Implementation guide for interoperable medicines

This guidance is under active development by NHS England and content may be added or updated on a regular basis.

Aspirin suppository

Dose-based VTM prescription with maximum dose.
IMPORTANT: This example cannot use the simple medicationCodeableConcept element. The VTM medication needs to be qualified with a form. This example uses a contained resource which would be suitable for a RESTful implementation. When using a FHIR Messaging implementation the instance of the Medication resource as another resource within the Bundle. 
<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="41dab799-fdbb-4a1e-bee2-a1a73dacac8d" />
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
    </meta>
    <contained>
        <Medication>
            <id value="med1" />
            <code>
                <coding>
                    <system value="https://dmd.nhs.uk" />
                    <code value="7947003" />
                    <display value="Aspirin" />
                </coding>
            </code>
            <form>
                <coding>
                    <system value="http://snomed.info/sct" />
                    <code value="385194003" />
                    <display value="Suppository" />
                </coding>
            </form>
        </Medication>
    </contained>
    <status value="active" />
    <intent value="order" />
    <category>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/medicationrequest-category" />
            <code value="outpatient" />
            <display value="outpatient" />
        </coding>
    </category>
    <medicationReference>
        <reference value="#med1" />
    </medicationReference>
    <subject>
        <identifier>
            <system value="https://fhir.nhs.uk/Id/nhs-number" />
            <value value="9999999999" />
        </identifier>
    </subject>
    <authoredOn value="2020-05-15T15:00:00Z" />
    <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>
        <text value="600 milligram - every 4 hours - Rectal - up to a maximum of 3.6 gram in 24 hours" />
        <timing>
            <repeat>
                <frequency value="1" />
                <period value="4" />
                <periodUnit value="h" />
            </repeat>
        </timing>
        <route>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="37161004" />
                <display value="Rectal" />
            </coding>
        </route>
        <doseAndRate>
            <doseQuantity>
                <value value="600" />
                <unit value="milligram" />
                <system value="http://unitsofmeasure.org" />
                <code value="mg" />
            </doseQuantity>
        </doseAndRate>
        <maxDosePerPeriod>
            <numerator>
                <value value="3.6" />
                <unit value="gram" />
                <system value="http://unitsofmeasure.org" />
                <code value="g" />
            </numerator>
            <denominator>
                <value value="24" />
                <unit value="hour" />
                <system value="http://unitsofmeasure.org" />
                <code value="h" />
            </denominator>
        </maxDosePerPeriod>
    </dosageInstruction>
    <substitution>
        <allowedBoolean value="false" />
    </substitution>
</MedicationRequest>

{
    "resourceType": "MedicationRequest",
    "id": "41dab799-fdbb-4a1e-bee2-a1a73dacac8d",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
        ]
    },
    "contained":  [
        {
            "resourceType": "Medication",
            "id": "med1",
            "code": {
                "coding":  [
                    {
                        "system": "https://dmd.nhs.uk",
                        "code": "7947003",
                        "display": "Aspirin"
                    }
                ]
            },
            "form": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "385194003",
                        "display": "Suppository"
                    }
                ]
            }
        }
    ],
    "status": "active",
    "intent": "order",
    "category":  [
        {
            "coding":  [
                {
                    "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                    "code": "outpatient",
                    "display": "outpatient"
                }
            ]
        }
    ],
    "medicationReference": {
        "reference": "#med1"
    },
    "subject": {
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9999999999"
        }
    },
    "authoredOn": "2020-05-15T15:00:00Z",
    "requester": {
        "reference": "urn:staff-1112",
        "display": "Dr Maikeu Well"
    },
    "recorder": {
        "reference": "urn:staff-1112",
        "display": "Dr Maikeu Well"
    },
    "dosageInstruction":  [
        {
            "text": "600 milligram - every 4 hours - Rectal - up to a maximum of 3.6 gram in 24 hours",
            "timing": {
                "repeat": {
                    "frequency": 1,
                    "period": 4,
                    "periodUnit": "h"
                }
            },
            "route": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "37161004",
                        "display": "Rectal"
                    }
                ]
            },
            "doseAndRate":  [
                {
                    "doseQuantity": {
                        "value": 600,
                        "unit": "milligram",
                        "system": "http://unitsofmeasure.org",
                        "code": "mg"
                    }
                }
            ],
            "maxDosePerPeriod": {
                "numerator": {
                    "value": 3.6,
                    "unit": "gram",
                    "system": "http://unitsofmeasure.org",
                    "code": "g"
                },
                "denominator": {
                    "value": 24,
                    "unit": "hour",
                    "system": "http://unitsofmeasure.org",
                    "code": "h"
                }
            }
        }
    ],
    "substitution": {
        "allowedBoolean": false
    }
}
MedicationRequest.id[0]41dab799-fdbb-4a1e-bee2-a1a73dacac8d
MedicationRequest.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
MedicationRequest.contained[0].id[0]med1
MedicationRequest.contained[0].code[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.contained[0].code[0].coding[0].code[0]7947003
MedicationRequest.contained[0].code[0].coding[0].display[0]Aspirin
MedicationRequest.contained[0].form[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.contained[0].form[0].coding[0].code[0]385194003
MedicationRequest.contained[0].form[0].coding[0].display[0]Suppository
MedicationRequest.status[0]active
MedicationRequest.intent[0]order
MedicationRequest.category[0].coding[0].system[0]http://terminology.hl7.org/CodeSystem/medicationrequest-category
MedicationRequest.category[0].coding[0].code[0]outpatient
MedicationRequest.category[0].coding[0].display[0]outpatient
MedicationRequest.medication[0].reference[0]#med1
MedicationRequest.subject[0].identifier[0].system[0]https://fhir.nhs.uk/Id/nhs-number
MedicationRequest.subject[0].identifier[0].value[0]9999999999
MedicationRequest.authoredOn[0]2020-05-15T15:00:00Z
MedicationRequest.requester[0].reference[0]urn:staff-1112
MedicationRequest.requester[0].display[0]Dr Maikeu Well
MedicationRequest.recorder[0].reference[0]urn:staff-1112
MedicationRequest.recorder[0].display[0]Dr Maikeu Well
MedicationRequest.dosageInstruction[0].text[0]600 milligram - every 4 hours - Rectal - up to a maximum of 3.6 gram in 24 hours
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].frequency[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].period[0]4
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].periodUnit[0]h
MedicationRequest.dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].route[0].coding[0].code[0]37161004
MedicationRequest.dosageInstruction[0].route[0].coding[0].display[0]Rectal
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].value[0]600
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].unit[0]milligram
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].code[0]mg
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].value[0]3.6
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].unit[0]gram
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].code[0]g
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].value[0]24
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].unit[0]hour
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].code[0]h
MedicationRequest.substitution[0].allowed[0]False
MedicationRequest

Example on-screen presentation:

Aspirin
Suppository - 600 milligram - every 4 hours - Rectal - up to a maximum of 3.6 gram in 24 hours
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