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.

Dosage Examples - Where free-text instructions are required

To illustrate how the FHIR Dosage structure should be used using 12 clinically verified examples where most data is fully coded data but important instructions cannot be coded so have to be conveyed using the free-text elements within the Dosage structure. These examples therefore cannot be fully machine readable and would require human interpretation to ensure the free-text instructions are adhered to, and that they do not contradict the coded instructions.

Note: All dosageInstruction.text element values have been constructed using the dose to text translation algorithm from within this guide.

Avloclor tablets

Product-based prescription (AMP) using patient instruction for start and duration.

Complex because the instruction to “start one week before travel and continue until 4 weeks after return” cannot be a coded instruction so is conveyed as free-text within patientlInstruction.

<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="1d0bc824-f2bf-42c8-b7f9-954e7f6bbd98" />
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
    </meta>
    <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>
    <medicationCodeableConcept>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="3727711000001102" />
            <display value="Avloclor 250mg tablets (Alliance Pharmaceuticals Ltd)" />
        </coding>
    </medicationCodeableConcept>
    <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="2 tablet - once a week - Start one week before travel and continue until 4 weeks after return" />
        <patientInstruction value="2 tablet - once a week - Start one week before travel and continue until 4 weeks after return" />
        <timing>
            <repeat>
                <frequency value="1" />
                <period value="1" />
                <periodUnit value="wk" />
            </repeat>
        </timing>
        <doseAndRate>
            <doseQuantity>
                <value value="2" />
                <unit value="tablet" />
                <system value="http://snomed.info/sct" />
                <code value="428673006" />
            </doseQuantity>
        </doseAndRate>
    </dosageInstruction>
    <dispenseRequest>
        <quantity>
            <value value="20" />
            <unit value="tablet" />
            <system value="http://snomed.info/sct" />
            <code value="428673006" />
        </quantity>
    </dispenseRequest>
    <substitution>
        <allowedBoolean value="false" />
    </substitution>
</MedicationRequest>

{
    "resourceType": "MedicationRequest",
    "id": "1d0bc824-f2bf-42c8-b7f9-954e7f6bbd98",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
        ]
    },
    "status": "active",
    "intent": "order",
    "category":  [
        {
            "coding":  [
                {
                    "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                    "code": "outpatient",
                    "display": "outpatient"
                }
            ]
        }
    ],
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "3727711000001102",
                "display": "Avloclor 250mg tablets (Alliance Pharmaceuticals Ltd)"
            }
        ]
    },
    "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": "2 tablet - once a week - Start one week before travel and continue until 4 weeks after return",
            "patientInstruction": "2 tablet - once a week - Start one week before travel and continue until 4 weeks after return",
            "timing": {
                "repeat": {
                    "frequency": 1,
                    "period": 1,
                    "periodUnit": "wk"
                }
            },
            "doseAndRate":  [
                {
                    "doseQuantity": {
                        "value": 2,
                        "unit": "tablet",
                        "system": "http://snomed.info/sct",
                        "code": "428673006"
                    }
                }
            ]
        }
    ],
    "dispenseRequest": {
        "quantity": {
            "value": 20,
            "unit": "tablet",
            "system": "http://snomed.info/sct",
            "code": "428673006"
        }
    },
    "substitution": {
        "allowedBoolean": false
    }
}
MedicationRequest.id[0]1d0bc824-f2bf-42c8-b7f9-954e7f6bbd98
MedicationRequest.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
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].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.medication[0].coding[0].code[0]3727711000001102
MedicationRequest.medication[0].coding[0].display[0]Avloclor 250mg tablets (Alliance Pharmaceuticals Ltd)
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]2 tablet - once a week - Start one week before travel and continue until 4 weeks after return
MedicationRequest.dosageInstruction[0].patientInstruction[0]2 tablet - once a week - Start one week before travel and continue until 4 weeks after return
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].frequency[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].period[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].periodUnit[0]wk
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].value[0]2
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].unit[0]tablet
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].code[0]428673006
MedicationRequest.dispenseRequest[0].quantity[0].value[0]20
MedicationRequest.dispenseRequest[0].quantity[0].unit[0]tablet
MedicationRequest.dispenseRequest[0].quantity[0].system[0]http://snomed.info/sct
MedicationRequest.dispenseRequest[0].quantity[0].code[0]428673006
MedicationRequest.substitution[0].allowed[0]False
MedicationRequest

Example on-screen presentation:

Avloclor 250mg tablets (Alliance Pharmaceuticals Ltd)
2 tablet - once a week - start one week before travel and continue until 4 weeks after return

Co-codamol tablets

Product-based VMP prescription which is fully coded but there is an alternative way of modelling this dosage instruction, see second example below. 
<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="c1ea9b0b-f157-4ee2-9771-84c6cbae5cad" />
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
    </meta>
    <status value="active" />
    <intent value="order" />
    <category>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/medicationrequest-category" />
            <code value="inpatient" />
            <display value="inpatient" />
        </coding>
    </category>
    <priority value="routine" />
    <medicationCodeableConcept>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="322307006" />
            <display value="Co-codamol 8mg/500mg tablets" />
        </coding>
    </medicationCodeableConcept>
    <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>
        <sequence value="1" />
        <text value="2 tablet - as required for Migraine - take once" />
        <timing>
            <repeat>
                <count value="1" />
            </repeat>
        </timing>
        <asNeededCodeableConcept>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="37796009" />
                <display value="Migraine" />
            </coding>
        </asNeededCodeableConcept>
        <doseAndRate>
            <doseQuantity>
                <value value="2" />
                <unit value="tablet" />
                <system value="http://snomed.info/sct" />
                <code value="428673006" />
            </doseQuantity>
        </doseAndRate>
    </dosageInstruction>
    <dosageInstruction>
        <sequence value="2" />
        <text value="2 tablet - every 4 hours - up to a maximum of 6 dose in 24 hours - when migraine recurs" />
        <patientInstruction value="when migraine recurs" />
        <timing>
            <repeat>
                <frequency value="1" />
                <period value="4" />
                <periodUnit value="h" />
            </repeat>
        </timing>
        <doseAndRate>
            <doseQuantity>
                <value value="2" />
                <unit value="tablet" />
                <system value="http://snomed.info/sct" />
                <code value="428673006" />
            </doseQuantity>
        </doseAndRate>
        <maxDosePerPeriod>
            <numerator>
                <value value="6" />
                <unit value="dose" />
                <system value="http://snomed.info/sct" />
                <code value="3317411000001100" />
            </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": "c1ea9b0b-f157-4ee2-9771-84c6cbae5cad",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
        ]
    },
    "status": "active",
    "intent": "order",
    "category":  [
        {
            "coding":  [
                {
                    "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                    "code": "inpatient",
                    "display": "inpatient"
                }
            ]
        }
    ],
    "priority": "routine",
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "322307006",
                "display": "Co-codamol 8mg/500mg tablets"
            }
        ]
    },
    "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":  [
        {
            "sequence": 1,
            "text": "2 tablet - as required for Migraine - take once",
            "timing": {
                "repeat": {
                    "count": 1
                }
            },
            "asNeededCodeableConcept": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "37796009",
                        "display": "Migraine"
                    }
                ]
            },
            "doseAndRate":  [
                {
                    "doseQuantity": {
                        "value": 2,
                        "unit": "tablet",
                        "system": "http://snomed.info/sct",
                        "code": "428673006"
                    }
                }
            ]
        },
        {
            "sequence": 2,
            "text": "2 tablet - every 4 hours - up to a maximum of 6 dose in 24 hours - when migraine recurs",
            "patientInstruction": "when migraine recurs",
            "timing": {
                "repeat": {
                    "frequency": 1,
                    "period": 4,
                    "periodUnit": "h"
                }
            },
            "doseAndRate":  [
                {
                    "doseQuantity": {
                        "value": 2,
                        "unit": "tablet",
                        "system": "http://snomed.info/sct",
                        "code": "428673006"
                    }
                }
            ],
            "maxDosePerPeriod": {
                "numerator": {
                    "value": 6,
                    "unit": "dose",
                    "system": "http://snomed.info/sct",
                    "code": "3317411000001100"
                },
                "denominator": {
                    "value": 24,
                    "unit": "hour",
                    "system": "http://unitsofmeasure.org/",
                    "code": "h"
                }
            }
        }
    ],
    "substitution": {
        "allowedBoolean": false
    }
}
MedicationRequest.id[0]c1ea9b0b-f157-4ee2-9771-84c6cbae5cad
MedicationRequest.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
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]inpatient
MedicationRequest.category[0].coding[0].display[0]inpatient
MedicationRequest.priority[0]routine
MedicationRequest.medication[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.medication[0].coding[0].code[0]322307006
MedicationRequest.medication[0].coding[0].display[0]Co-codamol 8mg/500mg tablets
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].sequence[0]1
MedicationRequest.dosageInstruction[0].text[0]2 tablet - as required for Migraine - take once
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].count[0]1
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].code[0]37796009
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].display[0]Migraine
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].value[0]2
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].unit[0]tablet
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].code[0]428673006
MedicationRequest.dosageInstruction[1].sequence[0]2
MedicationRequest.dosageInstruction[1].text[0]2 tablet - every 4 hours - up to a maximum of 6 dose in 24 hours - when migraine recurs
MedicationRequest.dosageInstruction[1].patientInstruction[0]when migraine recurs
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].frequency[0]1
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].period[0]4
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].periodUnit[0]h
MedicationRequest.dosageInstruction[1].doseAndRate[0].dose[0].value[0]2
MedicationRequest.dosageInstruction[1].doseAndRate[0].dose[0].unit[0]tablet
MedicationRequest.dosageInstruction[1].doseAndRate[0].dose[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[1].doseAndRate[0].dose[0].code[0]428673006
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].value[0]6
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].unit[0]dose
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].code[0]3317411000001100
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].denominator[0].value[0]24
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].denominator[0].unit[0]hour
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].denominator[0].system[0]http://unitsofmeasure.org/
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].denominator[0].code[0]h
MedicationRequest.substitution[0].allowed[0]False
MedicationRequest

Example on-screen presentation:

Co-codamol 8mg/500mg tablets
2 tablet - as required for Migraine - take once, then 2 tablet - every 4 hours - up to a maximum of 6 dose in 24 hours - when migraine recurs

Alternative Representation

Product-based VMP prescription using a simpler Dosage but where further instructions are text-based. 
<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="b31fcf06-b515-4468-92cd-ce7b13b0c256" />
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
    </meta>
    <status value="active" />
    <intent value="order" />
    <category>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/medicationrequest-category" />
            <code value="inpatient" />
            <display value="inpatient" />
        </coding>
    </category>
    <priority value="routine" />
    <medicationCodeableConcept>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="322307006" />
            <display value="Co-codamol 8mg/500mg tablets" />
        </coding>
    </medicationCodeableConcept>
    <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="2 tablet - every 4 hours - as required for Migraine - up to a maximum of 8 dose in 24 hours - Additional doses only to be taken after migraine recurrence" />
        <patientInstruction value="Additional doses only to be taken after migraine recurrence" />
        <timing>
            <repeat>
                <frequency value="1" />
                <period value="4" />
                <periodUnit value="h" />
            </repeat>
        </timing>
        <asNeededCodeableConcept>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="37796009" />
                <display value="Migraine" />
            </coding>
        </asNeededCodeableConcept>
        <doseAndRate>
            <doseQuantity>
                <value value="2" />
                <unit value="tablet" />
                <system value="http://snomed.info/sct" />
                <code value="428673006" />
            </doseQuantity>
        </doseAndRate>
        <maxDosePerPeriod>
            <numerator>
                <value value="8" />
                <unit value="dose" />
                <system value="http://snomed.info/sct" />
                <code value="3317411000001100" />
            </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": "b31fcf06-b515-4468-92cd-ce7b13b0c256",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
        ]
    },
    "status": "active",
    "intent": "order",
    "category":  [
        {
            "coding":  [
                {
                    "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                    "code": "inpatient",
                    "display": "inpatient"
                }
            ]
        }
    ],
    "priority": "routine",
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "322307006",
                "display": "Co-codamol 8mg/500mg tablets"
            }
        ]
    },
    "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": "2 tablet - every 4 hours - as required for Migraine - up to a maximum of 8 dose in 24 hours - Additional doses only to be taken after migraine recurrence",
            "patientInstruction": "Additional doses only to be taken after migraine recurrence",
            "timing": {
                "repeat": {
                    "frequency": 1,
                    "period": 4,
                    "periodUnit": "h"
                }
            },
            "asNeededCodeableConcept": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "37796009",
                        "display": "Migraine"
                    }
                ]
            },
            "doseAndRate":  [
                {
                    "doseQuantity": {
                        "value": 2,
                        "unit": "tablet",
                        "system": "http://snomed.info/sct",
                        "code": "428673006"
                    }
                }
            ],
            "maxDosePerPeriod": {
                "numerator": {
                    "value": 8,
                    "unit": "dose",
                    "system": "http://snomed.info/sct",
                    "code": "3317411000001100"
                },
                "denominator": {
                    "value": 24,
                    "unit": "hour",
                    "system": "http://unitsofmeasure.org/",
                    "code": "h"
                }
            }
        }
    ],
    "substitution": {
        "allowedBoolean": false
    }
}
MedicationRequest.id[0]b31fcf06-b515-4468-92cd-ce7b13b0c256
MedicationRequest.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
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]inpatient
MedicationRequest.category[0].coding[0].display[0]inpatient
MedicationRequest.priority[0]routine
MedicationRequest.medication[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.medication[0].coding[0].code[0]322307006
MedicationRequest.medication[0].coding[0].display[0]Co-codamol 8mg/500mg tablets
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]2 tablet - every 4 hours - as required for Migraine - up to a maximum of 8 dose in 24 hours - Additional doses only to be taken after migraine recurrence
MedicationRequest.dosageInstruction[0].patientInstruction[0]Additional doses only to be taken after migraine recurrence
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].asNeeded[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].code[0]37796009
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].display[0]Migraine
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].value[0]2
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].unit[0]tablet
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].code[0]428673006
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].value[0]8
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].unit[0]dose
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].code[0]3317411000001100
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:

Co-codamol 8mg/500mg tablets
2 tablet - every 4 hours - as required for Migraine - up to a maximum of 8 dose in 24 hours - Additional doses only to be taken after migraine recurrence

Colchicine tablets

Dose-based VTM prescription using free-text additional instructions to define the maximum dose per course. 
<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="f27b260e-8bdf-11eb-8dcd-0242ac130003" />
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
    </meta>
    <status value="active" />
    <intent value="order" />
    <category>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/medicationrequest-category" />
            <code value="inpatient" />
            <display value="inpatient" />
        </coding>
    </category>
    <priority value="routine" />
    <medicationCodeableConcept>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="73133000" />
            <display value="Colchicine" />
        </coding>
    </medicationCodeableConcept>
    <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="500 microgram - 3 times a day - oral - Until symptoms relieved - Maximum dose 6 mg per course and Do not repeat course for 3 days" />
        <additionalInstruction>
            <text value="Until symptoms relieved" />
        </additionalInstruction>
        <additionalInstruction>
            <text value="Maximum dose 6 mg per course" />
        </additionalInstruction>
        <additionalInstruction>
            <text value="Do not repeat course for 3 days" />
        </additionalInstruction>
        <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="500" />
                <unit value="microgram" />
                <system value="http://unitsofmeasure.org" />
                <code value="ug" />
            </doseQuantity>
        </doseAndRate>
    </dosageInstruction>
    <substitution>
        <allowedBoolean value="false" />
    </substitution>
</MedicationRequest>

{
    "resourceType": "MedicationRequest",
    "id": "f27b260e-8bdf-11eb-8dcd-0242ac130003",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
        ]
    },
    "status": "active",
    "intent": "order",
    "category":  [
        {
            "coding":  [
                {
                    "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                    "code": "inpatient",
                    "display": "inpatient"
                }
            ]
        }
    ],
    "priority": "routine",
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "73133000",
                "display": "Colchicine"
            }
        ]
    },
    "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": "500 microgram - 3 times a day - oral - Until symptoms relieved - Maximum dose 6 mg per course and Do not repeat course for 3 days",
            "additionalInstruction":  [
                {
                    "text": "Until symptoms relieved"
                },
                {
                    "text": "Maximum dose 6 mg per course"
                },
                {
                    "text": "Do not repeat course for 3 days"
                }
            ],
            "timing": {
                "repeat": {
                    "frequency": 3,
                    "period": 1,
                    "periodUnit": "d"
                }
            },
            "route": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "26643006",
                        "display": "oral"
                    }
                ]
            },
            "doseAndRate":  [
                {
                    "doseQuantity": {
                        "value": 500,
                        "unit": "microgram",
                        "system": "http://unitsofmeasure.org",
                        "code": "ug"
                    }
                }
            ]
        }
    ],
    "substitution": {
        "allowedBoolean": false
    }
}
MedicationRequest.id[0]f27b260e-8bdf-11eb-8dcd-0242ac130003
MedicationRequest.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
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]inpatient
MedicationRequest.category[0].coding[0].display[0]inpatient
MedicationRequest.priority[0]routine
MedicationRequest.medication[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.medication[0].coding[0].code[0]73133000
MedicationRequest.medication[0].coding[0].display[0]Colchicine
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]500 microgram - 3 times a day - oral - Until symptoms relieved - Maximum dose 6 mg per course and Do not repeat course for 3 days
MedicationRequest.dosageInstruction[0].additionalInstruction[0].text[0]Until symptoms relieved
MedicationRequest.dosageInstruction[0].additionalInstruction[1].text[0]Maximum dose 6 mg per course
MedicationRequest.dosageInstruction[0].additionalInstruction[2].text[0]Do not repeat course for 3 days
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].frequency[0]3
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].period[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].periodUnit[0]d
MedicationRequest.dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].route[0].coding[0].code[0]26643006
MedicationRequest.dosageInstruction[0].route[0].coding[0].display[0]oral
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].value[0]500
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].unit[0]microgram
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].code[0]ug
MedicationRequest.substitution[0].allowed[0]False
MedicationRequest

Example on-screen presentation:

Colchicine
500 microgram - 3 times a day - oral - Until symptoms relieved - Maximum dose 6 mg per course and Do not repeat course for 3 days

Eprex solution for injection pre-filled syringes

Product-based AMP prescription where the instruction 'with dialysis' is free-text. 
<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="808e7672-cf8d-48d8-885b-694c9bb9a417" />
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
    </meta>
    <status value="active" />
    <intent value="order" />
    <category>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/medicationrequest-category" />
            <code value="inpatient" />
            <display value="inpatient" />
        </coding>
    </category>
    <medicationCodeableConcept>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="2971511000001101" />
            <display value="Eprex 2,000units/0.5ml solution for injection pre-filled syringes (Janssen-Cilag Ltd)" />
        </coding>
    </medicationCodeableConcept>
    <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="Inject once a day - on Monday and Thursday - Subcutaneous route - with dialysis" />
        <additionalInstruction>
            <text value="with dialysis" />
        </additionalInstruction>
        <timing>
            <repeat>
                <frequency value="1" />
                <period value="1" />
                <periodUnit value="d" />
                <dayOfWeek value="mon" />
                <dayOfWeek value="thu" />
            </repeat>
        </timing>
        <route>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="34206005" />
                <display value="Subcutaneous route" />
            </coding>
        </route>
        <method>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="422145002" />
                <display value="Inject" />
            </coding>
        </method>
    </dosageInstruction>
    <substitution>
        <allowedBoolean value="false" />
    </substitution>
</MedicationRequest>

{
    "resourceType": "MedicationRequest",
    "id": "808e7672-cf8d-48d8-885b-694c9bb9a417",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
        ]
    },
    "status": "active",
    "intent": "order",
    "category":  [
        {
            "coding":  [
                {
                    "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                    "code": "inpatient",
                    "display": "inpatient"
                }
            ]
        }
    ],
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "2971511000001101",
                "display": "Eprex 2,000units/0.5ml solution for injection pre-filled syringes (Janssen-Cilag Ltd)"
            }
        ]
    },
    "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": "Inject once a day - on Monday and Thursday - Subcutaneous route - with dialysis",
            "additionalInstruction":  [
                {
                    "text": "with dialysis"
                }
            ],
            "timing": {
                "repeat": {
                    "frequency": 1,
                    "period": 1,
                    "periodUnit": "d",
                    "dayOfWeek":  [
                        "mon",
                        "thu"
                    ]
                }
            },
            "route": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "34206005",
                        "display": "Subcutaneous route"
                    }
                ]
            },
            "method": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "422145002",
                        "display": "Inject"
                    }
                ]
            }
        }
    ],
    "substitution": {
        "allowedBoolean": false
    }
}
MedicationRequest.id[0]808e7672-cf8d-48d8-885b-694c9bb9a417
MedicationRequest.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
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]inpatient
MedicationRequest.category[0].coding[0].display[0]inpatient
MedicationRequest.medication[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.medication[0].coding[0].code[0]2971511000001101
MedicationRequest.medication[0].coding[0].display[0]Eprex 2,000units/0.5ml solution for injection pre-filled syringes (Janssen-Cilag Ltd)
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]Inject once a day - on Monday and Thursday - Subcutaneous route - with dialysis
MedicationRequest.dosageInstruction[0].additionalInstruction[0].text[0]with dialysis
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].frequency[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].period[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].periodUnit[0]d
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].dayOfWeek[0]mon
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].dayOfWeek[1]thu
MedicationRequest.dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].route[0].coding[0].code[0]34206005
MedicationRequest.dosageInstruction[0].route[0].coding[0].display[0]Subcutaneous route
MedicationRequest.dosageInstruction[0].method[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].method[0].coding[0].code[0]422145002
MedicationRequest.dosageInstruction[0].method[0].coding[0].display[0]Inject
MedicationRequest.substitution[0].allowed[0]False
MedicationRequest

Example on-screen presentation:

Eprex 2,000units/0.5ml solution for injection pre-filled syringes (Janssen-Cilag Ltd)
Inject once a day - on Monday and Thursday - Subcutaneous route - with dialysis

Hydrocortisone cream

Product-based VMP prescription using a free-text patient instruction for the site as 'area around lips' is not SNOMED coded. 
<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="da60a842-d755-4fe6-a7eb-4cda52cf17f7" />
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
    </meta>
    <status value="active" />
    <intent value="order" />
    <category>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/medicationrequest-category" />
            <code value="inpatient" />
            <display value="inpatient" />
        </coding>
    </category>
    <medicationCodeableConcept>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="331680008" />
            <display value="Hydrocortisone 0.1% cream" />
        </coding>
    </medicationCodeableConcept>
    <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="Apply 2 to 3 times a day - for 7 days - Apply thinly to area around lips" />
        <patientInstruction value="Apply thinly to area around lips" />
        <timing>
            <repeat>
                <boundsDuration>
                    <value value="7" />
                    <unit value="day" />
                    <system value="http://unitsofmeasure.org" />
                    <code value="d" />
                </boundsDuration>
                <frequency value="2" />
                <frequencyMax value="3" />
                <period value="1" />
                <periodUnit value="d" />
            </repeat>
        </timing>
        <method>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="417924000" />
                <display value="Apply" />
            </coding>
        </method>
    </dosageInstruction>
    <substitution>
        <allowedBoolean value="false" />
    </substitution>
</MedicationRequest>

{
    "resourceType": "MedicationRequest",
    "id": "da60a842-d755-4fe6-a7eb-4cda52cf17f7",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
        ]
    },
    "status": "active",
    "intent": "order",
    "category":  [
        {
            "coding":  [
                {
                    "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                    "code": "inpatient",
                    "display": "inpatient"
                }
            ]
        }
    ],
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "331680008",
                "display": "Hydrocortisone 0.1% cream"
            }
        ]
    },
    "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": "Apply 2 to 3 times a day - for 7 days - Apply thinly to area around lips",
            "patientInstruction": "Apply thinly to area around lips",
            "timing": {
                "repeat": {
                    "boundsDuration": {
                        "value": 7,
                        "unit": "day",
                        "system": "http://unitsofmeasure.org",
                        "code": "d"
                    },
                    "frequency": 2,
                    "frequencyMax": 3,
                    "period": 1,
                    "periodUnit": "d"
                }
            },
            "method": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "417924000",
                        "display": "Apply"
                    }
                ]
            }
        }
    ],
    "substitution": {
        "allowedBoolean": false
    }
}
MedicationRequest.id[0]da60a842-d755-4fe6-a7eb-4cda52cf17f7
MedicationRequest.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
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]inpatient
MedicationRequest.category[0].coding[0].display[0]inpatient
MedicationRequest.medication[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.medication[0].coding[0].code[0]331680008
MedicationRequest.medication[0].coding[0].display[0]Hydrocortisone 0.1% cream
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]Apply 2 to 3 times a day - for 7 days - Apply thinly to area around lips
MedicationRequest.dosageInstruction[0].patientInstruction[0]Apply thinly to area around lips
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].bounds[0].value[0]7
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].bounds[0].unit[0]day
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].bounds[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].bounds[0].code[0]d
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].frequency[0]2
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].frequencyMax[0]3
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].period[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].periodUnit[0]d
MedicationRequest.dosageInstruction[0].method[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].method[0].coding[0].code[0]417924000
MedicationRequest.dosageInstruction[0].method[0].coding[0].display[0]Apply
MedicationRequest.substitution[0].allowed[0]False
MedicationRequest

Example on-screen presentation:

Hydrocortisone 0.1% cream
Apply 2 to 3 times a day - for 7 days - Apply thinly to area around lips

Hyoscine transdermal patches

Product-based VMP prescription. 
<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="18a8ea33-dc5f-4fb7-985e-acc474bf97cd" />
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
    </meta>
    <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>
    <medicationCodeableConcept>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="38898011000001108" />
            <display value="Hyoscine 1mg/72hours transdermal patches" />
        </coding>
    </medicationCodeableConcept>
    <subject>
        <identifier>
            <system value="https://fhir.nhs.uk/Id/nhs-number" />
            <value value="9999999999" />
        </identifier>
    </subject>
    <authoredOn value="2019-01-15T15:00:00Z" />
    <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="Apply 1 patch - every 72 hours - Rotate site of application" />
        <additionalInstruction>
            <text value="Rotate site of application" />
        </additionalInstruction>
        <timing>
            <repeat>
                <frequency value="1" />
                <period value="72" />
                <periodUnit value="h" />
            </repeat>
        </timing>
        <method>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="417924000" />
                <display value="Apply" />
            </coding>
        </method>
        <doseAndRate>
            <doseQuantity>
                <value value="1" />
                <unit value="patch" />
                <system value="http://snomed.info/sct" />
                <code value="419702001" />
            </doseQuantity>
        </doseAndRate>
    </dosageInstruction>
    <substitution>
        <allowedBoolean value="false" />
    </substitution>
</MedicationRequest>

{
    "resourceType": "MedicationRequest",
    "id": "18a8ea33-dc5f-4fb7-985e-acc474bf97cd",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
        ]
    },
    "status": "active",
    "intent": "order",
    "category":  [
        {
            "coding":  [
                {
                    "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                    "code": "outpatient",
                    "display": "outpatient"
                }
            ]
        }
    ],
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "38898011000001108",
                "display": "Hyoscine 1mg/72hours transdermal patches"
            }
        ]
    },
    "subject": {
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9999999999"
        }
    },
    "authoredOn": "2019-01-15T15:00:00Z",
    "requester": {
        "reference": "urn:staff-1112",
        "display": "Dr Maikeu Well"
    },
    "recorder": {
        "reference": "urn:staff-1112",
        "display": "Dr Maikeu Well"
    },
    "dosageInstruction":  [
        {
            "text": "Apply 1 patch - every 72 hours - Rotate site of application",
            "additionalInstruction":  [
                {
                    "text": "Rotate site of application"
                }
            ],
            "timing": {
                "repeat": {
                    "frequency": 1,
                    "period": 72,
                    "periodUnit": "h"
                }
            },
            "method": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "417924000",
                        "display": "Apply"
                    }
                ]
            },
            "doseAndRate":  [
                {
                    "doseQuantity": {
                        "value": 1,
                        "unit": "patch",
                        "system": "http://snomed.info/sct",
                        "code": "419702001"
                    }
                }
            ]
        }
    ],
    "substitution": {
        "allowedBoolean": false
    }
}
MedicationRequest.id[0]18a8ea33-dc5f-4fb7-985e-acc474bf97cd
MedicationRequest.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
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].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.medication[0].coding[0].code[0]38898011000001108
MedicationRequest.medication[0].coding[0].display[0]Hyoscine 1mg/72hours transdermal patches
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]2019-01-15T15:00:00Z
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]Apply 1 patch - every 72 hours - Rotate site of application
MedicationRequest.dosageInstruction[0].additionalInstruction[0].text[0]Rotate site of application
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].frequency[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].period[0]72
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].periodUnit[0]h
MedicationRequest.dosageInstruction[0].method[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].method[0].coding[0].code[0]417924000
MedicationRequest.dosageInstruction[0].method[0].coding[0].display[0]Apply
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].value[0]1
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].unit[0]patch
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].code[0]419702001
MedicationRequest.substitution[0].allowed[0]False
MedicationRequest

Example on-screen presentation:

Hyoscine 1mg/72hours transdermal patches
Apply 1 patch - every 72 hours - Rotate site of application

Migraleve tablets

Product-based VMP prescription using a free text additional instructions for the Pink and Yellow tablets. 
<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="859e5d8a-391a-4b2a-8f29-15e8c75180bb" />
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
    </meta>
    <status value="active" />
    <intent value="order" />
    <category>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/medicationrequest-category" />
            <code value="inpatient" />
            <display value="inpatient" />
        </coding>
    </category>
    <priority value="routine" />
    <medicationCodeableConcept>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="3363411000001108" />
            <display value="Migraleve tablets (McNeil Products Ltd)" />
        </coding>
    </medicationCodeableConcept>
    <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>
        <sequence value="1" />
        <text value="2 tablet - take once - as required for Migraine - up to a maximum of 2 tablet in 24 hours - Pink tablets" />
        <additionalInstruction>
            <text value="Pink tablets" />
        </additionalInstruction>
        <timing>
            <repeat>
                <count value="1" />
            </repeat>
        </timing>
        <asNeededCodeableConcept>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="37796009" />
                <display value="Migraine" />
            </coding>
        </asNeededCodeableConcept>
        <doseAndRate>
            <doseQuantity>
                <value value="2" />
                <unit value="tablet" />
                <system value="http://snomed.info/sct" />
                <code value="428673006" />
            </doseQuantity>
        </doseAndRate>
        <maxDosePerPeriod>
            <numerator>
                <value value="2" />
                <unit value="tablet" />
                <system value="http://snomed.info/sct" />
                <code value="428673006" />
            </numerator>
            <denominator>
                <value value="24" />
                <unit value="hour" />
                <system value="http://unitsofmeasure.org" />
                <code value="h" />
            </denominator>
        </maxDosePerPeriod>
    </dosageInstruction>
    <dosageInstruction>
        <sequence value="2" />
        <text value="2 tablet - every 4 hours - as required - up to a maximum of 6 tablet in 24 hours - Yellow tablets" />
        <additionalInstruction>
            <text value="Yellow tablets" />
        </additionalInstruction>
        <timing>
            <repeat>
                <frequency value="1" />
                <period value="4" />
                <periodUnit value="h" />
            </repeat>
        </timing>
        <asNeededBoolean value="true" />
        <doseAndRate>
            <doseQuantity>
                <value value="2" />
                <unit value="tablet" />
                <system value="http://snomed.info/sct" />
                <code value="428673006" />
            </doseQuantity>
        </doseAndRate>
        <maxDosePerPeriod>
            <numerator>
                <value value="6" />
                <unit value="tablet" />
                <system value="http://snomed.info/sct" />
                <code value="428673006" />
            </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": "859e5d8a-391a-4b2a-8f29-15e8c75180bb",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
        ]
    },
    "status": "active",
    "intent": "order",
    "category":  [
        {
            "coding":  [
                {
                    "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                    "code": "inpatient",
                    "display": "inpatient"
                }
            ]
        }
    ],
    "priority": "routine",
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "3363411000001108",
                "display": "Migraleve tablets (McNeil Products Ltd)"
            }
        ]
    },
    "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":  [
        {
            "sequence": 1,
            "text": "2 tablet - take once - as required for Migraine - up to a maximum of 2 tablet in 24 hours - Pink tablets",
            "additionalInstruction":  [
                {
                    "text": "Pink tablets"
                }
            ],
            "timing": {
                "repeat": {
                    "count": 1
                }
            },
            "asNeededCodeableConcept": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "37796009",
                        "display": "Migraine"
                    }
                ]
            },
            "doseAndRate":  [
                {
                    "doseQuantity": {
                        "value": 2,
                        "unit": "tablet",
                        "system": "http://snomed.info/sct",
                        "code": "428673006"
                    }
                }
            ],
            "maxDosePerPeriod": {
                "numerator": {
                    "value": 2,
                    "unit": "tablet",
                    "system": "http://snomed.info/sct",
                    "code": "428673006"
                },
                "denominator": {
                    "value": 24,
                    "unit": "hour",
                    "system": "http://unitsofmeasure.org",
                    "code": "h"
                }
            }
        },
        {
            "sequence": 2,
            "text": "2 tablet - every 4 hours - as required - up to a maximum of 6 tablet in 24 hours - Yellow tablets",
            "additionalInstruction":  [
                {
                    "text": "Yellow tablets"
                }
            ],
            "timing": {
                "repeat": {
                    "frequency": 1,
                    "period": 4,
                    "periodUnit": "h"
                }
            },
            "asNeededBoolean": true,
            "doseAndRate":  [
                {
                    "doseQuantity": {
                        "value": 2,
                        "unit": "tablet",
                        "system": "http://snomed.info/sct",
                        "code": "428673006"
                    }
                }
            ],
            "maxDosePerPeriod": {
                "numerator": {
                    "value": 6,
                    "unit": "tablet",
                    "system": "http://snomed.info/sct",
                    "code": "428673006"
                },
                "denominator": {
                    "value": 24,
                    "unit": "hour",
                    "system": "http://unitsofmeasure.org",
                    "code": "h"
                }
            }
        }
    ],
    "substitution": {
        "allowedBoolean": false
    }
}
MedicationRequest.id[0]859e5d8a-391a-4b2a-8f29-15e8c75180bb
MedicationRequest.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
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]inpatient
MedicationRequest.category[0].coding[0].display[0]inpatient
MedicationRequest.priority[0]routine
MedicationRequest.medication[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.medication[0].coding[0].code[0]3363411000001108
MedicationRequest.medication[0].coding[0].display[0]Migraleve tablets (McNeil Products Ltd)
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].sequence[0]1
MedicationRequest.dosageInstruction[0].text[0]2 tablet - take once - as required for Migraine - up to a maximum of 2 tablet in 24 hours - Pink tablets
MedicationRequest.dosageInstruction[0].additionalInstruction[0].text[0]Pink tablets
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].count[0]1
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].code[0]37796009
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].display[0]Migraine
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].value[0]2
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].unit[0]tablet
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].code[0]428673006
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].value[0]2
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].unit[0]tablet
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].code[0]428673006
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.dosageInstruction[1].sequence[0]2
MedicationRequest.dosageInstruction[1].text[0]2 tablet - every 4 hours - as required - up to a maximum of 6 tablet in 24 hours - Yellow tablets
MedicationRequest.dosageInstruction[1].additionalInstruction[0].text[0]Yellow tablets
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].frequency[0]1
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].period[0]4
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].periodUnit[0]h
MedicationRequest.dosageInstruction[1].asNeeded[0]True
MedicationRequest.dosageInstruction[1].doseAndRate[0].dose[0].value[0]2
MedicationRequest.dosageInstruction[1].doseAndRate[0].dose[0].unit[0]tablet
MedicationRequest.dosageInstruction[1].doseAndRate[0].dose[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[1].doseAndRate[0].dose[0].code[0]428673006
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].value[0]6
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].unit[0]tablet
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].code[0]428673006
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].denominator[0].value[0]24
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].denominator[0].unit[0]hour
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].denominator[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].denominator[0].code[0]h
MedicationRequest.substitution[0].allowed[0]False
MedicationRequest

Example on-screen presentation:

Migraleve tablets (McNeil Products Ltd)
2 tablet - take once - as required for Migraine - up to a maximum of 2 tablet in 24 hours - Pink tablets, and 2 tablet - every 4 hours - as required - up to a maximum of 6 tablet in 24 hours - Yellow tablets

Morphine bolus

Dose-based VTM prescription using a free text additional instructions to specify patient-administered with a 5 minute lockout. 
<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="1558295a-9213-44cb-81e1-e1ab8fcc3e81" />
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
    </meta>
    <status value="active" />
    <intent value="order" />
    <category>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/medicationrequest-category" />
            <code value="inpatient" />
            <display value="inpatient" />
        </coding>
    </category>
    <medicationCodeableConcept>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="73572009" />
            <display value="Morphine" />
        </coding>
    </medicationCodeableConcept>
    <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="Intermittent bolus 5 milligram - as required - Intravenous route - Administer via PCA with a 5 minute lockout" />
        <additionalInstruction>
            <text value="Administer via PCA with a 5 minute lockout" />
        </additionalInstruction>
        <asNeededBoolean value="true" />
        <route>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="47625008" />
                <display value="Intravenous route" />
            </coding>
        </route>
        <method>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="397884008" />
                <display value="Intermittent bolus" />
            </coding>
        </method>
        <doseAndRate>
            <doseQuantity>
                <value value="5" />
                <unit value="milligram" />
                <system value="http://unitsofmeasure.org" />
                <code value="mg" />
            </doseQuantity>
        </doseAndRate>
    </dosageInstruction>
    <substitution>
        <allowedBoolean value="false" />
    </substitution>
</MedicationRequest>

{
    "resourceType": "MedicationRequest",
    "id": "1558295a-9213-44cb-81e1-e1ab8fcc3e81",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
        ]
    },
    "status": "active",
    "intent": "order",
    "category":  [
        {
            "coding":  [
                {
                    "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                    "code": "inpatient",
                    "display": "inpatient"
                }
            ]
        }
    ],
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "73572009",
                "display": "Morphine"
            }
        ]
    },
    "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": "Intermittent bolus 5 milligram - as required - Intravenous route - Administer via PCA with a 5 minute lockout",
            "additionalInstruction":  [
                {
                    "text": "Administer via PCA with a 5 minute lockout"
                }
            ],
            "asNeededBoolean": true,
            "route": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "47625008",
                        "display": "Intravenous route"
                    }
                ]
            },
            "method": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "397884008",
                        "display": "Intermittent bolus"
                    }
                ]
            },
            "doseAndRate":  [
                {
                    "doseQuantity": {
                        "value": 5,
                        "unit": "milligram",
                        "system": "http://unitsofmeasure.org",
                        "code": "mg"
                    }
                }
            ]
        }
    ],
    "substitution": {
        "allowedBoolean": false
    }
}
MedicationRequest.id[0]1558295a-9213-44cb-81e1-e1ab8fcc3e81
MedicationRequest.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
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]inpatient
MedicationRequest.category[0].coding[0].display[0]inpatient
MedicationRequest.medication[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.medication[0].coding[0].code[0]73572009
MedicationRequest.medication[0].coding[0].display[0]Morphine
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]Intermittent bolus 5 milligram - as required - Intravenous route - Administer via PCA with a 5 minute lockout
MedicationRequest.dosageInstruction[0].additionalInstruction[0].text[0]Administer via PCA with a 5 minute lockout
MedicationRequest.dosageInstruction[0].asNeeded[0]True
MedicationRequest.dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].route[0].coding[0].code[0]47625008
MedicationRequest.dosageInstruction[0].route[0].coding[0].display[0]Intravenous route
MedicationRequest.dosageInstruction[0].method[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].method[0].coding[0].code[0]397884008
MedicationRequest.dosageInstruction[0].method[0].coding[0].display[0]Intermittent bolus
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].value[0]5
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.substitution[0].allowed[0]False
MedicationRequest

Example on-screen presentation:

Morphine
Intermittent bolus 5 milligram - as required - Intravenous route - PCA with a 5 minute lockout

NovoRapid Penfill solution for injection

Product-based AMP prescription using free-text patient instructions. 
<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="9599bbbd-5fb0-429b-ba24-bca6448f521a" />
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
    </meta>
    <status value="active" />
    <intent value="order" />
    <category>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/medicationrequest-category" />
            <code value="inpatient" />
            <display value="inpatient" />
        </coding>
    </category>
    <medicationCodeableConcept>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="3279211000001105" />
            <display value="NovoRapid Penfill 100units/ml solution for injection 3ml cartridges (Novo Nordisk Ltd)" />
        </coding>
    </medicationCodeableConcept>
    <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="Inject as required - according to insulin requirements" />
        <patientInstruction value="according to insulin requirements" />
        <asNeededBoolean value="true" />
        <method>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="422145002" />
                <display value="Inject" />
            </coding>
        </method>
    </dosageInstruction>
    <substitution>
        <allowedBoolean value="false" />
    </substitution>
</MedicationRequest>

{
    "resourceType": "MedicationRequest",
    "id": "9599bbbd-5fb0-429b-ba24-bca6448f521a",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
        ]
    },
    "status": "active",
    "intent": "order",
    "category":  [
        {
            "coding":  [
                {
                    "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                    "code": "inpatient",
                    "display": "inpatient"
                }
            ]
        }
    ],
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "3279211000001105",
                "display": "NovoRapid Penfill 100units/ml solution for injection 3ml cartridges (Novo Nordisk Ltd)"
            }
        ]
    },
    "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": "Inject as required - according to insulin requirements",
            "patientInstruction": "according to insulin requirements",
            "asNeededBoolean": true,
            "method": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "422145002",
                        "display": "Inject"
                    }
                ]
            }
        }
    ],
    "substitution": {
        "allowedBoolean": false
    }
}
MedicationRequest.id[0]9599bbbd-5fb0-429b-ba24-bca6448f521a
MedicationRequest.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
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]inpatient
MedicationRequest.category[0].coding[0].display[0]inpatient
MedicationRequest.medication[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.medication[0].coding[0].code[0]3279211000001105
MedicationRequest.medication[0].coding[0].display[0]NovoRapid Penfill 100units/ml solution for injection 3ml cartridges (Novo Nordisk Ltd)
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]Inject as required - according to insulin requirements
MedicationRequest.dosageInstruction[0].patientInstruction[0]according to insulin requirements
MedicationRequest.dosageInstruction[0].asNeeded[0]True
MedicationRequest.dosageInstruction[0].method[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].method[0].coding[0].code[0]422145002
MedicationRequest.dosageInstruction[0].method[0].coding[0].display[0]Inject
MedicationRequest.substitution[0].allowed[0]False
MedicationRequest

Example on-screen presentation:

NovoRapid Penfill 100units/ml solution for injection 3ml cartridges (Novo Nordisk Ltd)
Inject as required - according to insulin requirements

Oxygen by inhalation via nasal cannula

Dose-based VTM prescription where use of a 'nasal cannula' device is expressed as free-text additional instruction. 
<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="a8ca980c-72aa-11e7-8cf7-a6006ad3dba0" />
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
    </meta>
    <status value="active" />
    <intent value="order" />
    <category>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/medicationrequest-category" />
            <code value="out" />
            <display value="outpatient" />
        </coding>
    </category>
    <medicationCodeableConcept>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="375287000" />
            <display value="Oxygen" />
        </coding>
    </medicationCodeableConcept>
    <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="1 to 2 litre per minute - Inhalation - to be given via nasal cannula" />
        <additionalInstruction>
            <text value="to be given via nasal cannula" />
        </additionalInstruction>
        <route>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="18679011000001101" />
                <display value="Inhalation" />
            </coding>
        </route>
        <doseAndRate>
            <doseRange>
                <low>
                    <value value="1" />
                    <unit value="liter per minute" />
                    <system value="http://unitsofmeasure.org" />
                    <code value="L/min" />
                </low>
                <high>
                    <value value="2" />
                    <unit value="liter per minute" />
                    <system value="http://unitsofmeasure.org" />
                    <code value="L/min" />
                </high>
            </doseRange>
        </doseAndRate>
    </dosageInstruction>
    <substitution>
        <allowedBoolean value="false" />
    </substitution>
</MedicationRequest>

{
    "resourceType": "MedicationRequest",
    "id": "a8ca980c-72aa-11e7-8cf7-a6006ad3dba0",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
        ]
    },
    "status": "active",
    "intent": "order",
    "category":  [
        {
            "coding":  [
                {
                    "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                    "code": "out",
                    "display": "outpatient"
                }
            ]
        }
    ],
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "375287000",
                "display": "Oxygen"
            }
        ]
    },
    "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": "1 to 2 litre per minute - Inhalation - to be given via nasal cannula",
            "additionalInstruction":  [
                {
                    "text": "to be given via nasal cannula"
                }
            ],
            "route": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "18679011000001101",
                        "display": "Inhalation"
                    }
                ]
            },
            "doseAndRate":  [
                {
                    "doseRange": {
                        "low": {
                            "value": 1,
                            "unit": "liter per minute",
                            "system": "http://unitsofmeasure.org",
                            "code": "L/min"
                        },
                        "high": {
                            "value": 2,
                            "unit": "liter per minute",
                            "system": "http://unitsofmeasure.org",
                            "code": "L/min"
                        }
                    }
                }
            ]
        }
    ],
    "substitution": {
        "allowedBoolean": false
    }
}
MedicationRequest.id[0]a8ca980c-72aa-11e7-8cf7-a6006ad3dba0
MedicationRequest.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
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]out
MedicationRequest.category[0].coding[0].display[0]outpatient
MedicationRequest.medication[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.medication[0].coding[0].code[0]375287000
MedicationRequest.medication[0].coding[0].display[0]Oxygen
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]1 to 2 litre per minute - Inhalation - to be given via nasal cannula
MedicationRequest.dosageInstruction[0].additionalInstruction[0].text[0]to be given via nasal cannula
MedicationRequest.dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].route[0].coding[0].code[0]18679011000001101
MedicationRequest.dosageInstruction[0].route[0].coding[0].display[0]Inhalation
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].low[0].value[0]1
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].low[0].unit[0]liter per minute
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].low[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].low[0].code[0]L/min
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].high[0].value[0]2
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].high[0].unit[0]liter per minute
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].high[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].high[0].code[0]L/min
MedicationRequest.substitution[0].allowed[0]False
MedicationRequest

Example on-screen presentation:

Oxygen
1 to 2 litre per minute - Inhalation - to be given via nasal cannula

Permitabs tablets

Product-based AMP prescription with text-based patient instruction for the preparation.

Complex because contains a detailed preparation instruction which has to be conveyed as free-text within patientInstruction.

<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="1f4959a1-4a33-4b0e-bfad-f2ea1fccb2fa" />
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
    </meta>
    <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>
    <medicationCodeableConcept>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="4256811000001101" />
            <display value="Permitabs 400mg tablets for cutaneous solution (Alliance Pharmaceuticals Ltd)" />
        </coding>
    </medicationCodeableConcept>
    <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-3030" />
        <display value="Dr Callum Lund" />
    </requester>
    <recorder>
        <reference value="urn:staff-3030" />
        <display value="Dr Callum Lund" />
    </recorder>
    <dosageInstruction>
        <text value="Topical - Add one tablet to 500ml of warm water and dissolve. Make the resulting solution up to 8 litres and use to soak feet. Do not ingest." />
        <patientInstruction value="Add one tablet to 500ml of warm water and dissolve. Make the resulting solution up to 8 litres and use to soak feet. Do not ingest." />
        <route>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="6064005" />
                <display value="Topical" />
            </coding>
        </route>
    </dosageInstruction>
    <substitution>
        <allowedBoolean value="false" />
    </substitution>
</MedicationRequest>

{
    "resourceType": "MedicationRequest",
    "id": "1f4959a1-4a33-4b0e-bfad-f2ea1fccb2fa",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
        ]
    },
    "status": "active",
    "intent": "order",
    "category":  [
        {
            "coding":  [
                {
                    "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                    "code": "outpatient",
                    "display": "outpatient"
                }
            ]
        }
    ],
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "4256811000001101",
                "display": "Permitabs 400mg tablets for cutaneous solution (Alliance Pharmaceuticals Ltd)"
            }
        ]
    },
    "subject": {
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9999999999"
        }
    },
    "authoredOn": "2020-05-15T15:00:00Z",
    "requester": {
        "reference": "urn:staff-3030",
        "display": "Dr Callum Lund"
    },
    "recorder": {
        "reference": "urn:staff-3030",
        "display": "Dr Callum Lund"
    },
    "dosageInstruction":  [
        {
            "text": "Topical - Add one tablet to 500ml of warm water and dissolve. Make the resulting solution up to 8 litres and use to soak feet. Do not ingest.",
            "patientInstruction": "Add one tablet to 500ml of warm water and dissolve. Make the resulting solution up to 8 litres and use to soak feet. Do not ingest.",
            "route": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "6064005",
                        "display": "Topical"
                    }
                ]
            }
        }
    ],
    "substitution": {
        "allowedBoolean": false
    }
}
MedicationRequest.id[0]1f4959a1-4a33-4b0e-bfad-f2ea1fccb2fa
MedicationRequest.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
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].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.medication[0].coding[0].code[0]4256811000001101
MedicationRequest.medication[0].coding[0].display[0]Permitabs 400mg tablets for cutaneous solution (Alliance Pharmaceuticals Ltd)
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-3030
MedicationRequest.requester[0].display[0]Dr Callum Lund
MedicationRequest.recorder[0].reference[0]urn:staff-3030
MedicationRequest.recorder[0].display[0]Dr Callum Lund
MedicationRequest.dosageInstruction[0].text[0]Topical - Add one tablet to 500ml of warm water and dissolve. Make the resulting solution up to 8 litres and use to soak feet. Do not ingest.
MedicationRequest.dosageInstruction[0].patientInstruction[0]Add one tablet to 500ml of warm water and dissolve. Make the resulting solution up to 8 litres and use to soak feet. Do not ingest.
MedicationRequest.dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].route[0].coding[0].code[0]6064005
MedicationRequest.dosageInstruction[0].route[0].coding[0].display[0]Topical
MedicationRequest.substitution[0].allowed[0]False
MedicationRequest

Example on-screen presentation:

Permitabs 400mg tablets for cutaneous solution (Alliance Pharmaceuticals Ltd)
Add one tablet to 500ml of warm water and dissolve. Make the resulting solution up to 8 litres and use to soak feet. Do not ingest.

Phenoxymethylpenicillin tablets

Product-based VMP prescription using free text additional instruction because 'on an empty stomach' is neither SNOMED coded nor in a FHIR valueset.

It was decided that modelling only as 'an hour before food' would not be sufficient.

<timing>
    <repeat>
        <when value="C"/>
        <offset value="60" />
    </repeat>
</timing>

Therefore a free-text instruction needs to be added.

<additionalInstruction>
    <text value="or on an empty stomach" />
</additionalInstruction>


<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="5dcc8ffd-9838-45ed-8d31-fd20026fde4b" />
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
    </meta>
    <status value="active" />
    <intent value="order" />
    <category>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/medicationrequest-category" />
            <code value="inpatient" />
            <display value="inpatient" />
        </coding>
    </category>
    <medicationCodeableConcept>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="323416001" />
            <display value="Phenoxymethylpenicillin 250mg tablets" />
        </coding>
    </medicationCodeableConcept>
    <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="2 tablet - every 6 hours - 1 hour before a meal - oral - or on an empty stomach" />
        <additionalInstruction>
            <text value="or on an empty stomach" />
        </additionalInstruction>
        <timing>
            <repeat>
                <frequency value="1" />
                <period value="6" />
                <periodUnit value="h" />
                <when value="AC" />
                <offset value="60" />
            </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>
    </dosageInstruction>
    <substitution>
        <allowedBoolean value="false" />
    </substitution>
</MedicationRequest>

{
    "resourceType": "MedicationRequest",
    "id": "5dcc8ffd-9838-45ed-8d31-fd20026fde4b",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
        ]
    },
    "status": "active",
    "intent": "order",
    "category":  [
        {
            "coding":  [
                {
                    "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                    "code": "inpatient",
                    "display": "inpatient"
                }
            ]
        }
    ],
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "323416001",
                "display": "Phenoxymethylpenicillin 250mg tablets"
            }
        ]
    },
    "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": "2 tablet - every 6 hours - 1 hour before a meal - oral - or on an empty stomach",
            "additionalInstruction":  [
                {
                    "text": "or on an empty stomach"
                }
            ],
            "timing": {
                "repeat": {
                    "frequency": 1,
                    "period": 6,
                    "periodUnit": "h",
                    "when":  [
                        "AC"
                    ],
                    "offset": 60
                }
            },
            "route": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "26643006",
                        "display": "oral"
                    }
                ]
            },
            "doseAndRate":  [
                {
                    "doseQuantity": {
                        "value": 2,
                        "unit": "tablet",
                        "system": "http://snomed.info/sct",
                        "code": "428673006"
                    }
                }
            ]
        }
    ],
    "substitution": {
        "allowedBoolean": false
    }
}
MedicationRequest.id[0]5dcc8ffd-9838-45ed-8d31-fd20026fde4b
MedicationRequest.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
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]inpatient
MedicationRequest.category[0].coding[0].display[0]inpatient
MedicationRequest.medication[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.medication[0].coding[0].code[0]323416001
MedicationRequest.medication[0].coding[0].display[0]Phenoxymethylpenicillin 250mg tablets
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]2 tablet - every 6 hours - 1 hour before a meal - oral - or on an empty stomach
MedicationRequest.dosageInstruction[0].additionalInstruction[0].text[0]or on an empty stomach
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].frequency[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].period[0]6
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].periodUnit[0]h
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].when[0]AC
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].offset[0]60
MedicationRequest.dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].route[0].coding[0].code[0]26643006
MedicationRequest.dosageInstruction[0].route[0].coding[0].display[0]oral
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].value[0]2
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].unit[0]tablet
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].code[0]428673006
MedicationRequest.substitution[0].allowed[0]False
MedicationRequest

Example on-screen presentation:

Phenoxymethylpenicillin 250mg tablets
2 tablet - every 6 hours - 1 hour before a meal - oral - or on an empty stomach

Salbutamol using the metered dose device

Dose-based VTM prescription using free-text additional instruction for the use of a device. 
<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="00d31bbe-72f4-4a29-a880-df1a66075450" />
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
    </meta>
    <status value="active" />
    <intent value="order" />
    <category>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/medicationrequest-category" />
            <code value="inpatient" />
            <display value="inpatient" />
        </coding>
    </category>
    <medicationCodeableConcept>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="91143003" />
            <display value="Salbutamol" />
        </coding>
    </medicationCodeableConcept>
    <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="100 to 200 microgram - Inhalation - as required - up to a maximum of 8 dose in 1 day - using the metered dose device" />
        <additionalInstruction>
            <text value="using the metered dose device" />
        </additionalInstruction>
        <asNeededBoolean value="true" />
        <route>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="18679011000001101" />
                <display value="Inhalation" />
            </coding>
        </route>
        <doseAndRate>
            <doseRange>
                <low>
                    <value value="100" />
                    <unit value="microgram" />
                    <system value="http://unitsofmeasure.org" />
                    <code value="ug" />
                </low>
                <high>
                    <value value="200" />
                    <unit value="microgram" />
                    <system value="http://unitsofmeasure.org" />
                    <code value="ug" />
                </high>
            </doseRange>
        </doseAndRate>
        <maxDosePerPeriod>
            <numerator>
                <value value="8" />
                <unit value="dose" />
                <system value="http://snomed.info/sct" />
                <code value="3317411000001100" />
            </numerator>
            <denominator>
                <value value="1" />
                <unit value="day" />
                <system value="http://unitsofmeasure.org" />
                <code value="d" />
            </denominator>
        </maxDosePerPeriod>
    </dosageInstruction>
    <substitution>
        <allowedBoolean value="false" />
    </substitution>
</MedicationRequest>

{
    "resourceType": "MedicationRequest",
    "id": "00d31bbe-72f4-4a29-a880-df1a66075450",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
        ]
    },
    "status": "active",
    "intent": "order",
    "category":  [
        {
            "coding":  [
                {
                    "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                    "code": "inpatient",
                    "display": "inpatient"
                }
            ]
        }
    ],
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "91143003",
                "display": "Salbutamol"
            }
        ]
    },
    "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": "100 to 200 microgram - Inhalation - as required - up to a maximum of 8 dose in 1 day - using the metered dose device",
            "additionalInstruction":  [
                {
                    "text": "using the metered dose device"
                }
            ],
            "asNeededBoolean": true,
            "route": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "18679011000001101",
                        "display": "Inhalation"
                    }
                ]
            },
            "doseAndRate":  [
                {
                    "doseRange": {
                        "low": {
                            "value": 100,
                            "unit": "microgram",
                            "system": "http://unitsofmeasure.org",
                            "code": "ug"
                        },
                        "high": {
                            "value": 200,
                            "unit": "microgram",
                            "system": "http://unitsofmeasure.org",
                            "code": "ug"
                        }
                    }
                }
            ],
            "maxDosePerPeriod": {
                "numerator": {
                    "value": 8,
                    "unit": "dose",
                    "system": "http://snomed.info/sct",
                    "code": "3317411000001100"
                },
                "denominator": {
                    "value": 1,
                    "unit": "day",
                    "system": "http://unitsofmeasure.org",
                    "code": "d"
                }
            }
        }
    ],
    "substitution": {
        "allowedBoolean": false
    }
}
MedicationRequest.id[0]00d31bbe-72f4-4a29-a880-df1a66075450
MedicationRequest.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
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]inpatient
MedicationRequest.category[0].coding[0].display[0]inpatient
MedicationRequest.medication[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.medication[0].coding[0].code[0]91143003
MedicationRequest.medication[0].coding[0].display[0]Salbutamol
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]100 to 200 microgram - Inhalation - as required - up to a maximum of 8 dose in 1 day - using the metered dose device
MedicationRequest.dosageInstruction[0].additionalInstruction[0].text[0]using the metered dose device
MedicationRequest.dosageInstruction[0].asNeeded[0]True
MedicationRequest.dosageInstruction[0].route[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].route[0].coding[0].code[0]18679011000001101
MedicationRequest.dosageInstruction[0].route[0].coding[0].display[0]Inhalation
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].low[0].value[0]100
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].low[0].unit[0]microgram
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].low[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].low[0].code[0]ug
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].high[0].value[0]200
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].high[0].unit[0]microgram
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].high[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].high[0].code[0]ug
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].value[0]8
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].unit[0]dose
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].code[0]3317411000001100
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].value[0]1
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].unit[0]day
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].denominator[0].code[0]d
MedicationRequest.substitution[0].allowed[0]False
MedicationRequest

Example on-screen presentation:

Salbutamol
100 to 200 microgram - Inhalation - as required - up to a maximum of 8 dose in 1 day - using the metered dose device

Sumatriptan

Product-based VMP prescription which is fully coded but there is an alternative way of modelling this dosage instruction, see second example below. 
<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="c1ea9b0b-f157-4ee2-9771-84c6cbae5cad" />
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
    </meta>
    <status value="active" />
    <intent value="order" />
    <category>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/medicationrequest-category" />
            <code value="inpatient" />
            <display value="inpatient" />
        </coding>
    </category>
    <priority value="routine" />
    <medicationCodeableConcept>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="322815004" />
            <display value="Sumatriptan 50mg tablets" />
        </coding>
    </medicationCodeableConcept>
    <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>
        <sequence value="1" />
        <text value="1 tablet - take once - as required for Migraine" />
        <timing>
            <repeat>
                <count value="1" />
            </repeat>
        </timing>
        <asNeededCodeableConcept>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="37796009" />
                <display value="Migraine" />
            </coding>
        </asNeededCodeableConcept>
        <doseAndRate>
            <doseQuantity>
                <value value="1" />
                <unit value="tablet" />
                <system value="http://snomed.info/sct" />
                <code value="428673006" />
            </doseQuantity>
        </doseAndRate>
    </dosageInstruction>
    <dosageInstruction>
        <sequence value="2" />
        <text value="1 tablet - every 2 hours - as required for Migraine - up to a maximum of 6 tablet in 24 hours" />
        <timing>
            <repeat>
                <frequency value="1" />
                <period value="2" />
                <periodUnit value="h" />
            </repeat>
        </timing>
        <asNeededCodeableConcept>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="37796009" />
                <display value="Migraine" />
            </coding>
        </asNeededCodeableConcept>
        <doseAndRate>
            <doseQuantity>
                <value value="1" />
                <unit value="tablet" />
                <system value="http://snomed.info/sct" />
                <code value="428673006" />
            </doseQuantity>
        </doseAndRate>
        <maxDosePerPeriod>
            <numerator>
                <value value="6" />
                <unit value="tablet" />
                <system value="http://snomed.info/sct" />
                <code value="3317411000001100" />
            </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": "c1ea9b0b-f157-4ee2-9771-84c6cbae5cad",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
        ]
    },
    "status": "active",
    "intent": "order",
    "category":  [
        {
            "coding":  [
                {
                    "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                    "code": "inpatient",
                    "display": "inpatient"
                }
            ]
        }
    ],
    "priority": "routine",
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "322815004",
                "display": "Sumatriptan 50mg tablets"
            }
        ]
    },
    "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":  [
        {
            "sequence": 1,
            "text": "1 tablet - take once - as required for Migraine",
            "timing": {
                "repeat": {
                    "count": 1
                }
            },
            "asNeededCodeableConcept": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "37796009",
                        "display": "Migraine"
                    }
                ]
            },
            "doseAndRate":  [
                {
                    "doseQuantity": {
                        "value": 1,
                        "unit": "tablet",
                        "system": "http://snomed.info/sct",
                        "code": "428673006"
                    }
                }
            ]
        },
        {
            "sequence": 2,
            "text": "1 tablet - every 2 hours - as required for Migraine - up to a maximum of 6 tablet in 24 hours",
            "timing": {
                "repeat": {
                    "frequency": 1,
                    "period": 2,
                    "periodUnit": "h"
                }
            },
            "asNeededCodeableConcept": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "37796009",
                        "display": "Migraine"
                    }
                ]
            },
            "doseAndRate":  [
                {
                    "doseQuantity": {
                        "value": 1,
                        "unit": "tablet",
                        "system": "http://snomed.info/sct",
                        "code": "428673006"
                    }
                }
            ],
            "maxDosePerPeriod": {
                "numerator": {
                    "value": 6,
                    "unit": "tablet",
                    "system": "http://snomed.info/sct",
                    "code": "3317411000001100"
                },
                "denominator": {
                    "value": 24,
                    "unit": "hour",
                    "system": "http://unitsofmeasure.org/",
                    "code": "h"
                }
            }
        }
    ],
    "substitution": {
        "allowedBoolean": false
    }
}
MedicationRequest.id[0]c1ea9b0b-f157-4ee2-9771-84c6cbae5cad
MedicationRequest.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
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]inpatient
MedicationRequest.category[0].coding[0].display[0]inpatient
MedicationRequest.priority[0]routine
MedicationRequest.medication[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.medication[0].coding[0].code[0]322815004
MedicationRequest.medication[0].coding[0].display[0]Sumatriptan 50mg tablets
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].sequence[0]1
MedicationRequest.dosageInstruction[0].text[0]1 tablet - take once - as required for Migraine
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].count[0]1
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].code[0]37796009
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].display[0]Migraine
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].value[0]1
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].unit[0]tablet
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].code[0]428673006
MedicationRequest.dosageInstruction[1].sequence[0]2
MedicationRequest.dosageInstruction[1].text[0]1 tablet - every 2 hours - as required for Migraine - up to a maximum of 6 tablet in 24 hours
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].frequency[0]1
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].period[0]2
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].periodUnit[0]h
MedicationRequest.dosageInstruction[1].asNeeded[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[1].asNeeded[0].coding[0].code[0]37796009
MedicationRequest.dosageInstruction[1].asNeeded[0].coding[0].display[0]Migraine
MedicationRequest.dosageInstruction[1].doseAndRate[0].dose[0].value[0]1
MedicationRequest.dosageInstruction[1].doseAndRate[0].dose[0].unit[0]tablet
MedicationRequest.dosageInstruction[1].doseAndRate[0].dose[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[1].doseAndRate[0].dose[0].code[0]428673006
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].value[0]6
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].unit[0]tablet
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].numerator[0].code[0]3317411000001100
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].denominator[0].value[0]24
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].denominator[0].unit[0]hour
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].denominator[0].system[0]http://unitsofmeasure.org/
MedicationRequest.dosageInstruction[1].maxDosePerPeriod[0].denominator[0].code[0]h
MedicationRequest.substitution[0].allowed[0]False
MedicationRequest

Example on-screen presentation:

Sumatriptan 50mg tablets
1 tablet - take once - as required for Migraine, then 1 tablet - every 2 hours - as required for Migraine - up to a maximum of 6 tablet in 24 hours

Alternative Representation

Product-based VMP prescription using a simpler Dosage but where further instructions are text-based. 
<MedicationRequest xmlns="http://hl7.org/fhir">
    <id value="b31fcf06-b515-4468-92cd-ce7b13b0c256" />
    <meta>
        <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest" />
    </meta>
    <status value="active" />
    <intent value="order" />
    <category>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/medicationrequest-category" />
            <code value="inpatient" />
            <display value="inpatient" />
        </coding>
    </category>
    <priority value="routine" />
    <medicationCodeableConcept>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="322815004" />
            <display value="Sumatriptan 50mg tablets" />
        </coding>
    </medicationCodeableConcept>
    <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="1 tablet - every 2 hours - as required for Migraine - up to a maximum of 6 tablets in 24 hours - Additional doses only to be taken after migraine recurrence" />
        <patientInstruction value="Additional doses only to be taken after migraine recurrence" />
        <timing>
            <repeat>
                <frequency value="1" />
                <period value="2" />
                <periodUnit value="h" />
            </repeat>
        </timing>
        <asNeededCodeableConcept>
            <coding>
                <system value="http://snomed.info/sct" />
                <code value="37796009" />
                <display value="Migraine" />
            </coding>
        </asNeededCodeableConcept>
        <doseAndRate>
            <doseQuantity>
                <value value="1" />
                <unit value="tablet" />
                <system value="http://snomed.info/sct" />
                <code value="428673006" />
            </doseQuantity>
        </doseAndRate>
        <maxDosePerPeriod>
            <numerator>
                <value value="6" />
                <unit value="tablet" />
                <system value="http://snomed.info/sct" />
                <code value="3317411000001100" />
            </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": "b31fcf06-b515-4468-92cd-ce7b13b0c256",
    "meta": {
        "profile":  [
            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest"
        ]
    },
    "status": "active",
    "intent": "order",
    "category":  [
        {
            "coding":  [
                {
                    "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                    "code": "inpatient",
                    "display": "inpatient"
                }
            ]
        }
    ],
    "priority": "routine",
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "322815004",
                "display": "Sumatriptan 50mg tablets"
            }
        ]
    },
    "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": "1 tablet - every 2 hours - as required for Migraine - up to a maximum of 6 tablets in 24 hours - Additional doses only to be taken after migraine recurrence",
            "patientInstruction": "Additional doses only to be taken after migraine recurrence",
            "timing": {
                "repeat": {
                    "frequency": 1,
                    "period": 2,
                    "periodUnit": "h"
                }
            },
            "asNeededCodeableConcept": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "37796009",
                        "display": "Migraine"
                    }
                ]
            },
            "doseAndRate":  [
                {
                    "doseQuantity": {
                        "value": 1,
                        "unit": "tablet",
                        "system": "http://snomed.info/sct",
                        "code": "428673006"
                    }
                }
            ],
            "maxDosePerPeriod": {
                "numerator": {
                    "value": 6,
                    "unit": "tablet",
                    "system": "http://snomed.info/sct",
                    "code": "3317411000001100"
                },
                "denominator": {
                    "value": 24,
                    "unit": "hour",
                    "system": "http://unitsofmeasure.org/",
                    "code": "h"
                }
            }
        }
    ],
    "substitution": {
        "allowedBoolean": false
    }
}
MedicationRequest.id[0]b31fcf06-b515-4468-92cd-ce7b13b0c256
MedicationRequest.meta[0].profile[0]https://fhir.hl7.org.uk/StructureDefinition/UKCore-MedicationRequest
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]inpatient
MedicationRequest.category[0].coding[0].display[0]inpatient
MedicationRequest.priority[0]routine
MedicationRequest.medication[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.medication[0].coding[0].code[0]322815004
MedicationRequest.medication[0].coding[0].display[0]Sumatriptan 50mg tablets
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]1 tablet - every 2 hours - as required for Migraine - up to a maximum of 6 tablets in 24 hours - Additional doses only to be taken after migraine recurrence
MedicationRequest.dosageInstruction[0].patientInstruction[0]Additional doses only to be taken after migraine recurrence
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].frequency[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].period[0]2
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].periodUnit[0]h
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].code[0]37796009
MedicationRequest.dosageInstruction[0].asNeeded[0].coding[0].display[0]Migraine
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].value[0]1
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].unit[0]tablet
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].code[0]428673006
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].value[0]6
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].unit[0]tablet
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[0].maxDosePerPeriod[0].numerator[0].code[0]3317411000001100
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:

Sumatriptan 50mg tablets
1 tablet - every 2 hours - as required for Migraine - up to a maximum of 6 tablets in 24 hours - Additional doses only to be taken after migraine recurrence
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