diff --git a/src/lib/fhir/__tests__/build-bundle.test.ts b/src/lib/fhir/__tests__/build-bundle.test.ts
index 4605ba42e..f1312e1d7 100644
--- a/src/lib/fhir/__tests__/build-bundle.test.ts
+++ b/src/lib/fhir/__tests__/build-bundle.test.ts
@@ -516,7 +516,7 @@ describe("buildFhirDocumentBundle", () => {
             status: "completed",
             doseText: "10mg",
             dose: { value: 10, unit: "mg" },
-            injectionSite: "abdomen-left",
+            injectionSite: "ABDOMEN_LEFT",
             atcCode: "A10BX10",
             rxNormCode: "2601723",
             deliveryForm: "INJECTION",
@@ -542,8 +542,22 @@ describe("buildFhirDocumentBundle", () => {
       code: "mg",
     });
     expect(a.dosage?.text).toBe("10mg");
+    // Route carries an additive SNOMED coding (INJECTION → subcutaneous) plus
+    // the unchanged `.text` anchor.
     expect(a.dosage?.route?.text).toBe("Injection");
-    expect(a.dosage?.site?.text).toBe("abdomen-left");
+    expect(a.dosage?.route?.coding?.[0]).toEqual({
+      system: "http://snomed.info/sct",
+      code: "34206005",
+      display: "Subcutaneous route",
+    });
+    // Site `.text` is the raw enum value (laterality preserved); the SNOMED
+    // coding collapses to the gross body region.
+    expect(a.dosage?.site?.text).toBe("ABDOMEN_LEFT");
+    expect(a.dosage?.site?.coding?.[0]).toEqual({
+      system: "http://snomed.info/sct",
+      code: "818983003",
+      display: "Abdomen structure",
+    });
   });
 
   it("maps a skipped intake to a not-done administration with no dosage", () => {
@@ -643,6 +657,202 @@ describe("buildFhirDocumentBundle", () => {
     expect(refs).toContain("MedicationAdministration/medadmin-1");
   });
 
+  it("emits the oral SNOMED route coding alongside the unchanged `.text`", () => {
+    const bundle = buildFhirDocumentBundle(
+      makeData({
+        medicationAdministrations: [
+          {
+            medicationName: "Metformin",
+            effectiveAt: "2026-04-30T08:00:00.000Z",
+            status: "completed",
+            doseText: "500mg",
+            dose: { value: 500, unit: "mg" },
+            injectionSite: null,
+            atcCode: null,
+            rxNormCode: null,
+            deliveryForm: "ORAL",
+          },
+        ],
+      }),
+      { insuranceNumber: null },
+      FIXED_NOW,
+    );
+    const route = administrationsOf(bundle)[0].dosage?.route;
+    expect(route?.text).toBe("Oral");
+    expect(route?.coding?.[0]).toEqual({
+      system: "http://snomed.info/sct",
+      code: "26643006",
+      display: "Oral route",
+    });
+  });
+
+  it("maps every InjectionSite enum value to its body-region SNOMED concept, preserving laterality in `.text`", () => {
+    const cases: Array<[string, string, string]> = [
+      ["ABDOMEN_LEFT", "818983003", "Abdomen structure"],
+      ["ABDOMEN_RIGHT", "818983003", "Abdomen structure"],
+      ["ABDOMEN_UPPER_LEFT", "818983003", "Abdomen structure"],
+      ["ABDOMEN_UPPER_RIGHT", "818983003", "Abdomen structure"],
+      ["THIGH_LEFT", "68367000", "Thigh structure"],
+      ["THIGH_RIGHT", "68367000", "Thigh structure"],
+      ["UPPER_ARM_LEFT", "40983000", "Structure of upper arm"],
+      ["UPPER_ARM_RIGHT", "40983000", "Structure of upper arm"],
+    ];
+    for (const [site, code, display] of cases) {
+      const bundle = buildFhirDocumentBundle(
+        makeData({
+          medicationAdministrations: [
+            {
+              medicationName: "Mounjaro",
+              effectiveAt: "2026-04-30T08:12:00.000Z",
+              status: "completed",
+              doseText: "10mg",
+              dose: { value: 10, unit: "mg" },
+              injectionSite: site,
+              atcCode: null,
+              rxNormCode: null,
+              deliveryForm: "INJECTION",
+            },
+          ],
+        }),
+        { insuranceNumber: null },
+        FIXED_NOW,
+      );
+      const fhirSite = administrationsOf(bundle)[0].dosage?.site;
+      // Laterality / quadrant survives verbatim on the `.text` anchor.
+      expect(fhirSite?.text).toBe(site);
+      expect(fhirSite?.coding?.[0]).toEqual({
+        system: "http://snomed.info/sct",
+        code,
+        display,
+      });
+    }
+  });
+
+  it("emits no route for an unknown delivery form and no site when absent", () => {
+    const bundle = buildFhirDocumentBundle(
+      makeData({
+        medicationAdministrations: [
+          {
+            medicationName: "Mystery",
+            effectiveAt: "2026-04-30T08:00:00.000Z",
+            status: "completed",
+            doseText: "1 unit",
+            dose: { value: 1, unit: "unit" },
+            injectionSite: null,
+            atcCode: null,
+            rxNormCode: null,
+            deliveryForm: "TOPICAL",
+          },
+        ],
+      }),
+      { insuranceNumber: null },
+      FIXED_NOW,
+    );
+    const dosage = administrationsOf(bundle)[0].dosage;
+    expect(dosage?.route).toBeUndefined();
+    expect(dosage?.site).toBeUndefined();
+  });
+
+  it("emits exactly the WHO ATC coding by default (no BfArM appended)", () => {
+    const bundle = buildFhirDocumentBundle(
+      makeData({
+        medications: [
+          { name: "Empagliflozin", dose: "10mg", atcCode: "A10BK03", schedules: [] },
+        ],
+      }),
+      { insuranceNumber: null },
+      FIXED_NOW,
+    );
+    const stmt = bundle.entry
+      .map((e) => e.resource)
+      .find(
+        (r): r is FhirMedicationStatement =>
+          r.resourceType === "MedicationStatement",
+      );
+    const coding = stmt?.medicationCodeableConcept.coding;
+    expect(coding).toHaveLength(1);
+    expect(coding?.[0].system).toBe("http://www.whocc.no/atc");
+    expect(
+      coding?.some((c) => c.system === "http://fhir.de/CodeSystem/bfarm/atc"),
+    ).toBe(false);
+  });
+
+  it("appends the BfArM ATC coding AFTER the WHO entry when germanAtc is on", () => {
+    const bundle = buildFhirDocumentBundle(
+      makeData({
+        medications: [
+          { name: "Empagliflozin", dose: "10mg", atcCode: "A10BK03", schedules: [] },
+        ],
+        medicationAdministrations: [
+          {
+            medicationName: "Empagliflozin",
+            effectiveAt: "2026-04-30T08:00:00.000Z",
+            status: "completed",
+            doseText: "10mg",
+            dose: { value: 10, unit: "mg" },
+            injectionSite: null,
+            atcCode: "A10BK03",
+            rxNormCode: "1545150",
+            deliveryForm: "ORAL",
+          },
+        ],
+      }),
+      { insuranceNumber: null },
+      FIXED_NOW,
+      { germanAtc: true },
+    );
+    const stmt = bundle.entry
+      .map((e) => e.resource)
+      .find(
+        (r): r is FhirMedicationStatement =>
+          r.resourceType === "MedicationStatement",
+      );
+    const stmtCoding = stmt?.medicationCodeableConcept.coding;
+    // WHO stays coding[0], byte-identical.
+    expect(stmtCoding?.[0]).toEqual({
+      system: "http://www.whocc.no/atc",
+      code: "A10BK03",
+      display: "Empagliflozin",
+    });
+    expect(stmtCoding?.[1]).toEqual({
+      system: "http://fhir.de/CodeSystem/bfarm/atc",
+      code: "A10BK03",
+      display: "Empagliflozin",
+    });
+
+    // The administration concept reflects the flag identically; RxNorm follows.
+    const adminCoding =
+      administrationsOf(bundle)[0].medicationCodeableConcept.coding;
+    expect(adminCoding?.[0].system).toBe("http://www.whocc.no/atc");
+    expect(adminCoding?.[1].system).toBe(
+      "http://fhir.de/CodeSystem/bfarm/atc",
+    );
+    expect(adminCoding?.[2]).toEqual({
+      system: "http://www.nlm.nih.gov/research/umls/rxnorm",
+      code: "1545150",
+    });
+  });
+
+  it("never invents a BfArM coding when no ATC code is stored, even with germanAtc on", () => {
+    const bundle = buildFhirDocumentBundle(
+      makeData({
+        medications: [{ name: "Herbal mix", dose: "1 tab", schedules: [] }],
+      }),
+      { insuranceNumber: null },
+      FIXED_NOW,
+      { germanAtc: true },
+    );
+    const stmt = bundle.entry
+      .map((e) => e.resource)
+      .find(
+        (r): r is FhirMedicationStatement =>
+          r.resourceType === "MedicationStatement",
+      );
+    // Collapses to the text-only concept exactly as before.
+    expect(stmt?.medicationCodeableConcept.coding).toBeUndefined();
+    expect(stmt?.medicationCodeableConcept.text).toBe("Herbal mix");
+  });
+
   it("omits the mood Observation when mood is null (privacy default)", () => {
     const bundle = buildFhirDocumentBundle(
       makeData({ mood: null }),
diff --git a/src/lib/fhir/build-bundle.ts b/src/lib/fhir/build-bundle.ts
index 2dea9f6ca..0636ca0a2 100644
--- a/src/lib/fhir/build-bundle.ts
+++ b/src/lib/fhir/build-bundle.ts
@@ -69,22 +69,48 @@ const IKNR_SYSTEM = "http://fhir.de/sid/arge-ik/iknr";
  * free-text `.text` (the user's medication name) stays the anchor.
  */
 const ATC_SYSTEM = "http://www.whocc.no/atc";
+/**
+ * German national ATC URI maintained by the BfArM. Same ATC classification
+ * as WHO under a national CodeSystem; emitted as an ADDITIONAL coding (never
+ * a replacement) when a German-region export is requested, so the WHO entry
+ * stays first and byte-identical for every consumer.
+ */
+const ATC_BFARM_SYSTEM = "http://fhir.de/CodeSystem/bfarm/atc";
 const RXNORM_SYSTEM = "http://www.nlm.nih.gov/research/umls/rxnorm";
+/** SNOMED CT URI. Concept ids are referenced (not redistributed) in FHIR instances. */
+const SNOMED_SYSTEM = "http://snomed.info/sct";
+
+/** Options threaded from the export route into the builder. Additive, all defaulted. */
+export interface FhirBuildOptions {
+  /**
+   * When true, additionally emit the German BfArM ATC URI alongside the WHO
+   * entry on each medication concept. The WHO coding stays first and
+   * byte-identical; this only appends a second URI for the same leaf code.
+   * Defaults off; the route turns it on for a German-region export.
+   */
+  germanAtc?: boolean;
+}
 
 /**
  * Build a `medicationCodeableConcept` from a medication's free-text name
  * plus its optional user-asserted codes. ATC is emitted first (primary),
  * RxNorm second (secondary); both are omitted when NULL, collapsing to
  * exactly the pre-v1.9.0 `{ text }` shape. Never machine-guesses a code.
+ * When `germanAtc` is set, the same ATC leaf code is also published under
+ * the BfArM URI AFTER the WHO entry — additive, never reordering WHO.
  */
 function medicationConcept(
   name: string,
   atcCode: string | null | undefined,
   rxNormCode: string | null | undefined,
+  germanAtc: boolean,
 ): FhirCodeableConcept {
   const coding: NonNullable<FhirCodeableConcept["coding"]> = [];
   if (atcCode) {
     coding.push({ system: ATC_SYSTEM, code: atcCode, display: name });
+    if (germanAtc) {
+      coding.push({ system: ATC_BFARM_SYSTEM, code: atcCode, display: name });
+    }
   }
   if (rxNormCode) {
     coding.push({ system: RXNORM_SYSTEM, code: rxNormCode });
@@ -122,22 +148,71 @@ function doseQuantity(value: number, unit: string): {
 }
 
 /**
- * v1.9.0 — text-only route of administration derived from the
- * medication's delivery form. Text-only (no SNOMED licence concern); the
- * design doc upgrades to coded routes jointly with iOS later. Returns
- * `undefined` for an unknown / absent form so no empty route is emitted.
+ * Route of administration derived from the medication's delivery form,
+ * carrying an additive SNOMED CT `coding` alongside the existing `.text`
+ * anchor. HealthLog injections are subcutaneous (the injection-site picker
+ * exists for the GLP-1 / self-injection workflow), so `INJECTION` maps to
+ * the subcutaneous route. Returns `undefined` for an unknown / absent form
+ * so no empty route is emitted.
  */
+const ROUTE_SNOMED: Record<string, { code: string; display: string }> = {
+  ORAL: { code: "26643006", display: "Oral route" },
+  INJECTION: { code: "34206005", display: "Subcutaneous route" },
+};
+
 function routeConcept(
   deliveryForm: string | null,
 ): FhirCodeableConcept | undefined {
-  switch (deliveryForm) {
-    case "ORAL":
-      return { text: "Oral" };
-    case "INJECTION":
-      return { text: "Injection" };
-    default:
-      return undefined;
-  }
+  const text =
+    deliveryForm === "ORAL"
+      ? "Oral"
+      : deliveryForm === "INJECTION"
+        ? "Injection"
+        : undefined;
+  if (!text) return undefined;
+  const snomed = ROUTE_SNOMED[deliveryForm as string];
+  return snomed
+    ? {
+        coding: [
+          { system: SNOMED_SYSTEM, code: snomed.code, display: snomed.display },
+        ],
+        text,
+      }
+    : { text };
+}
+
+/**
+ * Administration body-site keyed on the raw `InjectionSite` enum value,
+ * carrying an additive SNOMED CT body-region `coding` alongside the `.text`
+ * anchor. The map collapses the eight enum members to three gross body-region
+ * concepts (abdomen / thigh / upper arm); laterality (left/right) and the
+ * abdominal quadrant are NOT lateralised SNOMED concepts here — they are
+ * preserved verbatim in the human-readable `.text` (the raw enum value), so
+ * no information is lost.
+ */
+const SITE_SNOMED: Record<string, { code: string; display: string }> = {
+  ABDOMEN_LEFT: { code: "818983003", display: "Abdomen structure" },
+  ABDOMEN_RIGHT: { code: "818983003", display: "Abdomen structure" },
+  ABDOMEN_UPPER_LEFT: { code: "818983003", display: "Abdomen structure" },
+  ABDOMEN_UPPER_RIGHT: { code: "818983003", display: "Abdomen structure" },
+  THIGH_LEFT: { code: "68367000", display: "Thigh structure" },
+  THIGH_RIGHT: { code: "68367000", display: "Thigh structure" },
+  UPPER_ARM_LEFT: { code: "40983000", display: "Structure of upper arm" },
+  UPPER_ARM_RIGHT: { code: "40983000", display: "Structure of upper arm" },
+};
+
+function siteConcept(injectionSite: string): FhirCodeableConcept {
+  const snomed = SITE_SNOMED[injectionSite];
+  // Preserve the full enum value (incl. laterality) as the readable anchor.
+  const text = injectionSite;
+  return snomed
+    ? {
+        coding: [
+          { system: SNOMED_SYSTEM, code: snomed.code, display: snomed.display },
+        ],
+        text,
+      }
+    : { text };
 }
 
 /** Escape the five XML-significant characters for the xhtml narrative. */
@@ -198,7 +273,9 @@ export function buildFhirDocumentBundle(
   data: DoctorReportData,
   identity: FhirPatientIdentity,
   now: Date = new Date(),
+  options: FhirBuildOptions = {},
 ): FhirBundle {
+  const germanAtc = options.germanAtc ?? false;
   const patientId = "patient-1";
   const patientRef: FhirReference = { reference: `Patient/${patientId}` };
   const entries: FhirBundleEntry[] = [];
@@ -479,6 +556,7 @@ export function buildFhirDocumentBundle(
         med.name,
         med.atcCode,
         med.rxNormCode,
+        germanAtc,
       ),
       subject: patientRef,
     };
@@ -509,15 +587,15 @@ export function buildFhirDocumentBundle(
         admin.medicationName,
         admin.atcCode,
         admin.rxNormCode,
+        germanAtc,
       ),
       subject: patientRef,
       effectiveDateTime: admin.effectiveAt,
     };
 
     // Dosage: only when a structured dose Quantity exists. Carry the
-    // free-text dose + route + site alongside it. Text-only route/site
-    // (no SNOMED licence concern); the design doc upgrades to coded
-    // routes jointly with iOS later.
+    // free-text dose + route + site alongside it. Route and site each carry
+    // an additive SNOMED coding plus the existing `.text` anchor.
     if (admin.dose) {
       const dosage: FhirDosage = {
         dose: doseQuantity(admin.dose.value, admin.dose.unit),
@@ -525,7 +603,7 @@ export function buildFhirDocumentBundle(
       if (admin.doseText) dosage.text = admin.doseText;
       const route = routeConcept(admin.deliveryForm);
       if (route) dosage.route = route;
-      if (admin.injectionSite) dosage.site = { text: admin.injectionSite };
+      if (admin.injectionSite) dosage.site = siteConcept(admin.injectionSite);
       resource.dosage = dosage;
     }
 
diff --git a/src/lib/fhir/types.ts b/src/lib/fhir/types.ts
index 649e6f54f..df65bbc80 100644
--- a/src/lib/fhir/types.ts
+++ b/src/lib/fhir/types.ts
@@ -86,9 +86,9 @@ export interface FhirDosage {
    * is available; a text-only dose stays on the `MedicationStatement`.
    */
   dose?: FhirQuantity;
-  /** v1.9.0 — route of administration. Text-only by default (no SNOMED licence concern). */
+  /** Route of administration: an additive SNOMED `coding` plus the `.text` anchor. */
   route?: FhirCodeableConcept;
-  /** v1.9.0 — administration body-site (e.g. injection site). Text-only by default. */
+  /** Administration body-site (e.g. injection site): additive SNOMED `coding` plus `.text`. */
   site?: FhirCodeableConcept;
 }