Release 4B Snapshot #1

This page is part of the FHIR Specification v4.3.0-snapshot1: R4B Snapshot to support the Jan 2022 Connectathon. About the R4B version of FHIR. The current officially released version is 4.3.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3

11.10.0 Dosage

Pharmacy Work GroupMaturity Level: 3Standards Status: Trial Use

The Dosage structure defines general dosage instruction information typically represented in medication requests, medication dispenses and medication statements.

Note: the Dosage structure allows modifier extensions.

11.10.0.1 Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. DosageΣTUBackBoneElementHow the medication is/was taken or should be taken
Elements defined in Ancestors: id, extension, modifierExtension
... sequenceΣ0..1integerThe order of the dosage instructions
... textΣ0..1stringFree text dosage instructions e.g. SIG
... additionalInstructionΣ0..*CodeableConceptSupplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
SNOMED CT Additional Dosage Instructions (Example)
... timingΣ0..1TimingWhen medication should be administered
... asNeeded[x]Σ0..1Take "as needed" (for x)
SNOMED CT Medication As Needed Reason Codes (Example)
.... asNeededBooleanboolean
.... asNeededCodeableConceptCodeableConcept
... siteΣ0..1CodeableConceptBody site to administer to
SNOMED CT Anatomical Structure for Administration Site Codes (Example)
... routeΣ0..1CodeableConceptHow drug should enter body
SNOMED CT Route Codes (Example)
... methodΣ0..1CodeableConceptTechnique for administering medication
SNOMED CT Administration Method Codes (Example)
... doseAndRateΣ0..*ElementAmount of medication administered
.... typeΣ0..1CodeableConceptThe kind of dose or rate specified
DoseAndRateType (Example)
.... dose[x]Σ0..1Amount of medication per dose
..... doseRangeRange
..... doseQuantitySimpleQuantity
.... rate[x]Σ0..1Amount of medication per unit of time
..... rateRatioRatio
..... rateRangeRange
..... rateQuantitySimpleQuantity
... maxDosePerPeriodΣ0..1RatioUpper limit on medication per unit of time
... maxDosePerAdministrationΣ0..1SimpleQuantityUpper limit on medication per administration
... maxDosePerLifetimeΣ0..1SimpleQuantityUpper limit on medication per lifetime of the patient

doco Documentation for this format

UML Diagram (Legend)

DosageIndicates the order in which the dosage instructions should be applied or interpretedsequence : integer [0..1]Free text dosage instructions e.g. SIGtext : string [0..1]Supplemental instructions to the patient on how to take the medication (e.g. "with meals" or"take half to one hour before food") or warnings for the patient about the medication (e.g. "may cause drowsiness" or "avoid exposure of skin to direct sunlight or sunlamps")additionalInstruction : CodeableConcept [0..*] « A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery". (Strength=Example) SNOMEDCTAdditionalDosageInstr...?? »Instructions in terms that are understood by the patient or consumerpatientInstruction : string [0..1]When medication should be administeredtiming : Timing [0..1]Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept)asNeeded[x] : Element [0..1] « boolean|CodeableConcept; A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc. (Strength=Example) SNOMEDCTMedicationAsNeededRea...?? »Body site to administer tosite : CodeableConcept [0..1] « A coded concept describing the site location the medicine enters into or onto the body. (Strength=Example)SNOMEDCTAnatomicalStructureFo...?? »How drug should enter bodyroute : CodeableConcept [0..1] « A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject. (Strength=Example)SNOMEDCTRouteCodes?? »Technique for administering medicationmethod : CodeableConcept [0..1] « A coded concept describing the technique by which the medicine is administered. (Strength=Example)SNOMEDCTAdministrationMethodC...?? »Upper limit on medication per unit of timemaxDosePerPeriod : Ratio [0..1]Upper limit on medication per administrationmaxDosePerAdministration : Quantity(SimpleQuantity) [0..1]Upper limit on medication per lifetime of the patientmaxDosePerLifetime : Quantity(SimpleQuantity) [0..1]DoseAndRateThe kind of dose or rate specified, for example, ordered or calculatedtype : CodeableConcept [0..1] « The kind of dose or rate specified. (Strength=Example)DoseAndRateType?? »Amount of medication per dosedose[x] : Element [0..1] « Range|Quantity(SimpleQuantity) »Amount of medication per unit of timerate[x] : Element [0..1] « Ratio|Range|Quantity(SimpleQuantity) »BackboneElementMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)modifierExtension : Extension [0..*]The amount of medication administereddoseAndRate[0..*]

XML Template

<Dosage xmlns="http://hl7.org/fhir">
 <!-- from BackboneElement: extension, modifierExtension -->
 <sequence value="[integer]"/><!-- 0..1 The order of the dosage instructions -->
 <text value="[string]"/><!-- 0..1 Free text dosage instructions e.g. SIG -->
 <additionalInstruction><!-- 0..* CodeableConcept Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness" --></additionalInstruction>
 <patientInstruction value="[string]"/><!-- 0..1 Patient or consumer oriented instructions -->
 <timing><!-- 0..1 Timing When medication should be administered --></timing>
 <asNeeded[x]><!-- 0..1 boolean|CodeableConcept Take "as needed" (for x) --></asNeeded[x]>
 <site><!-- 0..1 CodeableConcept Body site to administer to --></site>
 <route><!-- 0..1 CodeableConcept How drug should enter body --></route>
 <method><!-- 0..1 CodeableConcept Technique for administering medication --></method>
 <doseAndRate>  <!-- 0..* Amount of medication administered -->
  <type><!-- 0..1 CodeableConcept The kind of dose or rate specified --></type>
  <dose[x]><!-- 0..1 Range|Quantity(SimpleQuantity) Amount of medication per dose --></dose[x]>
  <rate[x]><!-- 0..1 Ratio|Range|Quantity(SimpleQuantity) Amount of medication per unit of time --></rate[x]>
 </doseAndRate>
 <maxDosePerPeriod><!-- 0..1 Ratio Upper limit on medication per unit of time --></maxDosePerPeriod>
 <maxDosePerAdministration><!-- 0..1 Quantity(SimpleQuantity) Upper limit on medication per administration --></maxDosePerAdministration>
 <maxDosePerLifetime><!-- 0..1 Quantity(SimpleQuantity) Upper limit on medication per lifetime of the patient --></maxDosePerLifetime>
</Dosage>

JSON Template

{doco
  // from BackboneElement: extension, modifierExtension
  "sequence" : <integer>, // The order of the dosage instructions
  "text" : "<string>", // Free text dosage instructions e.g. SIG
  "additionalInstruction" : [{ CodeableConcept }], // Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
  "patientInstruction" : "<string>", // Patient or consumer oriented instructions
  "timing" : { Timing }, // When medication should be administered
  // asNeeded[x]: Take "as needed" (for x). One of these 2:
  "asNeededBoolean" : <boolean>,
  "asNeededCodeableConcept" : { CodeableConcept },
  "site" : { CodeableConcept }, // Body site to administer to
  "route" : { CodeableConcept }, // How drug should enter body
  "method" : { CodeableConcept }, // Technique for administering medication
  "doseAndRate" : [{ // Amount of medication administered
    "type" : { CodeableConcept }, // The kind of dose or rate specified
    // dose[x]: Amount of medication per dose. One of these 2:
    "doseRange" : { Range },
    "doseQuantity" : { Quantity(SimpleQuantity) },
    // rate[x]: Amount of medication per unit of time. One of these 3:
    "rateRatio" : { Ratio }
    "rateRange" : { Range }
    "rateQuantity" : { Quantity(SimpleQuantity) }
  }],
  "maxDosePerPeriod" : { Ratio }, // Upper limit on medication per unit of time
  "maxDosePerAdministration" : { Quantity(SimpleQuantity) }, // Upper limit on medication per administration
  "maxDosePerLifetime" : { Quantity(SimpleQuantity) } // Upper limit on medication per lifetime of the patient
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .

[
 # from BackboneElement: Element.extension, BackboneElement.modifierextension
  fhir:Dosage.sequence [ integer ]; # 0..1 The order of the dosage instructions
  fhir:Dosage.text [ string ]; # 0..1 Free text dosage instructions e.g. SIG
  fhir:Dosage.additionalInstruction [ CodeableConcept ], ... ; # 0..* Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
  fhir:Dosage.patientInstruction [ string ]; # 0..1 Patient or consumer oriented instructions
  fhir:Dosage.timing [ Timing ]; # 0..1 When medication should be administered
  # Dosage.asNeeded[x] : 0..1 Take "as needed" (for x). One of these 2
    fhir:Dosage.asNeededBoolean [ boolean ]
    fhir:Dosage.asNeededCodeableConcept [ CodeableConcept ]
  fhir:Dosage.site [ CodeableConcept ]; # 0..1 Body site to administer to
  fhir:Dosage.route [ CodeableConcept ]; # 0..1 How drug should enter body
  fhir:Dosage.method [ CodeableConcept ]; # 0..1 Technique for administering medication
  fhir:Dosage.doseAndRate [ # 0..* Amount of medication administered
    fhir:Dosage.doseAndRate.type [ CodeableConcept ]; # 0..1 The kind of dose or rate specified
    # Dosage.doseAndRate.dose[x] : 0..1 Amount of medication per dose. One of these 2
      fhir:Dosage.doseAndRate.doseRange [ Range ]
      fhir:Dosage.doseAndRate.doseSimpleQuantity [ Quantity(SimpleQuantity) ]
    # Dosage.doseAndRate.rate[x] : 0..1 Amount of medication per unit of time. One of these 3
      fhir:Dosage.doseAndRate.rateRatio [ Ratio ]
      fhir:Dosage.doseAndRate.rateRange [ Range ]
      fhir:Dosage.doseAndRate.rateSimpleQuantity [ Quantity(SimpleQuantity) ]
  ], ...;
  fhir:Dosage.maxDosePerPeriod [ Ratio ]; # 0..1 Upper limit on medication per unit of time
  fhir:Dosage.maxDosePerAdministration [ Quantity(SimpleQuantity) ]; # 0..1 Upper limit on medication per administration
  fhir:Dosage.maxDosePerLifetime [ Quantity(SimpleQuantity) ]; # 0..1 Upper limit on medication per lifetime of the patient
]

Changes since Release 3

Dosage
Dosage.doseAndRate.dose[x]
  • Add Type Quantity()
  • Remove Type Quantity()
Dosage.doseAndRate.rate[x]
  • Add Type Quantity()
  • Remove Type Quantity()

See the Full Difference for further information

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. DosageΣTUBackBoneElementHow the medication is/was taken or should be taken
Elements defined in Ancestors: id, extension, modifierExtension
... sequenceΣ0..1integerThe order of the dosage instructions
... textΣ0..1stringFree text dosage instructions e.g. SIG
... additionalInstructionΣ0..*CodeableConceptSupplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
SNOMED CT Additional Dosage Instructions (Example)
... timingΣ0..1TimingWhen medication should be administered
... asNeeded[x]Σ0..1Take "as needed" (for x)
SNOMED CT Medication As Needed Reason Codes (Example)
.... asNeededBooleanboolean
.... asNeededCodeableConceptCodeableConcept
... siteΣ0..1CodeableConceptBody site to administer to
SNOMED CT Anatomical Structure for Administration Site Codes (Example)
... routeΣ0..1CodeableConceptHow drug should enter body
SNOMED CT Route Codes (Example)
... methodΣ0..1CodeableConceptTechnique for administering medication
SNOMED CT Administration Method Codes (Example)
... doseAndRateΣ0..*ElementAmount of medication administered
.... typeΣ0..1CodeableConceptThe kind of dose or rate specified
DoseAndRateType (Example)
.... dose[x]Σ0..1Amount of medication per dose
..... doseRangeRange
..... doseQuantitySimpleQuantity
.... rate[x]Σ0..1Amount of medication per unit of time
..... rateRatioRatio
..... rateRangeRange
..... rateQuantitySimpleQuantity
... maxDosePerPeriodΣ0..1RatioUpper limit on medication per unit of time
... maxDosePerAdministrationΣ0..1SimpleQuantityUpper limit on medication per administration
... maxDosePerLifetimeΣ0..1SimpleQuantityUpper limit on medication per lifetime of the patient

doco Documentation for this format

UML Diagram (Legend)

DosageIndicates the order in which the dosage instructions should be applied or interpretedsequence : integer [0..1]Free text dosage instructions e.g. SIGtext : string [0..1]Supplemental instructions to the patient on how to take the medication (e.g. "with meals" or"take half to one hour before food") or warnings for the patient about the medication (e.g. "may cause drowsiness" or "avoid exposure of skin to direct sunlight or sunlamps")additionalInstruction : CodeableConcept [0..*] « A coded concept identifying additional instructions such as "take with water" or "avoid operating heavy machinery". (Strength=Example) SNOMEDCTAdditionalDosageInstr...?? »Instructions in terms that are understood by the patient or consumerpatientInstruction : string [0..1]When medication should be administeredtiming : Timing [0..1]Indicates whether the Medication is only taken when needed within a specific dosing schedule (Boolean option), or it indicates the precondition for taking the Medication (CodeableConcept)asNeeded[x] : Element [0..1] « boolean|CodeableConcept; A coded concept identifying the precondition that should be met or evaluated prior to consuming or administering a medication dose. For example "pain", "30 minutes prior to sexual intercourse", "on flare-up" etc. (Strength=Example) SNOMEDCTMedicationAsNeededRea...?? »Body site to administer tosite : CodeableConcept [0..1] « A coded concept describing the site location the medicine enters into or onto the body. (Strength=Example)SNOMEDCTAnatomicalStructureFo...?? »How drug should enter bodyroute : CodeableConcept [0..1] « A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject. (Strength=Example)SNOMEDCTRouteCodes?? »Technique for administering medicationmethod : CodeableConcept [0..1] « A coded concept describing the technique by which the medicine is administered. (Strength=Example)SNOMEDCTAdministrationMethodC...?? »Upper limit on medication per unit of timemaxDosePerPeriod : Ratio [0..1]Upper limit on medication per administrationmaxDosePerAdministration : Quantity(SimpleQuantity) [0..1]Upper limit on medication per lifetime of the patientmaxDosePerLifetime : Quantity(SimpleQuantity) [0..1]DoseAndRateThe kind of dose or rate specified, for example, ordered or calculatedtype : CodeableConcept [0..1] « The kind of dose or rate specified. (Strength=Example)DoseAndRateType?? »Amount of medication per dosedose[x] : Element [0..1] « Range|Quantity(SimpleQuantity) »Amount of medication per unit of timerate[x] : Element [0..1] « Ratio|Range|Quantity(SimpleQuantity) »BackboneElementMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)modifierExtension : Extension [0..*]The amount of medication administereddoseAndRate[0..*]

XML Template

<Dosage xmlns="http://hl7.org/fhir">
 <!-- from BackboneElement: extension, modifierExtension -->
 <sequence value="[integer]"/><!-- 0..1 The order of the dosage instructions -->
 <text value="[string]"/><!-- 0..1 Free text dosage instructions e.g. SIG -->
 <additionalInstruction><!-- 0..* CodeableConcept Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness" --></additionalInstruction>
 <patientInstruction value="[string]"/><!-- 0..1 Patient or consumer oriented instructions -->
 <timing><!-- 0..1 Timing When medication should be administered --></timing>
 <asNeeded[x]><!-- 0..1 boolean|CodeableConcept Take "as needed" (for x) --></asNeeded[x]>
 <site><!-- 0..1 CodeableConcept Body site to administer to --></site>
 <route><!-- 0..1 CodeableConcept How drug should enter body --></route>
 <method><!-- 0..1 CodeableConcept Technique for administering medication --></method>
 <doseAndRate>  <!-- 0..* Amount of medication administered -->
  <type><!-- 0..1 CodeableConcept The kind of dose or rate specified --></type>
  <dose[x]><!-- 0..1 Range|Quantity(SimpleQuantity) Amount of medication per dose --></dose[x]>
  <rate[x]><!-- 0..1 Ratio|Range|Quantity(SimpleQuantity) Amount of medication per unit of time --></rate[x]>
 </doseAndRate>
 <maxDosePerPeriod><!-- 0..1 Ratio Upper limit on medication per unit of time --></maxDosePerPeriod>
 <maxDosePerAdministration><!-- 0..1 Quantity(SimpleQuantity) Upper limit on medication per administration --></maxDosePerAdministration>
 <maxDosePerLifetime><!-- 0..1 Quantity(SimpleQuantity) Upper limit on medication per lifetime of the patient --></maxDosePerLifetime>
</Dosage>

JSON Template

{doco
  // from BackboneElement: extension, modifierExtension
  "sequence" : <integer>, // The order of the dosage instructions
  "text" : "<string>", // Free text dosage instructions e.g. SIG
  "additionalInstruction" : [{ CodeableConcept }], // Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
  "patientInstruction" : "<string>", // Patient or consumer oriented instructions
  "timing" : { Timing }, // When medication should be administered
  // asNeeded[x]: Take "as needed" (for x). One of these 2:
  "asNeededBoolean" : <boolean>,
  "asNeededCodeableConcept" : { CodeableConcept },
  "site" : { CodeableConcept }, // Body site to administer to
  "route" : { CodeableConcept }, // How drug should enter body
  "method" : { CodeableConcept }, // Technique for administering medication
  "doseAndRate" : [{ // Amount of medication administered
    "type" : { CodeableConcept }, // The kind of dose or rate specified
    // dose[x]: Amount of medication per dose. One of these 2:
    "doseRange" : { Range },
    "doseQuantity" : { Quantity(SimpleQuantity) },
    // rate[x]: Amount of medication per unit of time. One of these 3:
    "rateRatio" : { Ratio }
    "rateRange" : { Range }
    "rateQuantity" : { Quantity(SimpleQuantity) }
  }],
  "maxDosePerPeriod" : { Ratio }, // Upper limit on medication per unit of time
  "maxDosePerAdministration" : { Quantity(SimpleQuantity) }, // Upper limit on medication per administration
  "maxDosePerLifetime" : { Quantity(SimpleQuantity) } // Upper limit on medication per lifetime of the patient
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .

[
 # from BackboneElement: Element.extension, BackboneElement.modifierextension
  fhir:Dosage.sequence [ integer ]; # 0..1 The order of the dosage instructions
  fhir:Dosage.text [ string ]; # 0..1 Free text dosage instructions e.g. SIG
  fhir:Dosage.additionalInstruction [ CodeableConcept ], ... ; # 0..* Supplemental instruction or warnings to the patient - e.g. "with meals", "may cause drowsiness"
  fhir:Dosage.patientInstruction [ string ]; # 0..1 Patient or consumer oriented instructions
  fhir:Dosage.timing [ Timing ]; # 0..1 When medication should be administered
  # Dosage.asNeeded[x] : 0..1 Take "as needed" (for x). One of these 2
    fhir:Dosage.asNeededBoolean [ boolean ]
    fhir:Dosage.asNeededCodeableConcept [ CodeableConcept ]
  fhir:Dosage.site [ CodeableConcept ]; # 0..1 Body site to administer to
  fhir:Dosage.route [ CodeableConcept ]; # 0..1 How drug should enter body
  fhir:Dosage.method [ CodeableConcept ]; # 0..1 Technique for administering medication
  fhir:Dosage.doseAndRate [ # 0..* Amount of medication administered
    fhir:Dosage.doseAndRate.type [ CodeableConcept ]; # 0..1 The kind of dose or rate specified
    # Dosage.doseAndRate.dose[x] : 0..1 Amount of medication per dose. One of these 2
      fhir:Dosage.doseAndRate.doseRange [ Range ]
      fhir:Dosage.doseAndRate.doseSimpleQuantity [ Quantity(SimpleQuantity) ]
    # Dosage.doseAndRate.rate[x] : 0..1 Amount of medication per unit of time. One of these 3
      fhir:Dosage.doseAndRate.rateRatio [ Ratio ]
      fhir:Dosage.doseAndRate.rateRange [ Range ]
      fhir:Dosage.doseAndRate.rateSimpleQuantity [ Quantity(SimpleQuantity) ]
  ], ...;
  fhir:Dosage.maxDosePerPeriod [ Ratio ]; # 0..1 Upper limit on medication per unit of time
  fhir:Dosage.maxDosePerAdministration [ Quantity(SimpleQuantity) ]; # 0..1 Upper limit on medication per administration
  fhir:Dosage.maxDosePerLifetime [ Quantity(SimpleQuantity) ]; # 0..1 Upper limit on medication per lifetime of the patient
]

Changes since Release 3

Dosage
Dosage.doseAndRate.dose[x]
  • Add Type Quantity()
  • Remove Type Quantity()
Dosage.doseAndRate.rate[x]
  • Add Type Quantity()
  • Remove Type Quantity()

See the Full Difference for further information

Constraints

Dosage is used in the following places: ActivityDefinition, MedicationDispense, MedicationKnowledge, MedicationRequest, MedicationStatement, Parameters, StructureMap and Task

11.10.0.2 Interpretation of Dosage in different contexts