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.

Metformin tablets

Product-based instruction using an VMP. 
<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="community" />
            <display value="community" />
        </coding>
    </category>
    <medicationCodeableConcept>
        <coding>
            <system value="https://dmd.nhs.uk" />
            <code value="325278007" />
            <display value="Metformin 500mg tablets" />
        </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>
        <sequence value="1" />
        <text value="1 tablet - once a day - at breakfast - for 1 week" />
        <timing>
            <repeat>
                <boundsDuration>
                    <value value="1" />
                    <unit value="week" />
                    <system value="http://unitsofmeasure.org" />
                    <code value="wk" />
                </boundsDuration>
                <frequency value="1" />
                <period value="1" />
                <periodUnit value="d" />
                <when value="CM" />
            </repeat>
        </timing>
        <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 - twice a day - at breakfast and at dinner - for 1 week" />
        <timing>
            <repeat>
                <boundsDuration>
                    <value value="1" />
                    <unit value="week" />
                    <system value="http://unitsofmeasure.org" />
                    <code value="wk" />
                </boundsDuration>
                <frequency value="2" />
                <period value="1" />
                <periodUnit value="d" />
                <when value="CM" />
                <when value="CV" />
            </repeat>
        </timing>
        <doseAndRate>
            <doseQuantity>
                <value value="1" />
                <unit value="tablet" />
                <system value="http://snomed.info/sct" />
                <code value="428673006" />
            </doseQuantity>
        </doseAndRate>
    </dosageInstruction>
    <dosageInstruction>
        <sequence value="3" />
        <text value="1 tablet - 3 times a day - at breakfast, at dinner and at lunch - for 1 week - up to a maximum of 4 tablet in 1 day" />
        <timing>
            <repeat>
                <boundsDuration>
                    <value value="1" />
                    <unit value="week" />
                    <system value="http://unitsofmeasure.org" />
                    <code value="wk" />
                </boundsDuration>
                <frequency value="3" />
                <period value="1" />
                <periodUnit value="d" />
                <when value="CM" />
                <when value="CV" />
                <when value="CD" />
            </repeat>
        </timing>
        <doseAndRate>
            <doseQuantity>
                <value value="1" />
                <unit value="tablet" />
                <system value="http://snomed.info/sct" />
                <code value="428673006" />
            </doseQuantity>
        </doseAndRate>
        <maxDosePerPeriod>
            <numerator>
                <value value="4" />
                <unit value="tablet" />
                <system value="http://snomed.info/sct" />
                <code value="428673006" />
            </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": "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": "community",
                    "display": "community"
                }
            ]
        }
    ],
    "medicationCodeableConcept": {
        "coding":  [
            {
                "system": "https://dmd.nhs.uk",
                "code": "325278007",
                "display": "Metformin 500mg tablets"
            }
        ]
    },
    "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":  [
        {
            "sequence": 1,
            "text": "1 tablet - once a day - at breakfast - for 1 week",
            "timing": {
                "repeat": {
                    "boundsDuration": {
                        "value": 1,
                        "unit": "week",
                        "system": "http://unitsofmeasure.org",
                        "code": "wk"
                    },
                    "frequency": 1,
                    "period": 1,
                    "periodUnit": "d",
                    "when":  [
                        "CM"
                    ]
                }
            },
            "doseAndRate":  [
                {
                    "doseQuantity": {
                        "value": 1,
                        "unit": "tablet",
                        "system": "http://snomed.info/sct",
                        "code": "428673006"
                    }
                }
            ]
        },
        {
            "sequence": 2,
            "text": "1 tablet - twice a day - at breakfast and at dinner - for 1 week",
            "timing": {
                "repeat": {
                    "boundsDuration": {
                        "value": 1,
                        "unit": "week",
                        "system": "http://unitsofmeasure.org",
                        "code": "wk"
                    },
                    "frequency": 2,
                    "period": 1,
                    "periodUnit": "d",
                    "when":  [
                        "CM",
                        "CV"
                    ]
                }
            },
            "doseAndRate":  [
                {
                    "doseQuantity": {
                        "value": 1,
                        "unit": "tablet",
                        "system": "http://snomed.info/sct",
                        "code": "428673006"
                    }
                }
            ]
        },
        {
            "sequence": 3,
            "text": "1 tablet - 3 times a day - at breakfast, at dinner and at lunch - for 1 week - up to a maximum of 4 tablet in 1 day",
            "timing": {
                "repeat": {
                    "boundsDuration": {
                        "value": 1,
                        "unit": "week",
                        "system": "http://unitsofmeasure.org",
                        "code": "wk"
                    },
                    "frequency": 3,
                    "period": 1,
                    "periodUnit": "d",
                    "when":  [
                        "CM",
                        "CV",
                        "CD"
                    ]
                }
            },
            "doseAndRate":  [
                {
                    "doseQuantity": {
                        "value": 1,
                        "unit": "tablet",
                        "system": "http://snomed.info/sct",
                        "code": "428673006"
                    }
                }
            ],
            "maxDosePerPeriod": {
                "numerator": {
                    "value": 4,
                    "unit": "tablet",
                    "system": "http://snomed.info/sct",
                    "code": "428673006"
                },
                "denominator": {
                    "value": 1,
                    "unit": "day",
                    "system": "http://unitsofmeasure.org",
                    "code": "d"
                }
            }
        }
    ],
    "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]community
MedicationRequest.category[0].coding[0].display[0]community
MedicationRequest.medication[0].coding[0].system[0]https://dmd.nhs.uk
MedicationRequest.medication[0].coding[0].code[0]325278007
MedicationRequest.medication[0].coding[0].display[0]Metformin 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]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].sequence[0]1
MedicationRequest.dosageInstruction[0].text[0]1 tablet - once a day - at breakfast - for 1 week
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].bounds[0].value[0]1
MedicationRequest.dosageInstruction[0].timing[0].repeat[0].bounds[0].unit[0]week
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]wk
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].when[0]CM
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 - twice a day - at breakfast and at dinner - for 1 week
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].bounds[0].value[0]1
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].bounds[0].unit[0]week
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].bounds[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].bounds[0].code[0]wk
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].frequency[0]2
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].period[0]1
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].periodUnit[0]d
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].when[0]CM
MedicationRequest.dosageInstruction[1].timing[0].repeat[0].when[1]CV
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[2].sequence[0]3
MedicationRequest.dosageInstruction[2].text[0]1 tablet - 3 times a day - at breakfast, at dinner and at lunch - for 1 week - up to a maximum of 4 tablet in 1 day
MedicationRequest.dosageInstruction[2].timing[0].repeat[0].bounds[0].value[0]1
MedicationRequest.dosageInstruction[2].timing[0].repeat[0].bounds[0].unit[0]week
MedicationRequest.dosageInstruction[2].timing[0].repeat[0].bounds[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[2].timing[0].repeat[0].bounds[0].code[0]wk
MedicationRequest.dosageInstruction[2].timing[0].repeat[0].frequency[0]3
MedicationRequest.dosageInstruction[2].timing[0].repeat[0].period[0]1
MedicationRequest.dosageInstruction[2].timing[0].repeat[0].periodUnit[0]d
MedicationRequest.dosageInstruction[2].timing[0].repeat[0].when[0]CM
MedicationRequest.dosageInstruction[2].timing[0].repeat[0].when[1]CV
MedicationRequest.dosageInstruction[2].timing[0].repeat[0].when[2]CD
MedicationRequest.dosageInstruction[2].doseAndRate[0].dose[0].value[0]1
MedicationRequest.dosageInstruction[2].doseAndRate[0].dose[0].unit[0]tablet
MedicationRequest.dosageInstruction[2].doseAndRate[0].dose[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[2].doseAndRate[0].dose[0].code[0]428673006
MedicationRequest.dosageInstruction[2].maxDosePerPeriod[0].numerator[0].value[0]4
MedicationRequest.dosageInstruction[2].maxDosePerPeriod[0].numerator[0].unit[0]tablet
MedicationRequest.dosageInstruction[2].maxDosePerPeriod[0].numerator[0].system[0]http://snomed.info/sct
MedicationRequest.dosageInstruction[2].maxDosePerPeriod[0].numerator[0].code[0]428673006
MedicationRequest.dosageInstruction[2].maxDosePerPeriod[0].denominator[0].value[0]1
MedicationRequest.dosageInstruction[2].maxDosePerPeriod[0].denominator[0].unit[0]day
MedicationRequest.dosageInstruction[2].maxDosePerPeriod[0].denominator[0].system[0]http://unitsofmeasure.org
MedicationRequest.dosageInstruction[2].maxDosePerPeriod[0].denominator[0].code[0]d
MedicationRequest.substitution[0].allowed[0]False
MedicationRequest

Example on-screen presentation:

Metformin 500mg tablets
1 tablet - once a day - at breakfast - for 1 week, then 1 tablet - twice a day - at breakfast and at dinner - for 1 week - up to a maximum of 4 tablet in 1 day, then 1 tablet - 3 times a day - at breakfast, at dinner and at lunch - for 1 week - up to a maximum of 4 tablet in 1 day
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