Admission, Discharge and change in Medication / Chris Packet

This example is in the process of being updated...

Patient Journey: Chris Packet

Chris is prescribed repeat medication of Paracetamol, Codeine and Ibuprofen by his GP. This is via the EPS and is out of scope for this implementation guide. Please assume the GP record of 'current medication' has been shared with the regional shared medication record.
Chris is admitted to hospital. A medicines reconcillation process is undertaken. The ePMA system receives a Bundle of MedicationStatement resources [Example 1] from the regional shared medication record.
The hospital doctor stops the Codeine medication and starts Pregabalin medication. A MedicationRequest [Example 2] is sent to the hospital pharmacy, unless the medication is available from ward stock.
If sent to the hospital pharmacy, they dispense and return a MedicationDispense [Example 3] to the ePMA system.
Chris is to be discharged and given two weeks supply of medication as a 'To Take Out' (TTO). A MedicationRequest [Example 4] is sent to the hospital pharmacy, unless the medication is available from ward stock.
If sent to the hospital pharmacy, they dispense and return a MedicationDispense [Example 5] to the ePMA system.
Chris' discharge medications are verified by a pharmacist. Due to Chris also on renal medication, the on-going dosage for the GP to continue Pregabalin is changed. Two MedicationStatement [Example 6] resources are sent to the regional shared medication record stating that Codeine medication has been stopped and Pregabalin, with the amended dose, has been started. A discharge summary is sent to Chris' GP requesting that their records are updated to stop Codeine and start Pregabalin.
The GP actions the discharge instructions, changes Chris' repeat medication and authorises a new prescription for his medication in time for when his TTO supply runs out. This is via the EPS and is out of scope for this implementation guide.
When the regional shared medication record is next updated from GP records it will include a MedicationStatement for the stopped Codeine medication, and a MedicationStatement for the new Pregabalin medication. See [Example 7].

Expected Outcome

At the start of this scenario, the patient's current medication is:

Paracetamol 500mg tablets - take 2 tablets - four times - daily - oral
Codeine 30mg tablets - take 2 tablets - four times - daily - oral
Ibuprofen 800mg modified-release tablets - take one - two times - daily - oral

At the end of this scenario, the patient's current medication is:

Paracetamol 500mg tablets - take 2 tablets - four times - daily - oral
[STOPPED] Codeine 30mg tablets - take 2 tablets - four times - daily - oral
Ibuprofen 800mg modified-release tablets - take one - two times - daily - oral
Pregabalin 100mg tablets - two times per day - oral

Note: The data held within a shared record should be fully structured and coded. Text is shown here to aid human readability.

Example 1: GP MedicationStatement

Note: This example below is a draft and requires clinical verification.

Chris currently has three active medications:

Paracetamol 500mg tablet - take 2 tablets - four times - daily - oral
Codeine 30mg tablet - take 2 tablets - four times - daily - oral
Ibuprofen 800mg modified-release tablet - take one - two times - daily - oral

Actors

Provider System = GP System

Consumer System = Any system requiring a view of current medication, including a shared patient record

Example

<Bundle xmlns="http://hl7.org/fhir">
    <id value="7cd3f180-76f7-4bc6-b6d5-e672acd83b81" />
    <identifier>
        <system value="urn:[organisation_name]:[system_name]" />
        <value value="urn:8cd8108d-8c72-4fe9-a284-cd28b127fcfa" />
    </identifier>
    <type value="message" />
    <timestamp value="2021-05-07T13:00:25Z" />
    <!--   Message Header   -->
    <entry>
        <fullUrl value="urn:message-header-234234234" />
        <resource>
            <MessageHeader>
                <id value="message-header-234234234" />
                <eventCoding>
                    <system value="http://hl7.org/fhir/message-events" />
                    <code value="current-medication" />
                    <display value="Current Medication" />
                </eventCoding>
                <source>
                    <name value="ACME GP Systems" />
                    <software value="ACME GP" />
                    <version value="5.5.00" />
                    <endpoint value="urn:nhs-uk:addressing:ods:M12345" />
                </source>
                <focus>
                    <reference value="urn:medication-statement-1234" />
                </focus>
                <focus>
                    <reference value="urn:medication-statement-3452456" />
                </focus>
                <focus>
                    <reference value="urn:medication-statement-876543" />
                </focus>
            </MessageHeader>
        </resource>
    </entry>
    <!--  // Patient associated with the encounter  -->
    <entry>
        <fullUrl value="urn:patient-01912" />
        <resource>
            <Patient>
                <id value="patient-01912" />
                <identifier>
                    <system value="https://fhir.nhs.uk/Id/nhs-number" />
                    <value value="4857773456" />
                </identifier>
                <name>
                    <use value="official" />
                    <text value="Mr Chris Packet" />
                    <family value="Packet" />
                    <given value="Chris" />
                    <prefix value="Mr" />
                </name>
                <gender value="male" />
                <birthDate value="1995-11-12" />
            </Patient>
        </resource>
    </entry>
    <!--  // Prescribing clinician associated with the encounter.   -->
    <entry>
        <fullUrl value="urn:staff-0002" />
        <resource>
            <Practitioner>
                <id value="staff-0002" />
                <name>
                    <text value="Dr Maikeu Better" />
                    <family value="Better" />
                    <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 #1: Paracetamol 500mg tablets  -->
    <entry>
        <fullUrl value="urn:medication-685463" />
        <resource>
            <Medication>
                <id value="medication-685463" />
                <code>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="90332006" />
                        <display value="Paracetamol 500mg tablets" />
                    </coding>
                </code>
            </Medication>
        </resource>
    </entry>
    <!--  // MedicationStatement #1: Paracetamol 500mg tablets  -->
    <entry>
        <fullUrl value="urn:medication-statement-1234" />
        <resource>
            <MedicationStatement>
                <id value="medication-statement-1234" />
                <status value="active" />
                <category>
                    <coding>
                        <system value="http://hl7.org/fhir/medication-request-category" />
                        <code value="patientspecified" />
                        <display value="patientspecified" />
                    </coding>
                </category>
                <medicationReference>
                    <reference value="medication-685463" />
                    <display value="Paracetamol 500mg tablets" />
                </medicationReference>
                <subject>
                    <reference value="patient-01912" />
                    <display value="Mr Chris PACKET" />
                </subject>
                <dateAsserted value="2021-05-07T13:00:25Z" />
                <informationSource>
                    <reference value="staff-0002" />
                    <display value="Dr Maikeu Better" />
                </informationSource>
                <dosage>
                    <timing>
                        <repeat>
                            <frequency value="4" />
                            <period value="1" />
                            <periodUnit value="d" />
                        </repeat>
                    </timing>
                    <route>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="26643006" />
                            <display value="oral" />
                        </coding>
                    </route>
                    <doseAndRate>
                        <doseQuantity>
                            <value value="2" />
                            <unit value="tablet" />
                            <system value="http://snomed.info/sct" />
                            <code value="428673006" />
                        </doseQuantity>
                    </doseAndRate>
                </dosage>
            </MedicationStatement>
        </resource>
    </entry>
    <!--  // Medication #2: Codeine 30mg tablet -->
    <entry>
        <fullUrl value="urn:medication-634523423" />
        <resource>
            <Medication>
                <id value="medication-634523423" />
                <code>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="322503009" />
                        <display value="Codeine 30mg tablets" />
                    </coding>
                </code>
            </Medication>
        </resource>
    </entry>
    <!--  // MedicationStatement #2: Codeine 30mg tablet  -->
    <entry>
        <fullUrl value="urn:medication-statement-3452456" />
        <resource>
            <MedicationStatement>
                <id value="medication-statement-3452456" />
                <status value="active" />
                <category>
                    <coding>
                        <system value="http://hl7.org/fhir/medication-request-category" />
                        <code value="patientspecified" />
                        <display value="patientspecified" />
                    </coding>
                </category>
                <medicationReference>
                    <reference value="medication-634523423" />
                    <display value="Codeine 30mg tablets" />
                </medicationReference>
                <subject>
                    <reference value="patient-01912" />
                    <display value="Mr Chris PACKET" />
                </subject>
                <dateAsserted value="2021-05-07T13:00:25Z" />
                <informationSource>
                    <reference value="staff-0002" />
                    <display value="Dr Maikeu Better" />
                </informationSource>
                <dosage>
                    <timing>
                        <repeat>
                            <frequency value="4" />
                            <period value="1" />
                            <periodUnit value="d" />
                        </repeat>
                    </timing>
                    <route>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="26643006" />
                            <display value="oral" />
                        </coding>
                    </route>
                    <doseAndRate>
                        <doseQuantity>
                            <value value="2" />
                            <unit value="tablet" />
                            <system value="http://snomed.info/sct" />
                            <code value="428673006" />
                        </doseQuantity>
                    </doseAndRate>
                </dosage>
            </MedicationStatement>
        </resource>
    </entry>
    <!--  // Medication #3: Ibuprofen 800mg modified-release tablets  -->
    <entry>
        <fullUrl value="urn:medication-784234" />
        <resource>
            <Medication>
                <id value="medication-784234" />
                <code>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="39110311000001101" />
                        <display value="Ibuprofen 800mg modified-release tablets" />
                    </coding>
                </code>
            </Medication>
        </resource>
    </entry>
    <!--  // MedicationStatement #3: Ibuprofen 800mg modified-release tablets  -->
    <entry>
        <fullUrl value="urn:medication-statement-876543" />
        <resource>
            <MedicationStatement>
                <id value="medication-statement-876543" />
                <status value="active" />
                <category>
                    <coding>
                        <system value="http://hl7.org/fhir/medication-request-category" />
                        <code value="patientspecified" />
                        <display value="patientspecified" />
                    </coding>
                </category>
                <medicationReference>
                    <reference value="medication-634523423" />
                    <display value="Ibuprofen 800mg modified-release tablets" />
                </medicationReference>
                <subject>
                    <reference value="patient-01912" />
                    <display value="Mr Chris PACKET" />
                </subject>
                <dateAsserted value="2021-05-07T13:00:25Z" />
                <informationSource>
                    <reference value="staff-0002" />
                    <display value="Dr Maikeu Better" />
                </informationSource>
                <dosage>
                    <timing>
                        <repeat>
                            <frequency value="2" />
                            <period value="1" />
                            <periodUnit value="d" />
                        </repeat>
                    </timing>
                    <route>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="26643006" />
                            <display value="oral" />
                        </coding>
                    </route>
                    <doseAndRate>
                        <doseQuantity>
                            <value value="1" />
                            <unit value="tablet" />
                            <system value="http://snomed.info/sct" />
                            <code value="428673006" />
                        </doseQuantity>
                    </doseAndRate>
                </dosage>
            </MedicationStatement>
        </resource>
    </entry>
</Bundle>

{
    "resourceType": "Bundle",
    "id": "7cd3f180-76f7-4bc6-b6d5-e672acd83b81",
    "identifier": {
        "system": "urn:[organisation_name]:[system_name]",
        "value": "urn:8cd8108d-8c72-4fe9-a284-cd28b127fcfa"
    },
    "type": "message",
    "timestamp": "2021-05-07T13:00:25Z",
    "entry":  [
        {
            "fullUrl": "urn:message-header-234234234",
            "resource": {
                "resourceType": "MessageHeader",
                "id": "message-header-234234234",
                "eventCoding": {
                    "system": "http://hl7.org/fhir/message-events",
                    "code": "current-medication",
                    "display": "Current Medication"
                },
                "source": {
                    "name": "ACME GP Systems",
                    "software": "ACME GP",
                    "version": "5.5.00",
                    "endpoint": "urn:nhs-uk:addressing:ods:M12345"
                },
                "focus":  [
                    {
                        "reference": "urn:medication-statement-1234"
                    },
                    {
                        "reference": "urn:medication-statement-3452456"
                    },
                    {
                        "reference": "urn:medication-statement-876543"
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:patient-01912",
            "resource": {
                "resourceType": "Patient",
                "id": "patient-01912",
                "identifier":  [
                    {
                        "system": "https://fhir.nhs.uk/Id/nhs-number",
                        "value": "4857773456"
                    }
                ],
                "name":  [
                    {
                        "use": "official",
                        "text": "Mr Chris Packet",
                        "family": "Packet",
                        "given":  [
                            "Chris"
                        ],
                        "prefix":  [
                            "Mr"
                        ]
                    }
                ],
                "gender": "male",
                "birthDate": "1995-11-12"
            }
        },
        {
            "fullUrl": "urn:staff-0002",
            "resource": {
                "resourceType": "Practitioner",
                "id": "staff-0002",
                "name":  [
                    {
                        "text": "Dr Maikeu Better",
                        "family": "Better",
                        "given":  [
                            "Maikeu"
                        ],
                        "prefix":  [
                            "Dr"
                        ]
                    }
                ],
                "qualification":  [
                    {
                        "code": {
                            "coding":  [
                                {
                                    "system": "https://fhir.hl7.org.uk/Id/gmc-number",
                                    "code": "2145879",
                                    "display": "General Medical Council"
                                }
                            ]
                        }
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:medication-685463",
            "resource": {
                "resourceType": "Medication",
                "id": "medication-685463",
                "code": {
                    "coding":  [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "90332006",
                            "display": "Paracetamol 500mg tablets"
                        }
                    ]
                }
            }
        },
        {
            "fullUrl": "urn:medication-statement-1234",
            "resource": {
                "resourceType": "MedicationStatement",
                "id": "medication-statement-1234",
                "status": "active",
                "category": {
                    "coding":  [
                        {
                            "system": "http://hl7.org/fhir/medication-request-category",
                            "code": "patientspecified",
                            "display": "patientspecified"
                        }
                    ]
                },
                "medicationReference": {
                    "reference": "medication-685463",
                    "display": "Paracetamol 500mg tablets"
                },
                "subject": {
                    "reference": "patient-01912",
                    "display": "Mr Chris PACKET"
                },
                "dateAsserted": "2021-05-07T13:00:25Z",
                "informationSource": {
                    "reference": "staff-0002",
                    "display": "Dr Maikeu Better"
                },
                "dosage":  [
                    {
                        "timing": {
                            "repeat": {
                                "frequency": 4,
                                "period": 1,
                                "periodUnit": "d"
                            }
                        },
                        "route": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "26643006",
                                    "display": "oral"
                                }
                            ]
                        },
                        "doseAndRate":  [
                            {
                                "doseQuantity": {
                                    "value": 2,
                                    "unit": "tablet",
                                    "system": "http://snomed.info/sct",
                                    "code": "428673006"
                                }
                            }
                        ]
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:medication-634523423",
            "resource": {
                "resourceType": "Medication",
                "id": "medication-634523423",
                "code": {
                    "coding":  [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "322503009",
                            "display": "Codeine 30mg tablets"
                        }
                    ]
                }
            }
        },
        {
            "fullUrl": "urn:medication-statement-3452456",
            "resource": {
                "resourceType": "MedicationStatement",
                "id": "medication-statement-3452456",
                "status": "active",
                "category": {
                    "coding":  [
                        {
                            "system": "http://hl7.org/fhir/medication-request-category",
                            "code": "patientspecified",
                            "display": "patientspecified"
                        }
                    ]
                },
                "medicationReference": {
                    "reference": "medication-634523423",
                    "display": "Codeine 30mg tablets"
                },
                "subject": {
                    "reference": "patient-01912",
                    "display": "Mr Chris PACKET"
                },
                "dateAsserted": "2021-05-07T13:00:25Z",
                "informationSource": {
                    "reference": "staff-0002",
                    "display": "Dr Maikeu Better"
                },
                "dosage":  [
                    {
                        "timing": {
                            "repeat": {
                                "frequency": 4,
                                "period": 1,
                                "periodUnit": "d"
                            }
                        },
                        "route": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "26643006",
                                    "display": "oral"
                                }
                            ]
                        },
                        "doseAndRate":  [
                            {
                                "doseQuantity": {
                                    "value": 2,
                                    "unit": "tablet",
                                    "system": "http://snomed.info/sct",
                                    "code": "428673006"
                                }
                            }
                        ]
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:medication-784234",
            "resource": {
                "resourceType": "Medication",
                "id": "medication-784234",
                "code": {
                    "coding":  [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "39110311000001101",
                            "display": "Ibuprofen 800mg modified-release tablets"
                        }
                    ]
                }
            }
        },
        {
            "fullUrl": "urn:medication-statement-876543",
            "resource": {
                "resourceType": "MedicationStatement",
                "id": "medication-statement-876543",
                "status": "active",
                "category": {
                    "coding":  [
                        {
                            "system": "http://hl7.org/fhir/medication-request-category",
                            "code": "patientspecified",
                            "display": "patientspecified"
                        }
                    ]
                },
                "medicationReference": {
                    "reference": "medication-634523423",
                    "display": "Ibuprofen 800mg modified-release tablets"
                },
                "subject": {
                    "reference": "patient-01912",
                    "display": "Mr Chris PACKET"
                },
                "dateAsserted": "2021-05-07T13:00:25Z",
                "informationSource": {
                    "reference": "staff-0002",
                    "display": "Dr Maikeu Better"
                },
                "dosage":  [
                    {
                        "timing": {
                            "repeat": {
                                "frequency": 2,
                                "period": 1,
                                "periodUnit": "d"
                            }
                        },
                        "route": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "26643006",
                                    "display": "oral"
                                }
                            ]
                        },
                        "doseAndRate":  [
                            {
                                "doseQuantity": {
                                    "value": 1,
                                    "unit": "tablet",
                                    "system": "http://snomed.info/sct",
                                    "code": "428673006"
                                }
                            }
                        ]
                    }
                ]
            }
        }
    ]
}

Bundle.id[0]	7cd3f180-76f7-4bc6-b6d5-e672acd83b81
Bundle.identifier[0].system[0]	urn:[organisation_name]:[system_name]
Bundle.identifier[0].value[0]	urn:8cd8108d-8c72-4fe9-a284-cd28b127fcfa
Bundle.type[0]	message
Bundle.timestamp[0]	2021-05-07T13:00:25Z
Bundle.entry[0].fullUrl[0]	urn:message-header-234234234
Bundle.entry[0].resource[0].id[0]	message-header-234234234
Bundle.entry[0].resource[0].eventCoding[0].system[0]	http://hl7.org/fhir/message-events
Bundle.entry[0].resource[0].eventCoding[0].code[0]	current-medication
Bundle.entry[0].resource[0].eventCoding[0].display[0]	Current Medication
Bundle.entry[0].resource[0].source[0].name[0]	ACME GP Systems
Bundle.entry[0].resource[0].source[0].software[0]	ACME GP
Bundle.entry[0].resource[0].source[0].version[0]	5.5.00
Bundle.entry[0].resource[0].source[0].endpoint[0]	urn:nhs-uk:addressing:ods:M12345
Bundle.entry[0].resource[0].focus[0].reference[0]	urn:medication-statement-1234
Bundle.entry[0].resource[0].focus[1].reference[0]	urn:medication-statement-3452456
Bundle.entry[0].resource[0].focus[2].reference[0]	urn:medication-statement-876543
Bundle.entry[1].fullUrl[0]	urn:patient-01912
Bundle.entry[1].resource[0].id[0]	patient-01912
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]	4857773456
Bundle.entry[1].resource[0].name[0].use[0]	official
Bundle.entry[1].resource[0].name[0].text[0]	Mr Chris Packet
Bundle.entry[1].resource[0].name[0].family[0]	Packet
Bundle.entry[1].resource[0].name[0].given[0]	Chris
Bundle.entry[1].resource[0].name[0].prefix[0]	Mr
Bundle.entry[1].resource[0].gender[0]	male
Bundle.entry[1].resource[0].birthDate[0]	1995-11-12
Bundle.entry[2].fullUrl[0]	urn:staff-0002
Bundle.entry[2].resource[0].id[0]	staff-0002
Bundle.entry[2].resource[0].name[0].text[0]	Dr Maikeu Better
Bundle.entry[2].resource[0].name[0].family[0]	Better
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]	urn:medication-685463
Bundle.entry[3].resource[0].id[0]	medication-685463
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]	90332006
Bundle.entry[3].resource[0].code[0].coding[0].display[0]	Paracetamol 500mg tablets
Bundle.entry[4].fullUrl[0]	urn:medication-statement-1234
Bundle.entry[4].resource[0].id[0]	medication-statement-1234
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]	patientspecified
Bundle.entry[4].resource[0].category[0].coding[0].display[0]	patientspecified
Bundle.entry[4].resource[0].medicationReference[0].reference[0]	medication-685463
Bundle.entry[4].resource[0].medicationReference[0].display[0]	Paracetamol 500mg tablets
Bundle.entry[4].resource[0].subject[0].reference[0]	patient-01912
Bundle.entry[4].resource[0].subject[0].display[0]	Mr Chris PACKET
Bundle.entry[4].resource[0].dateAsserted[0]	2021-05-07T13:00:25Z
Bundle.entry[4].resource[0].informationSource[0].reference[0]	staff-0002
Bundle.entry[4].resource[0].informationSource[0].display[0]	Dr Maikeu Better
Bundle.entry[4].resource[0].dosage[0].timing[0].repeat[0].frequency[0]	4
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].doseAndRate[0].doseQuantity[0].value[0]	2
Bundle.entry[4].resource[0].dosage[0].doseAndRate[0].doseQuantity[0].unit[0]	tablet
Bundle.entry[4].resource[0].dosage[0].doseAndRate[0].doseQuantity[0].system[0]	http://snomed.info/sct
Bundle.entry[4].resource[0].dosage[0].doseAndRate[0].doseQuantity[0].code[0]	428673006
Bundle.entry[5].fullUrl[0]	urn:medication-634523423
Bundle.entry[5].resource[0].id[0]	medication-634523423
Bundle.entry[5].resource[0].code[0].coding[0].system[0]	http://snomed.info/sct
Bundle.entry[5].resource[0].code[0].coding[0].code[0]	322503009
Bundle.entry[5].resource[0].code[0].coding[0].display[0]	Codeine 30mg tablets
Bundle.entry[6].fullUrl[0]	urn:medication-statement-3452456
Bundle.entry[6].resource[0].id[0]	medication-statement-3452456
Bundle.entry[6].resource[0].status[0]	active
Bundle.entry[6].resource[0].category[0].coding[0].system[0]	http://hl7.org/fhir/medication-request-category
Bundle.entry[6].resource[0].category[0].coding[0].code[0]	patientspecified
Bundle.entry[6].resource[0].category[0].coding[0].display[0]	patientspecified
Bundle.entry[6].resource[0].medicationReference[0].reference[0]	medication-634523423
Bundle.entry[6].resource[0].medicationReference[0].display[0]	Codeine 30mg tablets
Bundle.entry[6].resource[0].subject[0].reference[0]	patient-01912
Bundle.entry[6].resource[0].subject[0].display[0]	Mr Chris PACKET
Bundle.entry[6].resource[0].dateAsserted[0]	2021-05-07T13:00:25Z
Bundle.entry[6].resource[0].informationSource[0].reference[0]	staff-0002
Bundle.entry[6].resource[0].informationSource[0].display[0]	Dr Maikeu Better
Bundle.entry[6].resource[0].dosage[0].timing[0].repeat[0].frequency[0]	4
Bundle.entry[6].resource[0].dosage[0].timing[0].repeat[0].period[0]	1
Bundle.entry[6].resource[0].dosage[0].timing[0].repeat[0].periodUnit[0]	d
Bundle.entry[6].resource[0].dosage[0].route[0].coding[0].system[0]	http://snomed.info/sct
Bundle.entry[6].resource[0].dosage[0].route[0].coding[0].code[0]	26643006
Bundle.entry[6].resource[0].dosage[0].route[0].coding[0].display[0]	oral
Bundle.entry[6].resource[0].dosage[0].doseAndRate[0].doseQuantity[0].value[0]	2
Bundle.entry[6].resource[0].dosage[0].doseAndRate[0].doseQuantity[0].unit[0]	tablet
Bundle.entry[6].resource[0].dosage[0].doseAndRate[0].doseQuantity[0].system[0]	http://snomed.info/sct
Bundle.entry[6].resource[0].dosage[0].doseAndRate[0].doseQuantity[0].code[0]	428673006
Bundle.entry[7].fullUrl[0]	urn:medication-784234
Bundle.entry[7].resource[0].id[0]	medication-784234
Bundle.entry[7].resource[0].code[0].coding[0].system[0]	http://snomed.info/sct
Bundle.entry[7].resource[0].code[0].coding[0].code[0]	39110311000001101
Bundle.entry[7].resource[0].code[0].coding[0].display[0]	Ibuprofen 800mg modified-release tablets
Bundle.entry[8].fullUrl[0]	urn:medication-statement-876543
Bundle.entry[8].resource[0].id[0]	medication-statement-876543
Bundle.entry[8].resource[0].status[0]	active
Bundle.entry[8].resource[0].category[0].coding[0].system[0]	http://hl7.org/fhir/medication-request-category
Bundle.entry[8].resource[0].category[0].coding[0].code[0]	patientspecified
Bundle.entry[8].resource[0].category[0].coding[0].display[0]	patientspecified
Bundle.entry[8].resource[0].medicationReference[0].reference[0]	medication-634523423
Bundle.entry[8].resource[0].medicationReference[0].display[0]	Ibuprofen 800mg modified-release tablets
Bundle.entry[8].resource[0].subject[0].reference[0]	patient-01912
Bundle.entry[8].resource[0].subject[0].display[0]	Mr Chris PACKET
Bundle.entry[8].resource[0].dateAsserted[0]	2021-05-07T13:00:25Z
Bundle.entry[8].resource[0].informationSource[0].reference[0]	staff-0002
Bundle.entry[8].resource[0].informationSource[0].display[0]	Dr Maikeu Better
Bundle.entry[8].resource[0].dosage[0].timing[0].repeat[0].frequency[0]	2
Bundle.entry[8].resource[0].dosage[0].timing[0].repeat[0].period[0]	1
Bundle.entry[8].resource[0].dosage[0].timing[0].repeat[0].periodUnit[0]	d
Bundle.entry[8].resource[0].dosage[0].route[0].coding[0].system[0]	http://snomed.info/sct
Bundle.entry[8].resource[0].dosage[0].route[0].coding[0].code[0]	26643006
Bundle.entry[8].resource[0].dosage[0].route[0].coding[0].display[0]	oral
Bundle.entry[8].resource[0].dosage[0].doseAndRate[0].doseQuantity[0].value[0]	1
Bundle.entry[8].resource[0].dosage[0].doseAndRate[0].doseQuantity[0].unit[0]	tablet
Bundle.entry[8].resource[0].dosage[0].doseAndRate[0].doseQuantity[0].system[0]	http://snomed.info/sct
Bundle.entry[8].resource[0].dosage[0].doseAndRate[0].doseQuantity[0].code[0]	428673006

Bundle

id : 7cd3f180-76f7-4bc6-b6d5-e672acd83b81

identifier

system : urn:[organisation_name]:[system_name]

value : urn:8cd8108d-8c72-4fe9-a284-cd28b127fcfa

type : message

timestamp : 2021-05-07T13:00:25+00:00

entry

fullUrl : urn:message-header-234234234

resource

id : message-header-234234234

event

system : http://hl7.org/fhir/message-events

code : current-medication

display : Current Medication

source

name : ACME GP Systems

software : ACME GP

version : 5.5.00

endpoint : urn:nhs-uk:addressing:ods:M12345

focus

reference : urn:medication-statement-1234

focus

reference : urn:medication-statement-3452456

focus

reference : urn:medication-statement-876543

entry

fullUrl : urn:patient-01912

resource

id : patient-01912

identifier

system : https://fhir.nhs.uk/Id/nhs-number

value : 4857773456

name

use : official

text : Mr Chris Packet

family : Packet

given : Chris

prefix : Mr

gender : male

birthDate : 1995-11-12

entry

fullUrl : urn:staff-0002

resource

id : staff-0002

name

text : Dr Maikeu Better

family : Better

given : Maikeu

prefix : Dr

qualification

code

coding

system : https://fhir.hl7.org.uk/Id/gmc-number

code : 2145879

display : General Medical Council

entry

fullUrl : urn:medication-685463

resource

id : medication-685463

code

coding

system : http://snomed.info/sct

code : 90332006

display : Paracetamol 500mg tablets

entry

fullUrl : urn:medication-statement-1234

resource

id : medication-statement-1234

status : active

category

coding

system : http://hl7.org/fhir/medication-request-category

code : patientspecified

display : patientspecified

medication

reference : medication-685463

display : Paracetamol 500mg tablets

subject

reference : patient-01912

display : Mr Chris PACKET

dateAsserted : 2021-05-07T13:00:25Z

informationSource

reference : staff-0002

display : Dr Maikeu Better

dosage

timing

repeat

frequency : 4

period : 1

periodUnit : d

route

coding

system : http://snomed.info/sct

code : 26643006

display : oral

doseAndRate

dose

value : 2

unit : tablet

system : http://snomed.info/sct

code : 428673006

entry

fullUrl : urn:medication-634523423

resource

id : medication-634523423

code

coding

system : http://snomed.info/sct

code : 322503009

display : Codeine 30mg tablets

entry

fullUrl : urn:medication-statement-3452456

resource

id : medication-statement-3452456

status : active

category

coding

system : http://hl7.org/fhir/medication-request-category

code : patientspecified

display : patientspecified

medication

reference : medication-634523423

display : Codeine 30mg tablets

subject

reference : patient-01912

display : Mr Chris PACKET

dateAsserted : 2021-05-07T13:00:25Z

informationSource

reference : staff-0002

display : Dr Maikeu Better

dosage

timing

repeat

frequency : 4

period : 1

periodUnit : d

route

coding

system : http://snomed.info/sct

code : 26643006

display : oral

doseAndRate

dose

value : 2

unit : tablet

system : http://snomed.info/sct

code : 428673006

entry

fullUrl : urn:medication-784234

resource

id : medication-784234

code

coding

system : http://snomed.info/sct

code : 39110311000001101

display : Ibuprofen 800mg modified-release tablets

entry

fullUrl : urn:medication-statement-876543

resource

id : medication-statement-876543

status : active

category

coding

system : http://hl7.org/fhir/medication-request-category

code : patientspecified

display : patientspecified

medication

reference : medication-634523423

display : Ibuprofen 800mg modified-release tablets

subject

reference : patient-01912

display : Mr Chris PACKET

dateAsserted : 2021-05-07T13:00:25Z

informationSource

reference : staff-0002

display : Dr Maikeu Better

dosage

timing

repeat

frequency : 2

period : 1

periodUnit : d

route

coding

system : http://snomed.info/sct

code : 26643006

display : oral

doseAndRate

dose

value : 1

unit : tablet

system : http://snomed.info/sct

code : 428673006

Example 2: Inpatient MedicationRequest

Note: This example below is a draft and requires clinical verification.

Chris is started on new medication. 75mg of Pregabalin twice per day for three days, increased to 75mg three times per day thereafter.

Actors

Provider System = Ward EMPA system

Consumer System = Hospital pharamcy system

Example

<Bundle xmlns="http://hl7.org/fhir">
    <id value="7d107ed2-70c6-43d9-9cbe-f19c319d1456" />
    <identifier>
        <system value="urn:[organisation_name]:[system_name]" />
        <value value="urn:8cd8108d-8c72-4fe9-a284-cd28b127fcfa" />
    </identifier>
    <type value="message" />
    <timestamp value="2021-05-07T16:15:32Z" />
    <!--    Message Header    -->
    <entry>
        <fullUrl value="urn:message-header-167434" />
        <resource>
            <MessageHeader>
                <id value="urn:message-header-167434" />
                <eventCoding>
                    <system value="https://fhir.hl7.org.uk//CodeSystem/message-event" />
                    <code value="prescription-order" />
                    <display value="Prescription Order" />
                </eventCoding>
                <source>
                    <name value="ACME Clinical Systems" />
                    <software value="ACME ePMA" />
                    <version value="3.5.68" />
                    <endpoint value="urn:nhs-uk:addressing:ods:T48NT" />
                </source>
                <focus>
                    <reference value="urn:med-req-01923" />
                </focus>
            </MessageHeader>
        </resource>
    </entry>
    <!--  // Patient associated with the encounter   -->
    <entry>
        <fullUrl value="urn:patient-01912" />
        <resource>
            <Patient>
                <id value="patient-01912" />
                <identifier>
                    <system value="https://fhir.nhs.uk/Id/nhs-number" />
                    <value value="4857773456" />
                </identifier>
                <name>
                    <use value="official" />
                    <text value="Mr Chris Packet" />
                    <family value="Packet" />
                    <given value="Chris" />
                    <prefix value="Mr" />
                </name>
                <gender value="male" />
                <birthDate value="1995-11-12" />
            </Patient>
        </resource>
    </entry>
    <!--  // Prescribing clinician associated with the encounter.   -->
    <entry>
        <fullUrl value="urn: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="urn:medication-99101" />
        <resource>
            <Medication>
                <id value="medication-99101" />
                <code>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="415159003" />
                        <display value="Pregabalin" />
                    </coding>
                </code>
            </Medication>
        </resource>
    </entry>
    <!--   // Medication Request   -->
    <entry>
        <fullUrl value="urn:med-req-01923" />
        <resource>
            <MedicationRequest>
                <id value="med-req-01923" />
                <identifier>
                    <value value="6d2bfb69-656a-45ef-92d0-d4aae02bb438" />
                </identifier>
                <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-99101" />
                    <display value="Pregabalin" />
                </medicationReference>
                <subject>
                    <reference value="patient-01912" />
                    <display value="Mr Chris Packet" />
                </subject>
                <authoredOn value="2021-05-07T18:12:41+01:00" />
                <requester>
                    <reference value="staff-1112" />
                    <display value="Dr Maikeu Well" />
                </requester>
                <recorder>
                    <reference value="staff-1112" />
                    <display value="Dr Maikeu Well" />
                </recorder>
                <dosageInstruction>
                    <sequence value="1" />
                    <timing>
                        <repeat>
                            <boundsDuration>
                                <value value="3" />
                                <unit value="day" />
                                <system value="http://unitsofmeasure.org" />
                                <code value="d" />
                            </boundsDuration>
                            <frequency value="2" />
                            <period value="1" />
                            <periodUnit value="d" />
                        </repeat>
                    </timing>
                    <route>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="26643006" />
                            <display value="oral" />
                        </coding>
                    </route>
                    <doseAndRate>
                        <doseQuantity>
                            <value value="75" />
                            <unit value="milligram" />
                            <system value="http://unitsofmeasure.org" />
                            <code value="mg" />
                        </doseQuantity>
                    </doseAndRate>
                </dosageInstruction>
                <dosageInstruction>
                    <sequence value="2" />
                    <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>
                    <doseAndRate>
                        <doseQuantity>
                            <value value="75" />
                            <unit value="milligram" />
                            <system value="http://unitsofmeasure.org" />
                            <code value="mg" />
                        </doseQuantity>
                    </doseAndRate>
                </dosageInstruction>
                <substitution>
                    <allowedBoolean value="false" />
                </substitution>
            </MedicationRequest>
        </resource>
    </entry>
</Bundle>

{
    "resourceType": "Bundle",
    "id": "7d107ed2-70c6-43d9-9cbe-f19c319d1456",
    "identifier": {
        "system": "urn:[organisation_name]:[system_name]",
        "value": "urn:8cd8108d-8c72-4fe9-a284-cd28b127fcfa"
    },
    "type": "message",
    "timestamp": "2021-05-07T16:15:32Z",
    "entry":  [
        {
            "fullUrl": "urn:message-header-167434",
            "resource": {
                "resourceType": "MessageHeader",
                "id": "urn:message-header-167434",
                "eventCoding": {
                    "system": "https://fhir.hl7.org.uk//CodeSystem/message-event",
                    "code": "prescription-order",
                    "display": "Prescription Order"
                },
                "source": {
                    "name": "ACME Clinical Systems",
                    "software": "ACME ePMA",
                    "version": "3.5.68",
                    "endpoint": "urn:nhs-uk:addressing:ods:T48NT"
                },
                "focus":  [
                    {
                        "reference": "urn:med-req-01923"
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:patient-01912",
            "resource": {
                "resourceType": "Patient",
                "id": "patient-01912",
                "identifier":  [
                    {
                        "system": "https://fhir.nhs.uk/Id/nhs-number",
                        "value": "4857773456"
                    }
                ],
                "name":  [
                    {
                        "use": "official",
                        "text": "Mr Chris Packet",
                        "family": "Packet",
                        "given":  [
                            "Chris"
                        ],
                        "prefix":  [
                            "Mr"
                        ]
                    }
                ],
                "gender": "male",
                "birthDate": "1995-11-12"
            }
        },
        {
            "fullUrl": "urn: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": "urn:medication-99101",
            "resource": {
                "resourceType": "Medication",
                "id": "medication-99101",
                "code": {
                    "coding":  [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "415159003",
                            "display": "Pregabalin"
                        }
                    ]
                }
            }
        },
        {
            "fullUrl": "urn:med-req-01923",
            "resource": {
                "resourceType": "MedicationRequest",
                "id": "med-req-01923",
                "identifier":  [
                    {
                        "value": "6d2bfb69-656a-45ef-92d0-d4aae02bb438"
                    }
                ],
                "status": "active",
                "intent": "order",
                "category":  [
                    {
                        "coding":  [
                            {
                                "system": "http://hl7.org/fhir/medication-request-category",
                                "code": "inpatient",
                                "display": "inpatient"
                            }
                        ]
                    }
                ],
                "priority": "routine",
                "medicationReference": {
                    "reference": "medication-99101",
                    "display": "Pregabalin"
                },
                "subject": {
                    "reference": "patient-01912",
                    "display": "Mr Chris Packet"
                },
                "authoredOn": "2021-05-07T18:12:41+01:00",
                "requester": {
                    "reference": "staff-1112",
                    "display": "Dr Maikeu Well"
                },
                "recorder": {
                    "reference": "staff-1112",
                    "display": "Dr Maikeu Well"
                },
                "dosageInstruction":  [
                    {
                        "sequence": 1,
                        "timing": {
                            "repeat": {
                                "boundsDuration": {
                                    "value": 3,
                                    "unit": "day",
                                    "system": "http://unitsofmeasure.org",
                                    "code": "d"
                                },
                                "frequency": 2,
                                "period": 1,
                                "periodUnit": "d"
                            }
                        },
                        "route": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "26643006",
                                    "display": "oral"
                                }
                            ]
                        },
                        "doseAndRate":  [
                            {
                                "doseQuantity": {
                                    "value": 75,
                                    "unit": "milligram",
                                    "system": "http://unitsofmeasure.org",
                                    "code": "mg"
                                }
                            }
                        ]
                    },
                    {
                        "sequence": 2,
                        "timing": {
                            "repeat": {
                                "frequency": 3,
                                "period": 1,
                                "periodUnit": "d"
                            }
                        },
                        "route": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "26643006",
                                    "display": "oral"
                                }
                            ]
                        },
                        "doseAndRate":  [
                            {
                                "doseQuantity": {
                                    "value": 75,
                                    "unit": "milligram",
                                    "system": "http://unitsofmeasure.org",
                                    "code": "mg"
                                }
                            }
                        ]
                    }
                ],
                "substitution": {
                    "allowedBoolean": false
                }
            }
        }
    ]
}

Bundle.id[0]	7d107ed2-70c6-43d9-9cbe-f19c319d1456
Bundle.identifier[0].system[0]	urn:[organisation_name]:[system_name]
Bundle.identifier[0].value[0]	urn:8cd8108d-8c72-4fe9-a284-cd28b127fcfa
Bundle.type[0]	message
Bundle.timestamp[0]	2021-05-07T16:15:32Z
Bundle.entry[0].fullUrl[0]	urn:message-header-167434
Bundle.entry[0].resource[0].id[0]	urn:message-header-167434
Bundle.entry[0].resource[0].eventCoding[0].system[0]	https://fhir.hl7.org.uk//CodeSystem/message-event
Bundle.entry[0].resource[0].eventCoding[0].code[0]	prescription-order
Bundle.entry[0].resource[0].eventCoding[0].display[0]	Prescription Order
Bundle.entry[0].resource[0].source[0].name[0]	ACME Clinical Systems
Bundle.entry[0].resource[0].source[0].software[0]	ACME ePMA
Bundle.entry[0].resource[0].source[0].version[0]	3.5.68
Bundle.entry[0].resource[0].source[0].endpoint[0]	urn:nhs-uk:addressing:ods:T48NT
Bundle.entry[0].resource[0].focus[0].reference[0]	urn:med-req-01923
Bundle.entry[1].fullUrl[0]	urn:patient-01912
Bundle.entry[1].resource[0].id[0]	patient-01912
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]	4857773456
Bundle.entry[1].resource[0].name[0].use[0]	official
Bundle.entry[1].resource[0].name[0].text[0]	Mr Chris Packet
Bundle.entry[1].resource[0].name[0].family[0]	Packet
Bundle.entry[1].resource[0].name[0].given[0]	Chris
Bundle.entry[1].resource[0].name[0].prefix[0]	Mr
Bundle.entry[1].resource[0].gender[0]	male
Bundle.entry[1].resource[0].birthDate[0]	1995-11-12
Bundle.entry[2].fullUrl[0]	urn: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]	urn:medication-99101
Bundle.entry[3].resource[0].id[0]	medication-99101
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]	415159003
Bundle.entry[3].resource[0].code[0].coding[0].display[0]	Pregabalin
Bundle.entry[4].fullUrl[0]	urn:med-req-01923
Bundle.entry[4].resource[0].id[0]	med-req-01923
Bundle.entry[4].resource[0].identifier[0].value[0]	6d2bfb69-656a-45ef-92d0-d4aae02bb438
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].medicationReference[0].reference[0]	medication-99101
Bundle.entry[4].resource[0].medicationReference[0].display[0]	Pregabalin
Bundle.entry[4].resource[0].subject[0].reference[0]	patient-01912
Bundle.entry[4].resource[0].subject[0].display[0]	Mr Chris Packet
Bundle.entry[4].resource[0].authoredOn[0]	2021-05-07T18:12:41+01:00
Bundle.entry[4].resource[0].requester[0].reference[0]	staff-1112
Bundle.entry[4].resource[0].requester[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].sequence[0]	1
Bundle.entry[4].resource[0].dosageInstruction[0].timing[0].repeat[0].boundsDuration[0].value[0]	3
Bundle.entry[4].resource[0].dosageInstruction[0].timing[0].repeat[0].boundsDuration[0].unit[0]	day
Bundle.entry[4].resource[0].dosageInstruction[0].timing[0].repeat[0].boundsDuration[0].system[0]	http://unitsofmeasure.org
Bundle.entry[4].resource[0].dosageInstruction[0].timing[0].repeat[0].boundsDuration[0].code[0]	d
Bundle.entry[4].resource[0].dosageInstruction[0].timing[0].repeat[0].frequency[0]	2
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].doseAndRate[0].doseQuantity[0].value[0]	75
Bundle.entry[4].resource[0].dosageInstruction[0].doseAndRate[0].doseQuantity[0].unit[0]	milligram
Bundle.entry[4].resource[0].dosageInstruction[0].doseAndRate[0].doseQuantity[0].system[0]	http://unitsofmeasure.org
Bundle.entry[4].resource[0].dosageInstruction[0].doseAndRate[0].doseQuantity[0].code[0]	mg
Bundle.entry[4].resource[0].dosageInstruction[1].sequence[0]	2
Bundle.entry[4].resource[0].dosageInstruction[1].timing[0].repeat[0].frequency[0]	3
Bundle.entry[4].resource[0].dosageInstruction[1].timing[0].repeat[0].period[0]	1
Bundle.entry[4].resource[0].dosageInstruction[1].timing[0].repeat[0].periodUnit[0]	d
Bundle.entry[4].resource[0].dosageInstruction[1].route[0].coding[0].system[0]	http://snomed.info/sct
Bundle.entry[4].resource[0].dosageInstruction[1].route[0].coding[0].code[0]	26643006
Bundle.entry[4].resource[0].dosageInstruction[1].route[0].coding[0].display[0]	oral
Bundle.entry[4].resource[0].dosageInstruction[1].doseAndRate[0].doseQuantity[0].value[0]	75
Bundle.entry[4].resource[0].dosageInstruction[1].doseAndRate[0].doseQuantity[0].unit[0]	milligram
Bundle.entry[4].resource[0].dosageInstruction[1].doseAndRate[0].doseQuantity[0].system[0]	http://unitsofmeasure.org
Bundle.entry[4].resource[0].dosageInstruction[1].doseAndRate[0].doseQuantity[0].code[0]	mg
Bundle.entry[4].resource[0].substitution[0].allowedBoolean[0]	False

Bundle

id : 7d107ed2-70c6-43d9-9cbe-f19c319d1456

identifier

system : urn:[organisation_name]:[system_name]

value : urn:8cd8108d-8c72-4fe9-a284-cd28b127fcfa

type : message

timestamp : 2021-05-07T16:15:32+00:00

entry

fullUrl : urn:message-header-167434

resource

id : urn:message-header-167434

event

system : https://fhir.hl7.org.uk//CodeSystem/message-event

code : prescription-order

display : Prescription Order

source

name : ACME Clinical Systems

software : ACME ePMA

version : 3.5.68

endpoint : urn:nhs-uk:addressing:ods:T48NT

focus

reference : urn:med-req-01923

entry

fullUrl : urn:patient-01912

resource

id : patient-01912

identifier

system : https://fhir.nhs.uk/Id/nhs-number

value : 4857773456

name

use : official

text : Mr Chris Packet

family : Packet

given : Chris

prefix : Mr

gender : male

birthDate : 1995-11-12

entry

fullUrl : urn:staff-1112

resource

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

entry

fullUrl : urn:medication-99101

resource

id : medication-99101

code

coding

system : http://snomed.info/sct

code : 415159003

display : Pregabalin

entry

fullUrl : urn:med-req-01923

resource

id : med-req-01923

identifier

value : 6d2bfb69-656a-45ef-92d0-d4aae02bb438

status : active

intent : order

category

coding

system : http://hl7.org/fhir/medication-request-category

code : inpatient

display : inpatient

priority : routine

medication

reference : medication-99101

display : Pregabalin

subject

reference : patient-01912

display : Mr Chris Packet

authoredOn : 2021-05-07T18:12:41+01:00

requester

reference : staff-1112

display : Dr Maikeu Well

recorder

reference : staff-1112

display : Dr Maikeu Well

dosageInstruction

sequence : 1

timing

repeat

bounds

value : 3

unit : day

system : http://unitsofmeasure.org

code : d

frequency : 2

period : 1

periodUnit : d

route

coding

system : http://snomed.info/sct

code : 26643006

display : oral

doseAndRate

dose

value : 75

unit : milligram

system : http://unitsofmeasure.org

code : mg

dosageInstruction

sequence : 2

timing

repeat

frequency : 3

period : 1

periodUnit : d

route

coding

system : http://snomed.info/sct

code : 26643006

display : oral

doseAndRate

dose

value : 75

unit : milligram

system : http://unitsofmeasure.org

code : mg

substitution

allowed : False

Example 3: Inpatient MedicationDispense

Note: This example below has been temporarily removed as under review and will be re-published very soon.

The dispensing of Pregabalin.

Actors

Provider System = Hospital pharamcy system

Consumer System = Ward EMPA system

Example

Example will be re-published soon...

Example 4: Discharge MedicationRequest

Note: This example below is a draft and requires clinical verification.

Discharge TTO medication requests for Paracetamol , Ibuprofen and Pregabalin.

Actors

Provider System = Ward EMPA system

Consumer System = Hospital pharamcy system

Example

<Bundle xmlns="http://hl7.org/fhir">
    <id value="acd1d58c-4abd-415b-a5a3-88f5dac71ec0" />
    <type value="message" />
    <timestamp value="2021-05-07T16:15:32Z" />
    <!--    Message Header    -->
    <entry>
        <fullUrl value="urn:message-header-9920192" />
        <resource>
            <MessageHeader>
                <id value="urn:message-header-9920192" />
                <eventCoding>
                    <system value="https://fhir.nhs.uk/STU3/CodeSystem/EventType-1" />
                    <code value="prescription-order" />
                    <display value="Prescription Order" />
                </eventCoding>
                <source>
                    <name value="ACME Clinical Systems" />
                    <software value="ACME ePMA" />
                    <version value="3.5.68" />
                    <endpoint value="urn:nhs-uk:addressing:ods:T48NT" />
                </source>
                <focus>
                    <reference value="urn:med-req-76462" />
                </focus>
                <focus>
                    <reference value="urn:med-req-987765745" />
                </focus>
                <focus>
                    <reference value="urn:med-req-11adfw53446" />
                </focus>
            </MessageHeader>
        </resource>
    </entry>
    <!--   // Patient associated with the encounter    -->
    <entry>
        <fullUrl value="urn:patient-01912" />
        <resource>
            <Patient>
                <id value="urn:patient-01912" />
                <identifier>
                    <system value="https://fhir.nhs.uk/Id/nhs-number" />
                    <value value="4857773456" />
                </identifier>
                <name>
                    <use value="official" />
                    <text value="Mr Chris Packet" />
                    <family value="Packet" />
                    <given value="Chris" />
                    <prefix value="Mr" />
                </name>
                <gender value="male" />
                <birthDate value="1995-11-12" />
            </Patient>
        </resource>
    </entry>
    <!--   // Prescribing clinician associated with the encounter.    -->
    <entry>
        <fullUrl value="urn:staff-1112" />
        <resource>
            <Practitioner>
                <id value="urn: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 #1: Paracetamol   -->
    <entry>
        <fullUrl value="urn:medication-90332006" />
        <resource>
            <Medication>
                <id value="urn:medication-90332006" />
                <code>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="90332006" />
                        <display value="Paracetamol" />
                    </coding>
                </code>
            </Medication>
        </resource>
    </entry>
    <!--    // Medication Request #1: Paracetamol 1g four times a day    -->
    <entry>
        <fullUrl value="urn:med-req-76462" />
        <resource>
            <MedicationRequest>
                <id value="urn:med-req-76462" />
                <identifier>
                    <value value="35873655-0d53-469a-9428-04df65f5cbb4" />
                </identifier>
                <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="urn:medication-90332006" />
                    <display value="Paracetamol" />
                </medicationReference>
                <subject>
                    <reference value="urn:patient-01912" />
                    <display value="Mr Chris Packet" />
                </subject>
                <authoredOn value="2021-05-14T11:34:12+01:00" />
                <requester>
                    <reference value="urn:staff-1112" />
                    <display value="Dr Maikeu Well" />
                </requester>
                <recorder>
                    <reference value="urn:staff-1112" />
                    <display value="Dr Maikeu Well" />
                </recorder>
                <dosageInstruction>
                    <timing>
                        <repeat>
                            <frequency value="4" />
                            <period value="1" />
                            <periodUnit value="d" />
                        </repeat>
                    </timing>
                    <route>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="26643006" />
                            <display value="oral" />
                        </coding>
                    </route>
                    <doseAndRate>
                        <doseQuantity>
                            <value value="1" />
                            <unit value="gram" />
                            <system value="http://unitsofmeasure.org" />
                            <code value="g" />
                        </doseQuantity>
                    </doseAndRate>
                </dosageInstruction>
                <substitution>
                    <allowedBoolean value="false" />
                </substitution>
            </MedicationRequest>
        </resource>
    </entry>
    <!--   // Medication #2: Ibuprofen 800mg modified-release tablets   -->
    <entry>
        <fullUrl value="urn:medication-39110311000001101" />
        <resource>
            <Medication>
                <id value="urn:medication-39110311000001101" />
                <code>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="39110311000001101" />
                        <display value="Ibuprofen 800mg modified-release tablets" />
                    </coding>
                </code>
            </Medication>
        </resource>
    </entry>
    <!--    // Medication Request #2: Ibuprofen 800mg modified-release tablets   -->
    <entry>
        <fullUrl value="urn:med-req-987765745" />
        <resource>
            <MedicationRequest>
                <id value="urn:med-req-987765745" />
                <identifier>
                    <value value="63a40946-c387-4810-9458-c573f873d7b4" />
                </identifier>
                <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="urn:medication-39110311000001101" />
                    <display value="Ibuprofen 800mg modified-release tablets" />
                </medicationReference>
                <subject>
                    <reference value="urn:patient-01912" />
                    <display value="Mr Chris Packet" />
                </subject>
                <authoredOn value="2021-05-14T11:34:12Z" />
                <requester>
                    <reference value="urn:staff-1112" />
                    <display value="Dr Maikeu Well" />
                </requester>
                <recorder>
                    <reference value="urn:staff-1112" />
                    <display value="Dr Maikeu Well" />
                </recorder>
                <dosageInstruction>
                    <timing>
                        <repeat>
                            <frequency value="2" />
                            <period value="1" />
                            <periodUnit value="d" />
                        </repeat>
                    </timing>
                    <route>
                        <coding>
                            <system value="http://snomed.info/sct" />
                            <code value="26643006" />
                            <display value="oral" />
                        </coding>
                    </route>
                    <doseAndRate>
                        <doseQuantity>
                            <value value="800" />
                            <unit value="milligram" />
                            <system value="http://unitsofmeasure.org" />
                            <code value="mg" />
                        </doseQuantity>
                    </doseAndRate>
                </dosageInstruction>
                <substitution>
                    <allowedBoolean value="false" />
                </substitution>
            </MedicationRequest>
        </resource>
    </entry>
    <!--   // Medication #3: Pregabalin   -->
    <entry>
        <fullUrl value="urn:medication-234567321" />
        <resource>
            <Medication>
                <id value="urn:medication-234567321" />
                <code>
                    <coding>
                        <system value="http://snomed.info/sct" />
                        <code value="415160008" />
                        <display value="Pregabalin" />
                    </coding>
                </code>
            </Medication>
        </resource>
    </entry>
    <!--    // Medication Request #3: Pregabalin    -->
    <entry>
        <fullUrl value="urn:med-req-11adfw53446" />
        <resource>
            <MedicationRequest>
                <id value="urn:med-req-11adfw53446" />
                <identifier>
                    <value value="63a40946-c387-4810-9458-c573f873d7b4" />
                </identifier>
                <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="urn:medication-234567321" />
                    <display value="Pregabalin" />
                </medicationReference>
                <subject>
                    <reference value="urn:patient-01912" />
                    <display value="Mr Chris Packet" />
                </subject>
                <authoredOn value="2021-05-14T11:34:12Z" />
                <requester>
                    <reference value="urn:staff-1112" />
                    <display value="Dr Maikeu Well" />
                </requester>
                <recorder>
                    <reference value="urn: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>
                    <doseAndRate>
                        <doseQuantity>
                            <value value="75" />
                            <unit value="milligram" />
                            <system value="http://unitsofmeasure.org" />
                            <code value="mg" />
                        </doseQuantity>
                    </doseAndRate>
                </dosageInstruction>
                <substitution>
                    <allowedBoolean value="false" />
                </substitution>
            </MedicationRequest>
        </resource>
    </entry>
</Bundle>

{
    "resourceType": "Bundle",
    "id": "acd1d58c-4abd-415b-a5a3-88f5dac71ec0",
    "type": "message",
    "timestamp": "2021-05-07T16:15:32Z",
    "entry":  [
        {
            "fullUrl": "urn:message-header-9920192",
            "resource": {
                "resourceType": "MessageHeader",
                "id": "urn:message-header-9920192",
                "eventCoding": {
                    "system": "https://fhir.nhs.uk/STU3/CodeSystem/EventType-1",
                    "code": "prescription-order",
                    "display": "Prescription Order"
                },
                "source": {
                    "name": "ACME Clinical Systems",
                    "software": "ACME ePMA",
                    "version": "3.5.68",
                    "endpoint": "urn:nhs-uk:addressing:ods:T48NT"
                },
                "focus":  [
                    {
                        "reference": "urn:med-req-76462"
                    },
                    {
                        "reference": "urn:med-req-987765745"
                    },
                    {
                        "reference": "urn:med-req-11adfw53446"
                    }
                ]
            }
        },
        {
            "fullUrl": "urn:patient-01912",
            "resource": {
                "resourceType": "Patient",
                "id": "urn:patient-01912",
                "identifier":  [
                    {
                        "system": "https://fhir.nhs.uk/Id/nhs-number",
                        "value": "4857773456"
                    }
                ],
                "name":  [
                    {
                        "use": "official",
                        "text": "Mr Chris Packet",
                        "family": "Packet",
                        "given":  [
                            "Chris"
                        ],
                        "prefix":  [
                            "Mr"
                        ]
                    }
                ],
                "gender": "male",
                "birthDate": "1995-11-12"
            }
        },
        {
            "fullUrl": "urn:staff-1112",
            "resource": {
                "resourceType": "Practitioner",
                "id": "urn: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": "urn:medication-90332006",
            "resource": {
                "resourceType": "Medication",
                "id": "urn:medication-90332006",
                "code": {
                    "coding":  [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "90332006",
                            "display": "Paracetamol"
                        }
                    ]
                }
            }
        },
        {
            "fullUrl": "urn:med-req-76462",
            "resource": {
                "resourceType": "MedicationRequest",
                "id": "urn:med-req-76462",
                "identifier":  [
                    {
                        "value": "35873655-0d53-469a-9428-04df65f5cbb4"
                    }
                ],
                "status": "active",
                "intent": "order",
                "category":  [
                    {
                        "coding":  [
                            {
                                "system": "http://hl7.org/fhir/medication-request-category",
                                "code": "inpatient",
                                "display": "inpatient"
                            }
                        ]
                    }
                ],
                "priority": "routine",
                "medicationReference": {
                    "reference": "urn:medication-90332006",
                    "display": "Paracetamol"
                },
                "subject": {
                    "reference": "urn:patient-01912",
                    "display": "Mr Chris Packet"
                },
                "authoredOn": "2021-05-14T11:34:12+01:00",
                "requester": {
                    "reference": "urn:staff-1112",
                    "display": "Dr Maikeu Well"
                },
                "recorder": {
                    "reference": "urn:staff-1112",
                    "display": "Dr Maikeu Well"
                },
                "dosageInstruction":  [
                    {
                        "timing": {
                            "repeat": {
                                "frequency": 4,
                                "period": 1,
                                "periodUnit": "d"
                            }
                        },
                        "route": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "26643006",
                                    "display": "oral"
                                }
                            ]
                        },
                        "doseAndRate":  [
                            {
                                "doseQuantity": {
                                    "value": 1,
                                    "unit": "gram",
                                    "system": "http://unitsofmeasure.org",
                                    "code": "g"
                                }
                            }
                        ]
                    }
                ],
                "substitution": {
                    "allowedBoolean": false
                }
            }
        },
        {
            "fullUrl": "urn:medication-39110311000001101",
            "resource": {
                "resourceType": "Medication",
                "id": "urn:medication-39110311000001101",
                "code": {
                    "coding":  [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "39110311000001101",
                            "display": "Ibuprofen 800mg modified-release tablets"
                        }
                    ]
                }
            }
        },
        {
            "fullUrl": "urn:med-req-987765745",
            "resource": {
                "resourceType": "MedicationRequest",
                "id": "urn:med-req-987765745",
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                    }
                ],
                "status": "active",
                "intent": "order",
                "category":  [
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                        "coding":  [
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                                "system": "http://hl7.org/fhir/medication-request-category",
                                "code": "inpatient",
                                "display": "inpatient"
                            }
                        ]
                    }
                ],
                "priority": "routine",
                "medicationReference": {
                    "reference": "urn:medication-39110311000001101",
                    "display": "Ibuprofen 800mg modified-release tablets"
                },
                "subject": {
                    "reference": "urn:patient-01912",
                    "display": "Mr Chris Packet"
                },
                "authoredOn": "2021-05-14T11:34:12Z",
                "requester": {
                    "reference": "urn:staff-1112",
                    "display": "Dr Maikeu Well"
                },
                "recorder": {
                    "reference": "urn:staff-1112",
                    "display": "Dr Maikeu Well"
                },
                "dosageInstruction":  [
                    {
                        "timing": {
                            "repeat": {
                                "frequency": 2,
                                "period": 1,
                                "periodUnit": "d"
                            }
                        },
                        "route": {
                            "coding":  [
                                {
                                    "system": "http://snomed.info/sct",
                                    "code": "26643006",
                                    "display": "oral"
                                }
                            ]
                        },
                        "doseAndRate":  [
                            {
                                "doseQuantity": {
                                    "value": 800,
                                    "unit": "milligram",
                                    "system": "http://unitsofmeasure.org",
                                    "code": "mg"
                                }
                            }
                        ]
                    }
                ],
                "substitution": {
                    "allowedBoolean": false
                }
            }
        },
        {
            "fullUrl": "urn:medication-234567321",
            "resource": {
                "resourceType": "Medication",
                "id": "urn:medication-234567321",
                "code": {
                    "coding":  [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "415160008",
                            "display": "Pregabalin"
                        }
                    ]
                }
            }
        },
        {
            "fullUrl": "urn:med-req-11adfw53446",
            "resource": {
                "resourceType": "MedicationRequest",
                "id": "urn:med-req-11adfw53446",
                "identifier":  [
                    {
                        "value": "63a40946-c387-4810-9458-c573f873d7b4"
                    }
                ],
                "status": "active",
                "intent": "order",
                "category":  [
                    {
                        "coding":  [
                            {
                                "system": "http://hl7.org/fhir/medication-request-category",
                                "code": "inpatient",
                                "display": "inpatient"
                            }
                        ]
                    }
                ],
                "priority": "routine",
                "medicationReference": {
                    "reference": "urn:medication-234567321",
                    "display": "Pregabalin"
                },
                "subject": {
                    "reference": "urn:patient-01912",
                    "display": "Mr Chris Packet"
                },
                "authoredOn": "2021-05-14T11:34:12Z",
                "requester": {
                    "reference": "urn:staff-1112",
                    "display": "Dr Maikeu Well"
                },
                "recorder": {
                    "reference": "urn: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"
                                }
                            ]
                        },
                        "doseAndRate":  [
                            {
                                "doseQuantity": {
                                    "value": 75,
                                    "unit": "milligram",
                                    "system": "http://unitsofmeasure.org",
                                    "code": "mg"
                                }
                            }
                        ]
                    }
                ],
                "substitution": {
                    "allowedBoolean": false
                }
            }
        }
    ]
}

Bundle.id[0]	acd1d58c-4abd-415b-a5a3-88f5dac71ec0
Bundle.type[0]	message
Bundle.timestamp[0]	2021-05-07T16:15:32Z
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Bundle.entry[1].resource[0].name[0].text[0]	Mr Chris Packet
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Bundle.entry[2].fullUrl[0]	urn:staff-1112
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Bundle.entry[2].resource[0].name[0].prefix[0]	Dr
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Bundle.entry[4].resource[0].id[0]	urn:med-req-76462
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Bundle.entry[4].resource[0].status[0]	active
Bundle.entry[4].resource[0].intent[0]	order
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Bundle.entry[4].resource[0].category[0].coding[0].code[0]	inpatient
Bundle.entry[4].resource[0].category[0].coding[0].display[0]	inpatient
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Bundle.entry[4].resource[0].requester[0].reference[0]	urn:staff-1112
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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
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Bundle.entry[4].resource[0].dosageInstruction[0].doseAndRate[0].doseQuantity[0].value[0]	1
Bundle.entry[4].resource[0].dosageInstruction[0].doseAndRate[0].doseQuantity[0].unit[0]	gram
Bundle.entry[4].resource[0].dosageInstruction[0].doseAndRate[0].doseQuantity[0].system[0]	http://unitsofmeasure.org
Bundle.entry[4].resource[0].dosageInstruction[0].doseAndRate[0].doseQuantity[0].code[0]	g
Bundle.entry[4].resource[0].substitution[0].allowedBoolean[0]	False
Bundle.entry[5].fullUrl[0]	urn:medication-39110311000001101
Bundle.entry[5].resource[0].id[0]	urn:medication-39110311000001101
Bundle.entry[5].resource[0].code[0].coding[0].system[0]	http://snomed.info/sct
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Bundle.entry[6].resource[0].id[0]	urn:med-req-987765745
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Bundle.entry[6].resource[0].status[0]	active
Bundle.entry[6].resource[0].intent[0]	order
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Bundle.entry[6].resource[0].category[0].coding[0].code[0]	inpatient
Bundle.entry[6].resource[0].category[0].coding[0].display[0]	inpatient
Bundle.entry[6].resource[0].priority[0]	routine
Bundle.entry[6].resource[0].medicationReference[0].reference[0]	urn:medication-39110311000001101
Bundle.entry[6].resource[0].medicationReference[0].display[0]	Ibuprofen 800mg modified-release tablets
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Bundle.entry[6].resource[0].requester[0].reference[0]	urn:staff-1112
Bundle.entry[6].resource[0].requester[0].display[0]	Dr Maikeu Well
Bundle.entry[6].resource[0].recorder[0].reference[0]	urn:staff-1112
Bundle.entry[6].resource[0].recorder[0].display[0]	Dr Maikeu Well
Bundle.entry[6].resource[0].dosageInstruction[0].timing[0].repeat[0].frequency[0]	2
Bundle.entry[6].resource[0].dosageInstruction[0].timing[0].repeat[0].period[0]	1
Bundle.entry[6].resource[0].dosageInstruction[0].timing[0].repeat[0].periodUnit[0]	d
Bundle.entry[6].resource[0].dosageInstruction[0].route[0].coding[0].system[0]	http://snomed.info/sct
Bundle.entry[6].resource[0].dosageInstruction[0].route[0].coding[0].code[0]	26643006
Bundle.entry[6].resource[0].dosageInstruction[0].route[0].coding[0].display[0]	oral
Bundle.entry[6].resource[0].dosageInstruction[0].doseAndRate[0].doseQuantity[0].value[0]	800
Bundle.entry[6].resource[0].dosageInstruction[0].doseAndRate[0].doseQuantity[0].unit[0]	milligram
Bundle.entry[6].resource[0].dosageInstruction[0].doseAndRate[0].doseQuantity[0].system[0]	http://unitsofmeasure.org
Bundle.entry[6].resource[0].dosageInstruction[0].doseAndRate[0].doseQuantity[0].code[0]	mg
Bundle.entry[6].resource[0].substitution[0].allowedBoolean[0]	False
Bundle.entry[7].fullUrl[0]	urn:medication-234567321
Bundle.entry[7].resource[0].id[0]	urn:medication-234567321
Bundle.entry[7].resource[0].code[0].coding[0].system[0]	http://snomed.info/sct
Bundle.entry[7].resource[0].code[0].coding[0].code[0]	415160008
Bundle.entry[7].resource[0].code[0].coding[0].display[0]	Pregabalin
Bundle.entry[8].fullUrl[0]	urn:med-req-11adfw53446
Bundle.entry[8].resource[0].id[0]	urn:med-req-11adfw53446
Bundle.entry[8].resource[0].identifier[0].value[0]	63a40946-c387-4810-9458-c573f873d7b4
Bundle.entry[8].resource[0].status[0]	active
Bundle.entry[8].resource[0].intent[0]	order
Bundle.entry[8].resource[0].category[0].coding[0].system[0]	http://hl7.org/fhir/medication-request-category
Bundle.entry[8].resource[0].category[0].coding[0].code[0]	inpatient
Bundle.entry[8].resource[0].category[0].coding[0].display[0]	inpatient
Bundle.entry[8].resource[0].priority[0]	routine
Bundle.entry[8].resource[0].medicationReference[0].reference[0]	urn:medication-234567321
Bundle.entry[8].resource[0].medicationReference[0].display[0]	Pregabalin
Bundle.entry[8].resource[0].subject[0].reference[0]	urn:patient-01912
Bundle.entry[8].resource[0].subject[0].display[0]	Mr Chris Packet
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Bundle.entry[8].resource[0].substitution[0].allowedBoolean[0]	False

Bundle

id : acd1d58c-4abd-415b-a5a3-88f5dac71ec0

type : message

timestamp : 2021-05-07T16:15:32+00:00

entry

fullUrl : urn:message-header-9920192

resource

id : urn:message-header-9920192

event

system : https://fhir.nhs.uk/STU3/CodeSystem/EventType-1

code : prescription-order

display : Prescription Order

source

name : ACME Clinical Systems

software : ACME ePMA

version : 3.5.68

endpoint : urn:nhs-uk:addressing:ods:T48NT

focus

reference : urn:med-req-76462

focus

reference : urn:med-req-987765745

focus

reference : urn:med-req-11adfw53446

entry

fullUrl : urn:patient-01912

resource

id : urn:patient-01912

identifier

system : https://fhir.nhs.uk/Id/nhs-number

value : 4857773456

name

use : official

text : Mr Chris Packet

family : Packet

given : Chris

prefix : Mr

gender : male

birthDate : 1995-11-12

entry

fullUrl : urn:staff-1112

resource

id : urn:staff-1112

name

text : Dr Maikeu Well

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qualification

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coding

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entry

fullUrl : urn:medication-90332006

resource

id : urn:medication-90332006

code

coding

system : http://snomed.info/sct

code : 90332006

display : Paracetamol

entry

fullUrl : urn:med-req-76462

resource

id : urn:med-req-76462

identifier

value : 35873655-0d53-469a-9428-04df65f5cbb4

status : active

intent : order

category

coding

system : http://hl7.org/fhir/medication-request-category

code : inpatient

display : inpatient

priority : routine

medication

reference : urn:medication-90332006

display : Paracetamol

subject

reference : urn:patient-01912

display : Mr Chris Packet

authoredOn : 2021-05-14T11:34:12+01:00

requester

reference : urn:staff-1112

display : Dr Maikeu Well

recorder

reference : urn:staff-1112

display : Dr Maikeu Well

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timing

repeat

frequency : 4

period : 1

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route

coding

system : http://snomed.info/sct

code : 26643006

display : oral

doseAndRate

dose

value : 1

unit : gram

system : http://unitsofmeasure.org

code : g

substitution

allowed : False

entry

fullUrl : urn:medication-39110311000001101

resource

id : urn:medication-39110311000001101

code

coding

system : http://snomed.info/sct

code : 39110311000001101

display : Ibuprofen 800mg modified-release tablets

entry

fullUrl : urn:med-req-987765745

resource

id : urn:med-req-987765745

identifier

value : 63a40946-c387-4810-9458-c573f873d7b4

status : active

intent : order

category

coding

system : http://hl7.org/fhir/medication-request-category

code : inpatient

display : inpatient

priority : routine

medication

reference : urn:medication-39110311000001101

display : Ibuprofen 800mg modified-release tablets

subject

reference : urn:patient-01912

display : Mr Chris Packet

authoredOn : 2021-05-14T11:34:12Z

requester

reference : urn:staff-1112

display : Dr Maikeu Well

recorder

reference : urn:staff-1112

display : Dr Maikeu Well

dosageInstruction

timing

repeat

frequency : 2

period : 1

periodUnit : d

route

coding

system : http://snomed.info/sct

code : 26643006

display : oral

doseAndRate

dose

value : 800

unit : milligram

system : http://unitsofmeasure.org

code : mg

substitution

allowed : False

entry

fullUrl : urn:medication-234567321

resource

id : urn:medication-234567321

code

coding

system : http://snomed.info/sct

code : 415160008

display : Pregabalin

entry

fullUrl : urn:med-req-11adfw53446

resource

id : urn:med-req-11adfw53446

identifier

value : 63a40946-c387-4810-9458-c573f873d7b4

status : active

intent : order

category

coding

system : http://hl7.org/fhir/medication-request-category

code : inpatient

display : inpatient

priority : routine

medication

reference : urn:medication-234567321

display : Pregabalin

subject

reference : urn:patient-01912

display : Mr Chris Packet

authoredOn : 2021-05-14T11:34:12Z

requester

reference : urn:staff-1112

display : Dr Maikeu Well

recorder

reference : urn: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

doseAndRate

dose

value : 75

unit : milligram

system : http://unitsofmeasure.org

code : mg

substitution

allowed : False

Example 5: Discharge MedicationDispense

Note: This example below has been temporarily removed as under review and will be re-published very soon.

The pharmacy dispenseses the following for the Discharge Medication (TTO) request

Paracetamol 500mg tablets, 112 tablets
Ibuprofen 800mg modified-release tablets, 56 tablets
Pregabalin 75mg tablets, 56 tablets

Note: The odd quantities are because pharmacies usually give complete packs rather than split them.

Actors

Provider System = Hospital pharamcy system

Consumer System = Ward EMPA system

Example

Example will be re-published soon...

Implementation guide for digital medicines

Admission, Discharge and change in Medication / Chris Packet

Patient Journey: Chris Packet

Expected Outcome

Example 1: GP MedicationStatement

Actors

Example

Example 2: Inpatient MedicationRequest

Actors

Example

Example 3: Inpatient MedicationDispense

Actors

Example

Example 4: Discharge MedicationRequest

Actors

Example

Example 5: Discharge MedicationDispense

Actors

Example