Nictiz FHIR NL STU3 Zib2017
1.3.15 - CI Build

Nictiz FHIR NL STU3 Zib2017 - Local Development build (v1.3.15) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Data Type Profile: Zib InstructionsForUse - Detailed Descriptions

Active as of 2025-09-22

Definitions for the zib-InstructionsForUse data type profile.

Guidance on how to interpret the contents of this table can be foundhere

0. Dosage
Definition

Instructions for the use of the medication, e.g. dose and route of administration. In the event of medication use, this is the pattern of use established by the patient or which the patient followed

ShortInstructionsForUse
Comments

The wiki page https://informatiestandaarden.nictiz.nl/wiki/mp:V9.0Voorbeeldendoseringen provides dosage instruction examples. These examples consists of functional data and their representation in FHIR and CDA.

Alternate NamesGebruiksinstructie
2. Dosage.sequence
Definition

This indicates the sequence of the dosing instructions within the medication agreement.

ShortSequenceNumber
Alternate NamesVolgnummer
4. Dosage.text
Definition

Textual description of the complete instructions for use including the period of use.

ShortDescription
Alternate NamesOmschrijving
6. Dosage.additionalInstruction
Definition

The additional instructions contain extra information on the use of or considerations for the current prescription. This can also include all instructions for use. The text can come from the original 'paper' medication prescription, but can also be generated from the coded information. This concept may contain more information than what is structurally coded in the information below, but may not conflict with it. The instructions may not conflict with other components of the request for administration. The instructions can also refer to an existing protocol. The G standard contains many texts that can support this attribute, in for example G standard table 362, which contains texts from the general practitioners’ standard WCIA table 25. If desired, these texts can be used to structure this concept.

ShortAdditionalInstructions
BindingUnless not suitable, these codes SHALL be taken from Aanvullende gebruiksinstructie
(extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.9--20160407000000)
Alternate NamesAanvullendeInstructie
8. Dosage.timing
Definition

Specifications of the times at which the medication is to be administered. This is indicated as follows: Time(s) (16:00) or indications (“before meals”) at which the medication is to be taken each day. A specific number of times the medication is to be taken each day (“3x a day“), indicated with the frequency A time interval between consecutive doses (“Every 2 hours”, “every 3 days”), indicated with the word Interval. Combined periods with an interval and duration (“1 daily for three out of four weeks: the pill schedule”) If a certain medication is not to be taken daily, the aforementioned can be combined with daily indications: One or more week days on which the medication is to be administered (e.g. “Monday, Wednesday, Friday”) ”3x a week”, “2x a month”. The specified administration “infinite” is automatically to be repeated until: The end date and time has been reached The total administration duration has been reached (14 days) A specific amount of administrations has been reached (“20 doses”, “one-time only”), to be entered in the NumberOfDoses concept.

TypeTiming(HCIM AdministrationSchedule)
10. Dosage.asNeededCodeableConcept:asNeededCodeableConcept
Slice NameasNeededCodeableConcept
Definition

As needed means that the dose is only to be administered under certain conditions.

ShortAsNeeded
Comments

Using the term 'as needed' or a specific reason (eg 'in case of pain') to use medication leads to ambiguity. It is not always clear whether the whole dose is 'as needed' or only part of the dose. For example: 1x daily 1-2 tablets as needed. This can mean: 1 tablet fixed per day and 1 tablet as needed or, as needed, a maximum of 2 tablets.As needed medication is not included in GDS. In the first situation, 1 tablet comes in the GDS (drug dispensing systems) and 1 tablet is delivered separately. In the second situation there is only separate delivery.The system must make sufficiently clear whether the entire instruction or part of the dose is necessary. The HCIM supports both options described above.

BindingUnless not suitable, these codes SHALL be taken from ZonodigCriteriumCodelijst
(extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.12.4--20171231000000)

ZonodigCriteriumCodelijst

TypeCodeableConcept
Alternate NamesZo nodig, Criterium
12. Dosage.route
Definition

The route through which the medication is administered (oral, nasal, intravenous, etc.)

ShortRouteOfAdministration
BindingUnless not suitable, these codes SHALL be taken from MedicatieToedieningswegCodelijst
(extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.12.1--20171231000000)

ToedieningswegCodelijst

Alternate NamesToedieningsweg
ExampleExample of RouteOfAdministration: { "coding" : [{ "system" : "urn:oid:2.16.840.1.113883.2.4.4.9", "code" : "oraal", "display" : "Oraal" }] }
14. Dosage.dose[x]
Definition

The dose indicates the dose amount per administration.

The dosage is described in the unit accompanying the product; usually, this is just a number of units or doses. Liquids and other divisible products will usually include a unit of volume (preferably "ml").

In many cases, the prescriber will want to indicate the dose in units of weight of the active ingredient.

If only the ingredient is included and not the product, then the amount of that ingredient will be given. Paracetamol 1000mg is equivalent to 2 Paracetamol 500mg tablets or units.

The dosage is sometimes given as a calculation, in which the patient’s body weight or body surface area is used as a parameter. The calculation is however no more than an aid in reaching a decision.

In the event of constant administration, sometimes the dose is given in addition to the administration speed (infusion rate) (e.g. 20ml in a syringe or 500ml in a bag), but it is often also omitted.

A general dosage recommendation such as ‘Use according to protocol’ or ‘See instructions’ can be sufficient. In that case, no dose is given.

ShortDose
[x] NoteSeeChoice of Data Typesfor further information about how to use [x]
Alternate NamesKeerdosis
SlicingThis element introduces a set of slices on Dosage.dose[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • type @ $this
  • 16. Dosage.dose[x]:doseQuantity
    Slice NamedoseQuantity
    BindingThe codes SHALL be taken from G-Standaard Eenhedentabel
    (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453)

    GstdTabel902

    TypeQuantity(SimpleQuantity)
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    18. Dosage.dose[x]:doseRange
    Slice NamedoseRange
    TypeRange
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    20. Dosage.dose[x]:doseRange.low
    BindingThe codes SHALL be taken from G-Standaard Eenhedentabel
    (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453)

    GstdTabel902

    22. Dosage.dose[x]:doseRange.high
    BindingThe codes SHALL be taken from G-Standaard Eenhedentabel
    (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453)

    GstdTabel902

    24. Dosage.maxDosePerPeriod
    Definition

    A maximum dose indicates the maximum duration a product can be used with an ‘as needed’ prescription.

    For example: - Max 6 units per day - Max 200ml per week

    ShortMaximumDose
    Alternate NamesMaximale dosering, Maximale dosis (per dag enz.)
    26. Dosage.maxDosePerPeriod.numerator
    BindingThe codes SHALL be taken from G-Standaard Eenhedentabel
    (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453)

    GstdTabel902

    28. Dosage.rate[x]
    Definition

    The administering speed is used in slow administration of liquid. In practice, the measuring unit is almost always ml/hour. Entering an interval (such as 0-10 ml/hour) is also a commonly used option. For example, with an administering speed of 10ml/hour: amount = 10, dose unit = ml time unit = hour

    ShortAdministeringSpeed
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Alternate NamesToedieningssnelheid, Inloopsnelheid

    Guidance on how to interpret the contents of this table can be foundhere

    0. Dosage
    Definition

    Instructions for the use of the medication, e.g. dose and route of administration. In the event of medication use, this is the pattern of use established by the patient or which the patient followed


    Indicates how the medication is/was taken or should be taken by the patient.

    ShortInstructionsForUseHow the medication is/was taken or should be taken
    Comments

    The wiki page https://informatiestandaarden.nictiz.nl/wiki/mp:V9.0Voorbeeldendoseringen provides dosage instruction examples. These examples consists of functional data and their representation in FHIR and CDA.

    Control0..*
    This element is affected by the following invariants: ele-1
    Alternate NamesGebruiksinstructie
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
    ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
    2. Dosage.sequence
    Definition

    This indicates the sequence of the dosing instructions within the medication agreement.


    Indicates the order in which the dosage instructions should be applied or interpreted.

    ShortSequenceNumberThe order of the dosage instructions
    Control0..1
    Typeinteger
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Requirements

    If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. If the sequence number is different, then the Dosages are intended to be sequential.

    Alternate NamesVolgnummer
    4. Dosage.text
    Definition

    Textual description of the complete instructions for use including the period of use.


    Free text dosage instructions e.g. SIG.

    ShortDescriptionFree text dosage instructions e.g. SIG
    Control0..1
    Typestring
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Requirements

    Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing.

    Alternate NamesOmschrijving
    6. Dosage.additionalInstruction
    Definition

    The additional instructions contain extra information on the use of or considerations for the current prescription. This can also include all instructions for use. The text can come from the original 'paper' medication prescription, but can also be generated from the coded information. This concept may contain more information than what is structurally coded in the information below, but may not conflict with it. The instructions may not conflict with other components of the request for administration. The instructions can also refer to an existing protocol. The G standard contains many texts that can support this attribute, in for example G standard table 362, which contains texts from the general practitioners’ standard WCIA table 25. If desired, these texts can be used to structure this concept.


    Supplemental instruction - e.g. "with meals".

    ShortAdditionalInstructionsSupplemental instruction - e.g. "with meals"
    Control0..*
    BindingUnless not suitable, these codes SHALL be taken from For example codes, see Aanvullende gebruiksinstructiehttp://hl7.org/fhir/ValueSet/additional-instruction-codes|3.0.2
    (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.9--20160407000000)
    TypeCodeableConcept
    Summarytrue
    Requirements

    Additional instruction such as "Swallow with plenty of water" which may or may not be coded.

    Alternate NamesAanvullendeInstructie
    8. Dosage.timing
    Definition

    Specifications of the times at which the medication is to be administered. This is indicated as follows: Time(s) (16:00) or indications (“before meals”) at which the medication is to be taken each day. A specific number of times the medication is to be taken each day (“3x a day“), indicated with the frequency A time interval between consecutive doses (“Every 2 hours”, “every 3 days”), indicated with the word Interval. Combined periods with an interval and duration (“1 daily for three out of four weeks: the pill schedule”) If a certain medication is not to be taken daily, the aforementioned can be combined with daily indications: One or more week days on which the medication is to be administered (e.g. “Monday, Wednesday, Friday”) ”3x a week”, “2x a month”. The specified administration “infinite” is automatically to be repeated until: The end date and time has been reached The total administration duration has been reached (14 days) A specific amount of administrations has been reached (“20 doses”, “one-time only”), to be entered in the NumberOfDoses concept.


    When medication should be administered.

    ShortWhen medication should be administered
    Comments

    This attribute may not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.

    Control0..1
    TypeTiming(HCIM AdministrationSchedule)
    Summarytrue
    Requirements

    The timing schedule for giving the medication to the patient. The Schedule data type allows many different expressions. For example: "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

    10. Dosage.asNeeded[x]
    Definition

    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).

    ShortTake "as needed" (for x)
    Comments

    Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not "prn" or "as needed".

    Control0..1
    BindingFor example codes, see SNOMED CT Medication As Needed Reason Codeshttp://hl7.org/fhir/ValueSet/medication-as-needed-reason|3.0.2
    (example to http://hl7.org/fhir/ValueSet/medication-as-needed-reason|3.0.2)

    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.

    TypeCodeableConcept, boolean
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Summarytrue
    SlicingThis element introduces a set of slices on Dosage.asNeeded[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
    • type @ $this
    • 12. Dosage.asNeeded[x]:asNeededCodeableConcept
      Slice NameasNeededCodeableConcept
      Definition

      As needed means that the dose is only to be administered under certain conditions.


      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).

      ShortAsNeededTake "as needed" (for x)
      Comments

      Using the term 'as needed' or a specific reason (eg 'in case of pain') to use medication leads to ambiguity. It is not always clear whether the whole dose is 'as needed' or only part of the dose. For example: 1x daily 1-2 tablets as needed. This can mean: 1 tablet fixed per day and 1 tablet as needed or, as needed, a maximum of 2 tablets.As needed medication is not included in GDS. In the first situation, 1 tablet comes in the GDS (drug dispensing systems) and 1 tablet is delivered separately. In the second situation there is only separate delivery.The system must make sufficiently clear whether the entire instruction or part of the dose is necessary. The HCIM supports both options described above.


      Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not "prn" or "as needed".

      Control0..1
      BindingUnless not suitable, these codes SHALL be taken from For example codes, see ZonodigCriteriumCodelijsthttp://hl7.org/fhir/ValueSet/medication-as-needed-reason|3.0.2
      (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.12.4--20171231000000)

      ZonodigCriteriumCodelijst


      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.

      TypeCodeableConcept, boolean
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Summarytrue
      Alternate NamesZo nodig, Criterium
      14. Dosage.route
      Definition

      The route through which the medication is administered (oral, nasal, intravenous, etc.)


      How drug should enter body.

      ShortRouteOfAdministrationHow drug should enter body
      Control0..1
      BindingUnless not suitable, these codes SHALL be taken from For example codes, see MedicatieToedieningswegCodelijsthttp://hl7.org/fhir/ValueSet/route-codes|3.0.2
      (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.12.1--20171231000000)

      ToedieningswegCodelijst


      A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

      TypeCodeableConcept
      Summarytrue
      Requirements

      A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.

      Alternate NamesToedieningsweg
      ExampleExample of RouteOfAdministration: { "coding" : [{ "system" : "urn:oid:2.16.840.1.113883.2.4.4.9", "code" : "oraal", "display" : "Oraal" }] }
      16. Dosage.dose[x]
      Definition

      The dose indicates the dose amount per administration.

      The dosage is described in the unit accompanying the product; usually, this is just a number of units or doses. Liquids and other divisible products will usually include a unit of volume (preferably "ml").

      In many cases, the prescriber will want to indicate the dose in units of weight of the active ingredient.

      If only the ingredient is included and not the product, then the amount of that ingredient will be given. Paracetamol 1000mg is equivalent to 2 Paracetamol 500mg tablets or units.

      The dosage is sometimes given as a calculation, in which the patient’s body weight or body surface area is used as a parameter. The calculation is however no more than an aid in reaching a decision.

      In the event of constant administration, sometimes the dose is given in addition to the administration speed (infusion rate) (e.g. 20ml in a syringe or 500ml in a bag), but it is often also omitted.

      A general dosage recommendation such as ‘Use according to protocol’ or ‘See instructions’ can be sufficient. In that case, no dose is given.


      Amount of medication per dose.

      ShortDoseAmount of medication per dose
      Comments

      Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.

      Control0..1
      TypeChoice of: Range, Quantity(SimpleQuantity)
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Summarytrue
      Requirements

      The amount of therapeutic or other substance given at one administration event.

      Alternate NamesKeerdosis
      SlicingThis element introduces a set of slices on Dosage.dose[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
      • type @ $this
      • 18. Dosage.dose[x]:doseQuantity
        Slice NamedoseQuantity
        Definition

        Amount of medication per dose.

        ShortAmount of medication per dose
        Comments

        Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.

        Control0..1
        BindingThe codes SHALL be taken from For codes, see G-Standaard Eenhedentabel
        (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453)

        GstdTabel902

        TypeQuantity(SimpleQuantity), Range
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Summarytrue
        Requirements

        The amount of therapeutic or other substance given at one administration event.

        20. Dosage.dose[x]:doseRange
        Slice NamedoseRange
        Definition

        Amount of medication per dose.

        ShortAmount of medication per dose
        Comments

        Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.

        Control0..1
        TypeRange, Quantity(SimpleQuantity)
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Summarytrue
        Requirements

        The amount of therapeutic or other substance given at one administration event.

        22. Dosage.dose[x]:doseRange.low
        Definition

        The low limit. The boundary is inclusive.

        ShortLow limit
        Comments

        If the low element is missing, the low boundary is not known.

        Control0..1
        This element is affected by the following invariants: rng-2
        BindingThe codes SHALL be taken from For codes, see G-Standaard Eenhedentabel
        (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453)

        GstdTabel902

        TypeQuantity(SimpleQuantity)
        Summarytrue
        24. Dosage.dose[x]:doseRange.high
        Definition

        The high limit. The boundary is inclusive.

        ShortHigh limit
        Comments

        If the high element is missing, the high boundary is not known.

        Control0..1
        This element is affected by the following invariants: rng-2
        BindingThe codes SHALL be taken from For codes, see G-Standaard Eenhedentabel
        (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453)

        GstdTabel902

        TypeQuantity(SimpleQuantity)
        Summarytrue
        26. Dosage.maxDosePerPeriod
        Definition

        A maximum dose indicates the maximum duration a product can be used with an ‘as needed’ prescription.

        For example: - Max 6 units per day - Max 200ml per week


        Upper limit on medication per unit of time.

        ShortMaximumDoseUpper limit on medication per unit of time
        Comments

        This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".

        Control0..1
        TypeRatio
        Summarytrue
        Requirements

        The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours.

        Alternate NamesMaximale dosering, Maximale dosis (per dag enz.)
        28. Dosage.maxDosePerPeriod.numerator
        Definition

        The value of the numerator.

        ShortNumerator value
        Control0..1
        BindingThe codes SHALL be taken from For codes, see G-Standaard Eenhedentabel
        (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453)

        GstdTabel902

        TypeQuantity
        Summarytrue
        30. Dosage.rate[x]
        Definition

        The administering speed is used in slow administration of liquid. In practice, the measuring unit is almost always ml/hour. Entering an interval (such as 0-10 ml/hour) is also a commonly used option. For example, with an administering speed of 10ml/hour: amount = 10, dose unit = ml time unit = hour


        Amount of medication per unit of time.

        ShortAdministeringSpeedAmount of medication per unit of time
        Comments

        It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate.

        Control0..1
        TypeChoice of: Ratio, Range, Quantity(SimpleQuantity)
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Summarytrue
        Requirements

        Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

        Alternate NamesToedieningssnelheid, Inloopsnelheid

        Guidance on how to interpret the contents of this table can be foundhere

        0. Dosage
        Definition

        Instructions for the use of the medication, e.g. dose and route of administration. In the event of medication use, this is the pattern of use established by the patient or which the patient followed

        ShortInstructionsForUse
        Comments

        The wiki page https://informatiestandaarden.nictiz.nl/wiki/mp:V9.0Voorbeeldendoseringen provides dosage instruction examples. These examples consists of functional data and their representation in FHIR and CDA.

        Control0..*
        This element is affected by the following invariants: ele-1
        Alternate NamesGebruiksinstructie
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
        2. Dosage.id
        Definition

        unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

        Shortxml:id (or equivalent in JSON)
        Control0..1
        Typestring
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        4. Dosage.extension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element. In order 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 is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

        ShortAdditional Content defined by implementations
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Alternate Namesextensions, user content
        SlicingThis element introduces a set of slices on Dosage.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 6. Dosage.sequence
          Definition

          This indicates the sequence of the dosing instructions within the medication agreement.

          ShortSequenceNumber
          Control0..1
          Typeinteger
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          If the sequence number of multiple Dosages is the same, then it is implied that the instructions are to be treated as concurrent. If the sequence number is different, then the Dosages are intended to be sequential.

          Alternate NamesVolgnummer
          8. Dosage.text
          Definition

          Textual description of the complete instructions for use including the period of use.

          ShortDescription
          Control0..1
          Typestring
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          Free text dosage instructions can be used for cases where the instructions are too complex to code. The content of this attribute does not include the name or description of the medication. When coded instructions are present, the free text instructions may still be present for display to humans taking or administering the medication. It is expected that the text instructions will always be populated. If the dosage.timing attribute is also populated, then the dosage.text should reflect the same information as the timing.

          Alternate NamesOmschrijving
          10. Dosage.additionalInstruction
          Definition

          The additional instructions contain extra information on the use of or considerations for the current prescription. This can also include all instructions for use. The text can come from the original 'paper' medication prescription, but can also be generated from the coded information. This concept may contain more information than what is structurally coded in the information below, but may not conflict with it. The instructions may not conflict with other components of the request for administration. The instructions can also refer to an existing protocol. The G standard contains many texts that can support this attribute, in for example G standard table 362, which contains texts from the general practitioners’ standard WCIA table 25. If desired, these texts can be used to structure this concept.

          ShortAdditionalInstructions
          Control0..*
          BindingUnless not suitable, these codes SHALL be taken from Aanvullende gebruiksinstructie
          (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.9--20160407000000)
          TypeCodeableConcept
          Summarytrue
          Requirements

          Additional instruction such as "Swallow with plenty of water" which may or may not be coded.

          Alternate NamesAanvullendeInstructie
          12. Dosage.patientInstruction
          Definition

          Instructions in terms that are understood by the patient or consumer.

          ShortPatient or consumer oriented instructions
          Control0..1
          Typestring
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          14. Dosage.timing
          Definition

          Specifications of the times at which the medication is to be administered. This is indicated as follows: Time(s) (16:00) or indications (“before meals”) at which the medication is to be taken each day. A specific number of times the medication is to be taken each day (“3x a day“), indicated with the frequency A time interval between consecutive doses (“Every 2 hours”, “every 3 days”), indicated with the word Interval. Combined periods with an interval and duration (“1 daily for three out of four weeks: the pill schedule”) If a certain medication is not to be taken daily, the aforementioned can be combined with daily indications: One or more week days on which the medication is to be administered (e.g. “Monday, Wednesday, Friday”) ”3x a week”, “2x a month”. The specified administration “infinite” is automatically to be repeated until: The end date and time has been reached The total administration duration has been reached (14 days) A specific amount of administrations has been reached (“20 doses”, “one-time only”), to be entered in the NumberOfDoses concept.

          ShortWhen medication should be administered
          Comments

          This attribute may not always be populated while the Dosage.text is expected to be populated. If both are populated, then the Dosage.text should reflect the content of the Dosage.timing.

          Control0..1
          TypeTiming(HCIM AdministrationSchedule)
          Summarytrue
          Requirements

          The timing schedule for giving the medication to the patient. The Schedule data type allows many different expressions. For example: "Every 8 hours"; "Three times a day"; "1/2 an hour before breakfast for 10 days from 23-Dec 2011:"; "15 Oct 2013, 17 Oct 2013 and 1 Nov 2013". Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

          16. Dosage.asNeeded[x]
          Definition

          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).

          ShortTake "as needed" (for x)
          Comments

          Can express "as needed" without a reason by setting the Boolean = True. In this case the CodeableConcept is not populated. Or you can express "as needed" with a reason by including the CodeableConcept. In this case the Boolean is assumed to be True. If you set the Boolean to False, then the dose is given according to the schedule and is not "prn" or "as needed".

          Control0..1
          BindingFor example codes, see SNOMED CT Medication As Needed Reason Codes
          (example to http://hl7.org/fhir/ValueSet/medication-as-needed-reason|3.0.2)

          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.

          TypeCodeableConcept
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Summarytrue
          SlicingThis element introduces a set of slices on Dosage.asNeeded[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
          • type @ $this
          • 18. Dosage.asNeeded[x]:asNeededCodeableConcept
            Slice NameasNeededCodeableConcept
            Definition

            As needed means that the dose is only to be administered under certain conditions.

            ShortAsNeeded
            Comments

            Using the term 'as needed' or a specific reason (eg 'in case of pain') to use medication leads to ambiguity. It is not always clear whether the whole dose is 'as needed' or only part of the dose. For example: 1x daily 1-2 tablets as needed. This can mean: 1 tablet fixed per day and 1 tablet as needed or, as needed, a maximum of 2 tablets.As needed medication is not included in GDS. In the first situation, 1 tablet comes in the GDS (drug dispensing systems) and 1 tablet is delivered separately. In the second situation there is only separate delivery.The system must make sufficiently clear whether the entire instruction or part of the dose is necessary. The HCIM supports both options described above.

            Control0..1
            BindingUnless not suitable, these codes SHALL be taken from ZonodigCriteriumCodelijst
            (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.12.4--20171231000000)

            ZonodigCriteriumCodelijst

            TypeCodeableConcept
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Summarytrue
            Alternate NamesZo nodig, Criterium
            20. Dosage.site
            Definition

            Body site to administer to.

            ShortBody site to administer to
            Comments

            If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension body-site-instance. May be a summary code, or a reference to a very precise definition of the location, or both.

            Control0..1
            BindingFor example codes, see SNOMED CT Anatomical Structure for Administration Site Codes
            (example to http://hl7.org/fhir/ValueSet/approach-site-codes|3.0.2)

            A coded concept describing the site location the medicine enters into or onto the body.

            TypeCodeableConcept
            Summarytrue
            Requirements

            A coded specification of the anatomic site where the medication first enters the body.

            22. Dosage.route
            Definition

            The route through which the medication is administered (oral, nasal, intravenous, etc.)

            ShortRouteOfAdministration
            Control0..1
            BindingUnless not suitable, these codes SHALL be taken from MedicatieToedieningswegCodelijst
            (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.9.12.1--20171231000000)

            ToedieningswegCodelijst

            TypeCodeableConcept
            Summarytrue
            Requirements

            A code specifying the route or physiological path of administration of a therapeutic agent into or onto a patient's body.

            Alternate NamesToedieningsweg
            ExampleExample of RouteOfAdministration: { "coding" : [{ "system" : "urn:oid:2.16.840.1.113883.2.4.4.9", "code" : "oraal", "display" : "Oraal" }] }
            24. Dosage.method
            Definition

            Technique for administering medication.

            ShortTechnique for administering medication
            Comments

            Terminologies used often pre-coordinate this term with the route and or form of administration.

            Control0..1
            BindingFor example codes, see SNOMED CT Administration Method Codes
            (example to http://hl7.org/fhir/ValueSet/administration-method-codes|3.0.2)

            A coded concept describing the technique by which the medicine is administered.

            TypeCodeableConcept
            Summarytrue
            Requirements

            A coded value indicating the method by which the medication is introduced into or onto the body. Most commonly used for injections. For examples, Slow Push; Deep IV.

            26. Dosage.dose[x]
            Definition

            The dose indicates the dose amount per administration.

            The dosage is described in the unit accompanying the product; usually, this is just a number of units or doses. Liquids and other divisible products will usually include a unit of volume (preferably "ml").

            In many cases, the prescriber will want to indicate the dose in units of weight of the active ingredient.

            If only the ingredient is included and not the product, then the amount of that ingredient will be given. Paracetamol 1000mg is equivalent to 2 Paracetamol 500mg tablets or units.

            The dosage is sometimes given as a calculation, in which the patient’s body weight or body surface area is used as a parameter. The calculation is however no more than an aid in reaching a decision.

            In the event of constant administration, sometimes the dose is given in addition to the administration speed (infusion rate) (e.g. 20ml in a syringe or 500ml in a bag), but it is often also omitted.

            A general dosage recommendation such as ‘Use according to protocol’ or ‘See instructions’ can be sufficient. In that case, no dose is given.

            ShortDose
            Comments

            Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.

            Control0..1
            TypeChoice of: Range, Quantity(SimpleQuantity)
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Summarytrue
            Requirements

            The amount of therapeutic or other substance given at one administration event.

            Alternate NamesKeerdosis
            SlicingThis element introduces a set of slices on Dosage.dose[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
            • type @ $this
            • 28. Dosage.dose[x]:doseQuantity
              Slice NamedoseQuantity
              Definition

              Amount of medication per dose.

              ShortAmount of medication per dose
              Comments

              Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.

              Control0..1
              BindingThe codes SHALL be taken from G-Standaard Eenhedentabel
              (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453)

              GstdTabel902

              TypeQuantity(SimpleQuantity)
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Summarytrue
              Requirements

              The amount of therapeutic or other substance given at one administration event.

              30. Dosage.dose[x]:doseRange
              Slice NamedoseRange
              Definition

              Amount of medication per dose.

              ShortAmount of medication per dose
              Comments

              Note that this specifies the quantity of the specified medication, not the quantity for each active ingredient(s). Each ingredient amount can be communicated in the Medication resource. For example, if one wants to communicate that a tablet was 375 mg, where the dose was one tablet, you can use the Medication resource to document that the tablet was comprised of 375 mg of drug XYZ. Alternatively if the dose was 375 mg, then you may only need to use the Medication resource to indicate this was a tablet. If the example were an IV such as dopamine and you wanted to communicate that 400mg of dopamine was mixed in 500 ml of some IV solution, then this would all be communicated in the Medication resource. If the administration is not intended to be instantaneous (rate is present or timing has a duration), this can be specified to convey the total amount to be administered over the period of time as indicated by the schedule e.g. 500 ml in dose, with timing used to convey that this should be done over 4 hours.

              Control0..1
              TypeRange
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Summarytrue
              Requirements

              The amount of therapeutic or other substance given at one administration event.

              32. Dosage.dose[x]:doseRange.id
              Definition

              unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

              Shortxml:id (or equivalent in JSON)
              Control0..1
              Typestring
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              XML FormatIn the XML format, this property is represented as an attribute.
              34. Dosage.dose[x]:doseRange.extension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element. In order 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 is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

              ShortAdditional Content defined by implementations
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Alternate Namesextensions, user content
              SlicingThis element introduces a set of slices on Dosage.dose[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 36. Dosage.dose[x]:doseRange.low
                Definition

                The low limit. The boundary is inclusive.

                ShortLow limit
                Comments

                If the low element is missing, the low boundary is not known.

                Control0..1
                This element is affected by the following invariants: rng-2
                BindingThe codes SHALL be taken from G-Standaard Eenhedentabel
                (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453)

                GstdTabel902

                TypeQuantity(SimpleQuantity)
                Summarytrue
                38. Dosage.dose[x]:doseRange.high
                Definition

                The high limit. The boundary is inclusive.

                ShortHigh limit
                Comments

                If the high element is missing, the high boundary is not known.

                Control0..1
                This element is affected by the following invariants: rng-2
                BindingThe codes SHALL be taken from G-Standaard Eenhedentabel
                (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453)

                GstdTabel902

                TypeQuantity(SimpleQuantity)
                Summarytrue
                40. Dosage.maxDosePerPeriod
                Definition

                A maximum dose indicates the maximum duration a product can be used with an ‘as needed’ prescription.

                For example: - Max 6 units per day - Max 200ml per week

                ShortMaximumDose
                Comments

                This is intended for use as an adjunct to the dosage when there is an upper cap. For example "2 tablets every 4 hours to a maximum of 8/day".

                Control0..1
                TypeRatio
                Summarytrue
                Requirements

                The maximum total quantity of a therapeutic substance that may be administered to a subject over the period of time. For example, 1000mg in 24 hours.

                Alternate NamesMaximale dosering, Maximale dosis (per dag enz.)
                42. Dosage.maxDosePerPeriod.id
                Definition

                unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                Shortxml:id (or equivalent in JSON)
                Control0..1
                Typestring
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                XML FormatIn the XML format, this property is represented as an attribute.
                44. Dosage.maxDosePerPeriod.extension
                Definition

                May be used to represent additional information that is not part of the basic definition of the element. In order 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 is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                ShortAdditional Content defined by implementations
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Alternate Namesextensions, user content
                SlicingThis element introduces a set of slices on Dosage.maxDosePerPeriod.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 46. Dosage.maxDosePerPeriod.numerator
                  Definition

                  The value of the numerator.

                  ShortNumerator value
                  Control0..1
                  BindingThe codes SHALL be taken from G-Standaard Eenhedentabel
                  (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.20.77.11.27--20160830202453)

                  GstdTabel902

                  TypeQuantity
                  Summarytrue
                  48. Dosage.maxDosePerPeriod.denominator
                  Definition

                  The value of the denominator.

                  ShortDenominator value
                  Control0..1
                  TypeQuantity
                  Summarytrue
                  50. Dosage.maxDosePerAdministration
                  Definition

                  Upper limit on medication per administration.

                  ShortUpper limit on medication per administration
                  Comments

                  This is intended for use as an adjunct to the dosage when there is an upper cap. For example, a body surface area related dose with a maximum amount, such as 1.5 mg/m2 (maximum 2 mg) IV over 5 – 10 minutes would have doseQuantity of 1.5 mg/m2 and maxDosePerAdministration of 2 mg.

                  Control0..1
                  TypeQuantity(SimpleQuantity)
                  Summarytrue
                  Requirements

                  The maximum total quantity of a therapeutic substance that may be administered to a subject per administration.

                  52. Dosage.maxDosePerLifetime
                  Definition

                  Upper limit on medication per lifetime of the patient.

                  ShortUpper limit on medication per lifetime of the patient
                  Control0..1
                  TypeQuantity(SimpleQuantity)
                  Summarytrue
                  Requirements

                  The maximum total quantity of a therapeutic substance that may be administered per lifetime of the subject.

                  54. Dosage.rate[x]
                  Definition

                  The administering speed is used in slow administration of liquid. In practice, the measuring unit is almost always ml/hour. Entering an interval (such as 0-10 ml/hour) is also a commonly used option. For example, with an administering speed of 10ml/hour: amount = 10, dose unit = ml time unit = hour

                  ShortAdministeringSpeed
                  Comments

                  It is possible to supply both a rate and a doseQuantity to provide full details about how the medication is to be administered and supplied. If the rate is intended to change over time, depending on local rules/regulations, each change should be captured as a new version of the MedicationRequest with an updated rate, or captured with a new MedicationRequest with the new rate.

                  Control0..1
                  TypeChoice of: Ratio, Range, Quantity(SimpleQuantity)
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Summarytrue
                  Requirements

                  Identifies the speed with which the medication was or will be introduced into the patient. Typically the rate for an infusion e.g. 100 ml per 1 hour or 100 ml/hr. May also be expressed as a rate per unit of time e.g. 500 ml per 2 hours. Other examples: 200 mcg/min or 200 mcg/1 minute; 1 liter/8 hours. Sometimes, a rate can imply duration when expressed as total volume / duration (e.g. 500mL/2 hours implies a duration of 2 hours). However, when rate doesn't imply duration (e.g. 250mL/hour), then the timing.repeat.duration is needed to convey the infuse over time period.

                  Alternate NamesToedieningssnelheid, Inloopsnelheid