrl[0]medication-27658006
Bundle.entry[3].resource[0].id[0]medication-27658006
Bundle.entry[3].resource[0].code[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[3].resource[0].code[0].coding[0].code[0]27658006
Bundle.entry[3].resource[0].code[0].coding[0].display[0]Amoxicillin
Bundle.entry[4].fullUrl[0]medication-statement-27658006
Bundle.entry[4].resource[0].id[0]medication-statement-27658006
Bundle.entry[4].resource[0].status[0]active
Bundle.entry[4].resource[0].category[0].coding[0].system[0]http://hl7.org/fhir/medication-request-category
Bundle.entry[4].resource[0].category[0].coding[0].code[0]inpatient
Bundle.entry[4].resource[0].category[0].coding[0].display[0]inpatient
Bundle.entry[4].resource[0].medication[0].reference[0]medication-27658006
Bundle.entry[4].resource[0].medication[0].display[0]Amoxicillin
Bundle.entry[4].resource[0].subject[0].reference[0]patient-01020304
Bundle.entry[4].resource[0].subject[0].display[0]Mrs Anne Teak
Bundle.entry[4].resource[0].taken[0]unk
Bundle.entry[4].resource[0].dosage[0].timing[0].repeat[0].frequency[0]3
Bundle.entry[4].resource[0].dosage[0].timing[0].repeat[0].period[0]1
Bundle.entry[4].resource[0].dosage[0].timing[0].repeat[0].periodUnit[0]d
Bundle.entry[4].resource[0].dosage[0].route[0].coding[0].system[0]http://snomed.info/sct
Bundle.entry[4].resource[0].dosage[0].route[0].coding[0].code[0]26643006
Bundle.entry[4].resource[0].dosage[0].route[0].coding[0].display[0]oral
Bundle.entry[4].resource[0].dosage[0].dose[0].value[0]500
Bundle.entry[4].resource[0].dosage[0].dose[0].unit[0]milligram
Bundle.entry[4].resource[0].dosage[0].dose[0].system[0]http://unitsofmeasure.org
Bundle.entry[4].resource[0].dosage[0].dose[0].code[0]mg
Bundle
Note: This example would be relevant AFTER the medication dispensing event.
<!-- This xml example is for illustrative purposes only and has not been clinically verified. -->
<Bundle xmlns="http://hl7.org/fhir">
    <id value="74b0087c-89ba-46c1-84ce-570334d87421" />
    <type value="message" />
    <!--       Message Header       -->
    <entry>
        <fullUrl value="message-header-167434" />
        <resource>
            <MessageHeader>
                <id value="message-header-167434" />
                <text>
                    <status value="generated" />
                    <div xmlns="http://www.w3.org/1999/xhtml"><p>The quick brown fox jumps over the lazy dog</p></div>
                </text>
                <event>
                    <system value="https://fhir.nhs.uk/STU3/CodeSystem/EventType-1" />
                    <code value="individual-requirements-1" />
                    <display value="Individual Requirements" />
                </event>
                <timestamp value="2021-05-07T16:15:32Z" />
                <source>
                    <endpoint value="nhs-uk:addressing:ods:T48NT" />
                </source>
                <focus>
                    <reference value="medication-statement-367673234" />
                </focus>
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Bundle
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