Element: sequence
Multi-sequence dosage instructions.
A multi-sequence would be required where a dosage instruction changes over a given time schedule, where a dosage instruction includes optional follow-up doses or where a concurrent dosage instruction is required for the same medication at a different dose.
Examples below include Prednisolone to treat Bell’s palsy where a dose starts at 60 mg per day for a period of time then reduces by 10 mg per day. This would be described as a sequential dosage instruction. A concurrent dosage example is provided to describe a different dose in the morning to that at midday.
Sequential Instructions
Where the value of sequence is an incremental integer it defines a sequential instruction.
Example use of the FHIR R4 Dosage using multiple sequential sequences
| MedicationRequest.id[0] | 43955772-3136-49be-829e-ac04b56894d5 |
| 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] | 52388000 |
| MedicationRequest.medication[0].coding[0].display[0] | Prednisolone |
| 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] | 60 milligram - once a day - for 4 days |
| MedicationRequest.dosageInstruction[0].timing[0].repeat[0].bounds[0].value[0] | 4 |
| 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] | 1 |
| MedicationRequest.dosageInstruction[0].timing[0].repeat[0].period[0] | 1 |
| MedicationRequest.dosageInstruction[0].timing[0].repeat[0].periodUnit[0] | d |
| MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].value[0] | 60 |
| MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].unit[0] | milligram |
| MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].system[0] | http://unitsofmeasure.org |
| MedicationRequest.dosageInstruction[0].doseAndRate[0].dose[0].code[0] | mg |
| MedicationRequest.dosageInstruction[1].sequence[0] | 2 |
| MedicationRequest.dosageInstruction[1].text[0] | 50 milligram - once a day - for 1 day |
| MedicationRequest.dosageInstruction[1].timing[0].repeat[0].bounds[0].value[0] | 1 |
| MedicationRequest.dosageInstruction[1].timing[0].repeat[0].bounds[0].unit[0] | day |
| 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] | d |
| MedicationRequest.dosageInstruction[1].timing[0].repeat[0].frequency[0] | 1 |
| MedicationRequest.dosageInstruction[1].timing[0].repeat[0].period[0] | 1 |
| MedicationRequest.dosageInstruction[1].timing[0].repeat[0].periodUnit[0] | d |
| MedicationRequest.dosageInstruction[1].doseAndRate[0].dose[0].value[0] | 50 |
| MedicationRequest.dosageInstruction[1].doseAndRate[0].dose[0].unit[0] | milligram |
| MedicationRequest.dosageInstruction[1].doseAndRate[0].dose[0].system[0] | http://unitsofmeasure.org |
| MedicationRequest.dosageInstruction[1].doseAndRate[0].dose[0].code[0] | mg |
| MedicationRequest.dosageInstruction[2].sequence[0] | 3 |
| MedicationRequest.dosageInstruction[2].text[0] | 40 milligram - once a day - for 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] | day |
| 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] | d |
| MedicationRequest.dosageInstruction[2].timing[0].repeat[0].frequency[0] | 1 |
| MedicationRequest.dosageInstruction[2].timing[0].repeat[0].period[0] | 1 |
| MedicationRequest.dosageInstruction[2].timing[0].repeat[0].periodUnit[0] | d |
| MedicationRequest.dosageInstruction[2].doseAndRate[0].dose[0].value[0] | 40 |
| MedicationRequest.dosageInstruction[2].doseAndRate[0].dose[0].unit[0] | milligram |
| MedicationRequest.dosageInstruction[2].doseAndRate[0].dose[0].system[0] | http://unitsofmeasure.org |
| MedicationRequest.dosageInstruction[2].doseAndRate[0].dose[0].code[0] | mg |
| MedicationRequest.dosageInstruction[3].sequence[0] | 4 |
| MedicationRequest.dosageInstruction[3].text[0] | 30 milligram - once a day - for 1 day |
| MedicationRequest.dosageInstruction[3].timing[0].repeat[0].bounds[0].value[0] | 1 |
| MedicationRequest.dosageInstruction[3].timing[0].repeat[0].bounds[0].unit[0] | day |
| MedicationRequest.dosageInstruction[3].timing[0].repeat[0].bounds[0].system[0] | http://unitsofmeasure.org |
| MedicationRequest.dosageInstruction[3].timing[0].repeat[0].bounds[0].code[0] | d |
| MedicationRequest.dosageInstruction[3].timing[0].repeat[0].frequency[0] | 1 |
| MedicationRequest.dosageInstruction[3].timing[0].repeat[0].period[0] | 1 |
| MedicationRequest.dosageInstruction[3].timing[0].repeat[0].periodUnit[0] | d |
| MedicationRequest.dosageInstruction[3].doseAndRate[0].dose[0].value[0] | 30 |
| MedicationRequest.dosageInstruction[3].doseAndRate[0].dose[0].unit[0] | milligram |
| MedicationRequest.dosageInstruction[3].doseAndRate[0].dose[0].system[0] | http://unitsofmeasure.org |
| MedicationRequest.dosageInstruction[3].doseAndRate[0].dose[0].code[0] | mg |
| MedicationRequest.dosageInstruction[4].sequence[0] | 5 |
| MedicationRequest.dosageInstruction[4].text[0] | 20 milligram - once a day - for 1 day |
| MedicationRequest.dosageInstruction[4].timing[0].repeat[0].bounds[0].value[0] | 1 |
| MedicationRequest.dosageInstruction[4].timing[0].repeat[0].bounds[0].unit[0] | day |
| MedicationRequest.dosageInstruction[4].timing[0].repeat[0].bounds[0].system[0] | http://unitsofmeasure.org |
| MedicationRequest.dosageInstruction[4].timing[0].repeat[0].bounds[0].code[0] | d |
| MedicationRequest.dosageInstruction[4].timing[0].repeat[0].frequency[0] | 1 |
| MedicationRequest.dosageInstruction[4].timing[0].repeat[0].period[0] | 1 |
| MedicationRequest.dosageInstruction[4].timing[0].repeat[0].periodUnit[0] | d |
| MedicationRequest.dosageInstruction[4].doseAndRate[0].dose[0].value[0] | 20 |
| MedicationRequest.dosageInstruction[4].doseAndRate[0].dose[0].unit[0] | milligram |
| MedicationRequest.dosageInstruction[4].doseAndRate[0].dose[0].system[0] | http://unitsofmeasure.org |
| MedicationRequest.dosageInstruction[4].doseAndRate[0].dose[0].code[0] | mg |
| MedicationRequest.dosageInstruction[5].sequence[0] | 6 |
| MedicationRequest.dosageInstruction[5].text[0] | 10 milligram - once a day - for 1 day - Then stop |
| MedicationRequest.dosageInstruction[5].additionalInstruction[0].coding[0].system[0] | http://snomed.info/sct |
| MedicationRequest.dosageInstruction[5].additionalInstruction[0].coding[0].code[0] | 422327006 |
| MedicationRequest.dosageInstruction[5].additionalInstruction[0].coding[0].display[0] | Then stop |
| MedicationRequest.dosageInstruction[5].timing[0].repeat[0].bounds[0].value[0] | 1 |
| MedicationRequest.dosageInstruction[5].timing[0].repeat[0].bounds[0].unit[0] | day |
| MedicationRequest.dosageInstruction[5].timing[0].repeat[0].bounds[0].system[0] | http://unitsofmeasure.org |
| MedicationRequest.dosageInstruction[5].timing[0].repeat[0].bounds[0].code[0] | d |
| MedicationRequest.dosageInstruction[5].timing[0].repeat[0].frequency[0] | 1 |
| MedicationRequest.dosageInstruction[5].timing[0].repeat[0].period[0] | 1 |
| MedicationRequest.dosageInstruction[5].timing[0].repeat[0].periodUnit[0] | d |
| MedicationRequest.dosageInstruction[5].doseAndRate[0].dose[0].value[0] | 10 |
| MedicationRequest.dosageInstruction[5].doseAndRate[0].dose[0].unit[0] | milligram |
| MedicationRequest.dosageInstruction[5].doseAndRate[0].dose[0].system[0] | http://unitsofmeasure.org |
| MedicationRequest.dosageInstruction[5].doseAndRate[0].dose[0].code[0] | mg |
| MedicationRequest.substitution[0].allowed[0] | False |
| MedicationRequest |
| id : 43955772-3136-49be-829e-ac04b56894d5 |
| 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 |
| medication |
| coding |
| system : https://dmd.nhs.uk |
| code : 52388000 |
| display : Prednisolone |
| 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 : 60 milligram - once a day - for 4 days |
| timing |
| repeat |
| bounds |
| value : 4 |
| unit : day |
| system : http://unitsofmeasure.org |
| code : d |
| frequency : 1 |
| period : 1 |
| periodUnit : d |
| doseAndRate |
| dose |
| value : 60 |
| unit : milligram |
| system : http://unitsofmeasure.org |
| code : mg |
| dosageInstruction |
| sequence : 2 |
| text : 50 milligram - once a day - for 1 day |
| timing |
| repeat |
| bounds |
| value : 1 |
| unit : day |
| system : http://unitsofmeasure.org |
| code : d |
| frequency : 1 |
| period : 1 |
| periodUnit : d |
| doseAndRate |
| dose |
| value : 50 |
| unit : milligram |
| system : http://unitsofmeasure.org |
| code : mg |
| dosageInstruction |
| sequence : 3 |
| text : 40 milligram - once a day - for 1 day |
| timing |
| repeat |
| bounds |
| value : 1 |
| unit : day |
| system : http://unitsofmeasure.org |
| code : d |
| frequency : 1 |
| period : 1 |
| periodUnit : d |
| doseAndRate |
| dose |
| value : 40 |
| unit : milligram |
| system : http://unitsofmeasure.org |
| code : mg |
| dosageInstruction |
| sequence : 4 |
| text : 30 milligram - once a day - for 1 day |
| timing |
| repeat |
| bounds |
| value : 1 |
| unit : day |
| system : http://unitsofmeasure.org |
| code : d |
| frequency : 1 |
| period : 1 |
| periodUnit : d |
| doseAndRate |
| dose |
| value : 30 |
| unit : milligram |
| system : http://unitsofmeasure.org |
| code : mg |
| dosageInstruction |
| sequence : 5 |
| text : 20 milligram - once a day - for 1 day |
| timing |
| repeat |
| bounds |
| value : 1 |
| unit : day |
| system : http://unitsofmeasure.org |
| code : d |
| frequency : 1 |
| period : 1 |
| periodUnit : d |
| doseAndRate |
| dose |
| value : 20 |
| unit : milligram |
| system : http://unitsofmeasure.org |
| code : mg |
| dosageInstruction |
| sequence : 6 |
| text : 10 milligram - once a day - for 1 day - Then stop |
| additionalInstruction |
| coding |
| system : http://snomed.info/sct |
| code : 422327006 |
| display : Then stop |
| timing |
| repeat |
| bounds |
| value : 1 |
| unit : day |
| system : http://unitsofmeasure.org |
| code : d |
| frequency : 1 |
| period : 1 |
| periodUnit : d |
| doseAndRate |
| dose |
| value : 10 |
| unit : milligram |
| system : http://unitsofmeasure.org |
| code : mg |
| substitution |
| allowed : False |
Concurrent Instructions
Where the same integer value of sequence is defines it means a concurrent instruction.
| MedicationRequest.id[0] | 79159c4f-13c4-457a-8962-67fa22432c15 |
| 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] | 317972000 |
| MedicationRequest.medication[0].coding[0].display[0] | Furosemide 40mg 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 - daily - at 08:00 - 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].period[0] | 1 |
| MedicationRequest.dosageInstruction[0].timing[0].repeat[0].periodUnit[0] | d |
| MedicationRequest.dosageInstruction[0].timing[0].repeat[0].timeOfDay[0] | 08:00:00 |
| 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] | 1 |
| MedicationRequest.dosageInstruction[1].text[0] | 1 tablet - daily - at 12:00 - 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].period[0] | 1 |
| MedicationRequest.dosageInstruction[1].timing[0].repeat[0].periodUnit[0] | d |
| MedicationRequest.dosageInstruction[1].timing[0].repeat[0].timeOfDay[0] | 12:00:00 |
| 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.substitution[0].allowed[0] | False |
| MedicationRequest |
| id : 79159c4f-13c4-457a-8962-67fa22432c15 |
| 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 |
| medication |
| coding |
| system : https://dmd.nhs.uk |
| code : 317972000 |
| display : Furosemide 40mg 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 - daily - at 08:00 - for 1 week |
| timing |
| repeat |
| bounds |
| value : 1 |
| unit : week |
| system : http://unitsofmeasure.org |
| code : wk |
| period : 1 |
| periodUnit : d |
| timeOfDay : 08:00:00 |
| doseAndRate |
| dose |
| value : 2 |
| unit : tablet |
| system : http://snomed.info/sct |
| code : 428673006 |
| dosageInstruction |
| sequence : 1 |
| text : 1 tablet - daily - at 12:00 - for 1 week |
| timing |
| repeat |
| bounds |
| value : 1 |
| unit : week |
| system : http://unitsofmeasure.org |
| code : wk |
| period : 1 |
| periodUnit : d |
| timeOfDay : 12:00:00 |
| doseAndRate |
| dose |
| value : 1 |
| unit : tablet |
| system : http://snomed.info/sct |
| code : 428673006 |
| substitution |
| allowed : False |