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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