2nd DSTU Draft For Comment

This page is part of the FHIR Specification (v0.4.0: DSTU 2 Draft). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions

Profile Clinical Quality Framework (CQF) Nutrition Order Profile - Definitions

Todo

Definitions for the cqf-nutritionorder-cqf-nutritionorder Profile.

NutritionOrder(cqf-nutritionorder)
Definition

A request to supply a diet, formula feeding (enteral) or oral nutritional supplement to a patient/resident.

Control1..1
Requirements
Alternate NamesDiet Order, Diet, Nutritional Supplement, Enteral Nutrition
Comments

Referenced by an Order Request (workflow).

InvariantsDefined on this element
nor-1: Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula class (xpath: exists(f:oralDiet) or exists(f:supplement) or exists(f:enteralFormula))
NutritionOrder.id
Definition

The logical id of the resource, as used in the url for the resoure. Once assigned, this value never changes.

Control0..1
Typeid
Requirements
Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Bundles always have an id, though it is usually a generated UUID.

NutritionOrder.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

Control0..1
TypeMeta
Requirements
Comments
NutritionOrder.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

Control0..1
Typeuri
Is Modifiertrue
Requirements
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element as much as possible.

NutritionOrder.language
Definition

The base language in which the resource is written.

Control0..1
BindingA human language
The codes SHALL be taken from http://tools.ietf.org/html/bcp47
Typecode
Requirements
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource

Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

NutritionOrder.text
Definition

A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Control0..1 This element is affected by the following invariants: dom-1
TypeNarrative
Requirements
Alternate Namesnarrative, html, xhtml, display
Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative.

NutritionOrder.contained
Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

Control0..*
TypeResource
Requirements
Alternate Namesinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.

NutritionOrder.extension
Definition

May be used to represent additional information that is not part of the basic definition of the resource. 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.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content
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.

NutritionOrder.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content
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.

NutritionOrder.patient
Definition

The person (patient) who needs the nutrition order for an oral diet, nutritional supplement and/or enteral or formula feeding.

Control1..1
TypeReference(Profile = (Profile = http://hl7.org/fhir/Profile/Patient))
Must Supporttrue
Requirements
Comments
NutritionOrder.orderer
Definition

The practitioner that holds legal responsibility for ordering the diet, nutritional supplement, or formula feedings.

Control0..1
TypeReference(Profile = (Profile = http://hl7.org/fhir/Profile/Practitioner))
Must Supporttrue
Requirements
Comments
NutritionOrder.identifier
Definition

Identifiers assigned to this order by the order sender or by the order receiver.

Control0..*
TypeIdentifier
Requirements
Comments
NutritionOrder.encounter
Definition

An encounter that provides additional information about the healthcare context in which this request is made.

Control0..1
TypeReference(Profile = (Profile = http://hl7.org/fhir/Profile/Encounter))
Must Supporttrue
Requirements
Comments
NutritionOrder.dateTime
Definition

The date and time that this nutrition order was requested.

Control1..1
TypedateTime
Must Supporttrue
Requirements
Comments
NutritionOrder.allergyIntolerance
Definition

The ability to list substances that may cause allergies or intolerances which should be included in the nutrition order.

Control0..*
TypeReference(Profile = (Profile = http://hl7.org/fhir/Profile/AllergyIntolerance))
Must Supporttrue
Requirements
Comments
NutritionOrder.foodPreferenceModifier
Definition

This modifier is used to convey order-specific modifiers about the type of food that should be given. These can be derived from patient allergies, intolerances, or preferences such as Halal, Vegan or Kosher. This modifier applies to the entire nutrition order inclusive of the oral diet, nutritional supplements and enteral formula feedings.

Control0..*
BindingMedical, cultural or ethical food preferences to help with catering requirements
The codes SHOULD be taken from Diet; other codes may be used where these codes are not suitable
TypeCodeableConcept
Must Supporttrue
Requirements
Comments
NutritionOrder.excludeFoodModifier
Definition

This modifier is used to convey order-specific modifiers about the type of food that should NOT be given. These can be derived from patient allergies, intolerances, or preferences such as No Red Meat, No Soy or No Wheat or Gluten-Free. This modifier applies to the entire nutrition order inclusive of the oral diet, nutritional supplements and enteral formula feedings.

Control0..*
BindingTODO
For example codes, see ExcludeFoodModifier
TypeCodeableConcept
Must Supporttrue
Requirements
Comments
NutritionOrder.oralDiet
Definition

Class that defines the components of an oral diet order for the patient.

Control0..1 This element is affected by the following invariants: nor-1
Must Supporttrue
Requirements
Comments
NutritionOrder.oralDiet.id
Definition

unique id for the element within a resource (for internal references).

Control0..1
Typeid
Requirements
Comments
NutritionOrder.oralDiet.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.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content
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.

NutritionOrder.oralDiet.modifierExtension
Definition

May 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 that contains it. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content, modifiers
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.

NutritionOrder.oralDiet.type
Definition

Indicates the type of oral diet or diet restrictions that describe what can be consumed orally (i.e., take via the mouth).

Control0..*
BindingTODO
For example codes, see DietCode
TypeCodeableConcept
Must Supporttrue
Requirements
Comments
NutritionOrder.oralDiet.scheduled
Definition

The time period and frequency at which the diet should be given.

Control0..1
TypeTiming
Must Supporttrue
Requirements
Alternate Namesfrequency
Comments
NutritionOrder.oralDiet.nutrients
Definition

Class that defines the details of any nutrient modifications required for the oral diet.

Control0..*
Must Supporttrue
Requirements
Comments
NutritionOrder.oralDiet.nutrients.id
Definition

unique id for the element within a resource (for internal references).

Control0..1
Typeid
Requirements
Comments
NutritionOrder.oralDiet.nutrients.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.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content
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.

NutritionOrder.oralDiet.nutrients.modifierExtension
Definition

May 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 that contains it. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content, modifiers
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.

NutritionOrder.oralDiet.nutrients.modifier
Definition

Identifies the type of nutrient that is being modified such as carbohydrate or sodium.

Control0..1
BindingTODO
For example codes, see NutrientModifier
TypeCodeableConcept
Must Supporttrue
Requirements
Comments
NutritionOrder.oralDiet.nutrients.amount
Definition

The quantity of the specified nutrient to include in diet.

Control0..1
TypeQuantity
Must Supporttrue
Requirements
Comments
NutritionOrder.oralDiet.texture
Definition

Class that describes any texture modifications required for the patient to safely consume various types of solid foods.

Control0..*
Must Supporttrue
Requirements
Comments
NutritionOrder.oralDiet.texture.id
Definition

unique id for the element within a resource (for internal references).

Control0..1
Typeid
Requirements
Comments
NutritionOrder.oralDiet.texture.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.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content
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.

NutritionOrder.oralDiet.texture.modifierExtension
Definition

May 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 that contains it. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content, modifiers
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.

NutritionOrder.oralDiet.texture.modifier
Definition

Identifies any texture modifications (for solid foods) that should be made, e.g. easy to chew, chopped, ground, and pureed.

Control0..1
BindingTODO
For example codes, see TextureModifier
TypeCodeableConcept
Must Supporttrue
Requirements
Comments

Coupled with the foodType (Meat).

NutritionOrder.oralDiet.texture.foodType
Definition

Indicates what specific type of food (e.g., meats) the texture modification applies to or may apply to all foods in the diet.

Control0..1
BindingTODO
For example codes, see FoodType
TypeCodeableConcept
Must Supporttrue
Requirements
Comments

Coupled with the textureModifier; could be (All Foods).

NutritionOrder.oralDiet.fluidConsistencyType
Definition

Identifies the required consistency (e.g., honey-thick, nectar-thick, thin, thickened.) of liquids or fluids served to the patient.

Control0..*
BindingTODO
For example codes, see FluidConsistencyType
TypeCodeableConcept
Must Supporttrue
Requirements
Comments
NutritionOrder.oralDiet.instruction
Definition

Additional instructions or information pertaining to the oral diet.

Control0..1
Typestring
Requirements
Comments
NutritionOrder.supplement
Definition

Class that defines the components of a supplement order for the patient.

Control0..1 This element is affected by the following invariants: nor-1
Must Supporttrue
Requirements
Comments
NutritionOrder.supplement.id
Definition

unique id for the element within a resource (for internal references).

Control0..1
Typeid
Requirements
Comments
NutritionOrder.supplement.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.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content
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.

NutritionOrder.supplement.modifierExtension
Definition

May 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 that contains it. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content, modifiers
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.

NutritionOrder.supplement.type
Definition

Indicates the type of nutritional supplement product required such as high protein or pediatric clear liquid supplement.

Control0..1
BindingTODO
For example codes, see SupplementType
TypeCodeableConcept
Must Supporttrue
Requirements
Comments
NutritionOrder.supplement.productName
Definition

The product or brand name of the nutritional supplement product to be provided to the patient.

Control0..1
Typestring
Must Supporttrue
Requirements
Comments
NutritionOrder.supplement.scheduled
Definition

The time period and frequency at which the supplement(s) should be given.

Control0..1
TypeTiming
Must Supporttrue
Requirements
Alternate Namesfrequency
Comments
NutritionOrder.supplement.quantity
Definition

The amount of the nutritional supplement product to provide to the patient.

Control0..1
TypeQuantity
Must Supporttrue
Requirements
Comments
NutritionOrder.enteralFormula
Definition

Class that defines the components of an enteral formula order for the patient.

Control0..1 This element is affected by the following invariants: nor-1
Must Supporttrue
Requirements
Comments
NutritionOrder.enteralFormula.id
Definition

unique id for the element within a resource (for internal references).

Control0..1
Typeid
Requirements
Comments
NutritionOrder.enteralFormula.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.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content
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.

NutritionOrder.enteralFormula.modifierExtension
Definition

May 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 that contains it. Usually modifier elements provide negation or qualification. 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. Applications processing a resource are required to check for modifier extensions.

Control0..*
TypeExtension
Requirements
Alternate Namesextensions, user content, modifiers
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.

NutritionOrder.enteralFormula.administrationInstructions
Definition

Free text formula administration or feeding instructions for cases where the instructions are too complex to code.

Control0..1
Typestring
Requirements
Comments
NutritionOrder.enteralFormula.baseFormulaType
Definition

Indicates the type of enteral or infant formula requested such as an adult standard formula with fiber or a soy-based infant formula.

Control0..1
BindingTODO
For example codes, see EnteralFormulaType
TypeCodeableConcept
Must Supporttrue
Requirements
Comments
NutritionOrder.enteralFormula.baseFormulaProductName
Definition

The product or brand name of the enteral or infant formula product to be provided to the patient.

Control0..1
Typestring
Must Supporttrue
Requirements
Comments
NutritionOrder.enteralFormula.scheduled
Definition

The time period and frequency at which the enteral formula should be delivered to the patient.

Control0..1
TypeTiming
Must Supporttrue
Requirements
Alternate Namesfrequency
Comments
NutritionOrder.enteralFormula.additiveType
Definition

Indicates the type of modular component such as protein, carbohydrate, fat or fiber to be provided in addition to or mixed with the base formula.

Control0..1
BindingTODO
For example codes, see EnteralFormulaAdditiveType
TypeCodeableConcept
Must Supporttrue
Requirements
Comments
NutritionOrder.enteralFormula.additiveProductName
Definition

The product or brand name of the type of modular component to be added to the formula.

Control0..1
Typestring
Must Supporttrue
Requirements
Comments
NutritionOrder.enteralFormula.caloricDensity
Definition

The amount of energy (Calories) that the formula should provide per specified volume, typically per mL or fluid oz. For example, an infant may require a formula the provides 24 Calories per fluid ounce or an adult may require an enteral formula that provides 1.5 Calorie/mL.

Control0..1
TypeQuantity
Must Supporttrue
Requirements
Comments
NutritionOrder.enteralFormula.routeofAdministration
Definition

A coded concept specifying the route or physiological path of administration into the patient 's gastrointestinal tract for purposes of providing the formula feeding, e.g., nasogastric tube.

Control0..1
BindingThis value set contains concepts to support administration of formula feeding via oral or enteral feeding tubes
The codes SHOULD be taken from enteral-route; other codes may be used where these codes are not suitable
TypeCodeableConcept
Must Supporttrue
Requirements
Comments
NutritionOrder.enteralFormula.quantity
Definition

The volume of formula to provide to the patient per the specified administration schedule.

Control0..1
TypeQuantity
Must Supporttrue
Requirements
Comments
NutritionOrder.enteralFormula.rate
Definition

Identifies the speed with which the formula is introduced into the subject via a feeding pump, e.g., 60 mL per hour, according to the specified schedule.

Control0..1
TypeRatio
Must Supporttrue
Requirements
Comments
NutritionOrder.enteralFormula.rateAdjustment
Definition

The change in the administration rate over a given time, e.g. increase by 10 mL/hour every 4 hours.

Control0..1
TypeQuantity
Must Supporttrue
Requirements
Comments
NutritionOrder.enteralFormula.maxVolumeToDeliver
Definition

The maximum total quantity of formula that may be administered to a subject over the period of time, e.g., 1440 mL over 24 hours.

Control0..1
TypeQuantity
Must Supporttrue
Requirements
Comments
NutritionOrder.status
Definition

requested | active | inactive | held.

Control0..1
BindingValue set for a NutritionOrder status which excludes Canceled code
The codes SHALL be taken from NutritionOrderStatusNotCanceled
Typecode
Is Modifiertrue
Must Supporttrue
Requirements
Comments

Typically the system placing the order sets the status to requested. There after, the order is maintained by the receiver that updates the status as the request is handled.