DSTU2 Ballot Source

This page is part of the FHIR Specification (v0.5.0: DSTU 2 Ballot 2). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

4.17 Resource NutritionOrder - Content

This resource maintained by the Orders and Observations Work Group

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

4.17.1 Scope and Usage

The NutritionOrder resource describes a request for oral diets (including general diets such as General Healthy diet, or therapeutic diets such as Consistent Carbohydrate, 2 gram Sodium, or Fluid Restricted), oral nutrition supplements (such as nutritionally complete pre-packed drinks), enteral nutrition (tube feedings) and infant formula which govern the distribution of food and nutritional products used to feed patients within an in-patient setting. These nutrition orders are combined with information on a patient's food allergies and intolerances, and ethnic or cultural food preferences (e.g. Kosher or Vegetarian) to inform healthcare personnel about the type, texture, and/or quantity of foods that the patient should receive or consume.

4.17.2 Boundaries and Relationships

The NutritionOrder resource is used for requesting oral diets, oral nutrition supplements and enteral feedings in an in-patient setting. The MedicationPrescription resource should be used for requesting parenteral(IV) nutrition and prescribing dietary supplements such as vitamin or mineral supplements.

The Nutrition Order is a record of the request for the supply of a diet, oral supplement or enteral formulas for a patient. However, to initiate the request requires the use of the Order resource and its associated workflow with the Nutrition Order referenced from the Order.details, or by using the Nutrition Order resource in the context of a messaging or service workflow where the request is explicit or implicit.

This resource is referenced by CarePlan, ClinicalImpression and Goal

4.17.3 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. NutritionOrder IDomainResourceA request for a diet, formula or nutritional supplement
Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula class
... patient Σ1..1PatientThe person who requires the diet, formula or nutritional supplement
... orderer Σ0..1PractitionerWho ordered the diet, formula or nutritional supplement
... identifier 0..*IdentifierIdentifiers assigned to this order
... encounter 0..1EncounterThe encounter associated with that this nutrition order
... dateTime Σ1..1dateTimeDate and time the nutrition order was requested
... status ?! Σ0..1codeproposed | draft | planned | requested | active | on-hold | completed | cancelled
NutritionOrderStatus (Required)
... allergyIntolerance 0..*AllergyIntoleranceList of the patient's food and nutrition-related allergies and intolerances
... foodPreferenceModifier 0..*CodeableConceptOrder-specific modifier about the type of food that should be given
PatientDiet (Example)
... excludeFoodModifier 0..*CodeableConceptOrder-specific modifier about the type of food that should not be given
FoodType (Example)
... oralDiet I0..1ElementOral diet components
.... type Σ0..*CodeableConceptType of oral diet or diet restrictions that describe what can be consumed orally
OralDiet (Example)
.... scheduled 0..1TimingScheduled frequency of diet
.... nutrient 0..*ElementRequired nutrient modifications
..... modifier 0..1CodeableConceptType of nutrient that is being modified
NutrientModifier (Example)
..... amount 0..1QuantityQuantity of the specified nutrient
.... texture 0..*ElementRequired texture modifications
..... modifier 0..1CodeableConceptCode to indicate how to alter the texture of the foods, e.g., pureed
TextureModifier (Example)
..... foodType 0..1CodeableConceptConcepts that are used to identify an entity that is ingested for nutritional purposes
TextureModifiedFoodType (Example)
.... fluidConsistencyType 0..*CodeableConceptThe required consistency of fluids and liquids provided to the patient
FluidConsistencyType (Example)
.... instruction 0..1stringInstructions or additional information about the oral diet
... supplement I0..*ElementSupplement components
.... type Σ0..1CodeableConceptType of supplement product requested
SupplementType (Example)
.... productName 0..1stringProduct or brand name of the nutritional supplement
.... scheduled 0..1TimingScheduled frequency of supplement
.... quantity 0..1QuantityAmount of the nutritional supplement
.... instruction 0..1stringInstructions or additional information about the oral supplement
... enteralFormula I0..1ElementEnteral formula components
.... administrationInstructions 0..1stringFormula feeding instructions expressed as text
.... baseFormulaType Σ0..1CodeableConceptType of enteral or infant formula
EnteralFormulaType (Example)
.... baseFormulaProductName 0..1stringProduct or brand name of the enteral or infant formula
.... scheduled 0..1TimingScheduled frequency of enteral feeding
.... additiveType 0..1CodeableConceptType of modular component to add to the feeding
EnteralFormulaAdditiveType (Example)
.... additiveProductName 0..1stringProduct or brand name of the modular additive
.... caloricDensity 0..1QuantityAmount of energy per specified volume that is required
.... routeofAdministration 0..1CodeableConceptHow the formula should enter the patient's gastrointestinal tract
EnteralRouteOfAdministration (Required)
.... quantity 0..1QuantityThe volume of formula to provide
.... rate 0..1RatioSpeed with which the formula is provided per period of time
.... rateAdjustment 0..1QuantityChange in the rate of administration over a given time
.... maxVolumeToDeliver 0..1QuantityUpper limit on formula volume per unit of time

UML Diagram

NutritionOrder (DomainResource)The person (patient) who needs the nutrition order for an oral diet, nutritional supplement and/or enteral or formula feedingpatient : Reference(Patient) 1..1The practitioner that holds legal responsibility for ordering the diet, nutritional supplement, or formula feedingsorderer : Reference(Practitioner) 0..1Identifiers assigned to this order by the order sender or by the order receiveridentifier : Identifier 0..*An encounter that provides additional information about the healthcare context in which this request is madeencounter : Reference(Encounter) 0..1The date and time that this nutrition order was requesteddateTime : dateTime 1..1The workflow status of the nutrition order/request (this element modifies the meaning of other elements)status : code 0..1 « Codes specifying the state of the request. Describes the lifecycle of the nutrition order.NutritionOrderStatus »A link to a record of allergies or Intolerances which should be included in the nutrition orderallergyIntolerance : Reference(AllergyIntolerance) 0..*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 feedingsfoodPreferenceModifier : CodeableConcept 0..* « (Medical, cultural or ethical food preferences to help with catering requirementsPatientDiet) »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 feedingsexcludeFoodModifier : CodeableConcept 0..* « (Codes used to indicate the type of food that should NOT be given to the patient.FoodType) »OralDietThe kind of diet or dietary restriction such as fiber restricted diet or diabetic diettype : CodeableConcept 0..* « (Codes used to indicate the type of diet being ordered for a patient.OralDiet) »The time period and frequency at which the diet should be givenscheduled : Timing 0..1The required consistency (e.g., honey-thick, nectar-thick, thin, thickened.) of liquids or fluids served to the patientfluidConsistencyType : CodeableConcept 0..* « (Codes used to represent the consistency of fluids and liquids provided to the patient.FluidConsistencyType) »Free text or additional instructions or information pertaining to the oral dietinstruction : string 0..1NutrientThe nutrient that is being modified such as carbohydrate or sodiummodifier : CodeableConcept 0..1 « (Codes for types of nutrient that is being modified such as carbohydrate or sodium.NutrientModifier) »The quantity of the specified nutrient to include in dietamount : Quantity 0..1TextureAny texture modifications (for solid foods) that should be made, e.g. easy to chew, chopped, ground, and pureedmodifier : CodeableConcept 0..1 « (Codes for food consistency types or texture modifications to apply to foods.TextureModifier) »The food type(s) (e.g., meats, all foods) that the texture modification applies to. This could be all foods typesfoodType : CodeableConcept 0..1 « (Codes for types of foods that are texture modified.TextureModifiedFoodType) »SupplementThe kind of nutritional supplement product required such as a high protein or pediatric clear liquid supplementtype : CodeableConcept 0..1 « (Codes for nutritional supplements to be provided to the patientSupplementType) »The product or brand name of the nutritional supplement such as "Acme Protein Shake"productName : string 0..1The time period and frequency at which the supplement(s) should be givenscheduled : Timing 0..1The amount of the nutritional supplement to be givenquantity : Quantity 0..1Free text or additional instructions or information pertaining to the oral supplementinstruction : string 0..1EnteralFormulaFree text formula administration, feeding instructions or additional instructions or informationadministrationInstructions : string 0..1The type of enteral or infant formula such as an adult standard formula with fiber or a soy-based infant formulabaseFormulaType : CodeableConcept 0..1 « (Codes for type of enteral formula to be administered to patient.EnteralFormulaType) »The product or brand name of the enteral or infant formula product such as "ACME Adult Standard Formula"baseFormulaProductName : string 0..1The time period and frequency at which the enteral formula should be delivered to the patientscheduled : Timing 0..1Indicates the type of modular component such as protein, carbohydrate, fat or fiber to be provided in addition to or mixed with the base formulaadditiveType : CodeableConcept 0..1 « (Codes for the type of modular component such as protein, carbohydrate or fiber to be provided in addition to or mixed with the base formula.EnteralFormulaAdditiveType) »The product or brand name of the type of modular component to be added to the formulaadditiveProductName : string 0..1The 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/mLcaloricDensity : Quantity 0..1The route or physiological path of administration into the patient 's gastrointestinal tract for purposes of providing the formula feeding, e.g., nasogastric tuberouteofAdministration : CodeableConcept 0..1 « Codes specifying the route of administration of enteral formula.EnteralRouteOfAdministration »The volume of formula to provide to the patient per the specified administration schedulequantity : Quantity 0..1The rate of administration of formula via a feeding pump, e.g., 60 mL per hour, according to the specified schedulerate : Ratio 0..1The change in the rate of administration over a given time, e.g. increase by 10 mL/hour every 4 hoursrateAdjustment : Quantity 0..1The maximum total quantity of formula that may be administered to a subject over the period of time, e.g., 1440 mL over 24 hoursmaxVolumeToDeliver : Quantity 0..1Class that defines the quantity and type of nutrient modifications required for the oral dietnutrient0..*Class that describes any texture modifications required for the patient to safely consume various types of solid foodstexture0..*Diet given orally in contrast to enteral (tube) feedingoralDiet0..1Oral nutritional products given in order to add further nutritional value to the patient's dietsupplement0..*Feeding provided through the gastrointestinal tract via a tube, catheter, or stoma that delivers nutrition distal to the oral cavityenteralFormula0..1

XML Template

<NutritionOrder xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <patient><!-- 1..1 Reference(Patient) 
     The person who requires the diet, formula or nutritional supplement --></patient>
 <orderer><!-- 0..1 Reference(Practitioner) 
     Who ordered the diet, formula or nutritional supplement --></orderer>
 <identifier><!-- 0..* Identifier Identifiers assigned to this order --></identifier>
 <encounter><!-- 0..1 Reference(Encounter) 
     The encounter associated with that this nutrition order --></encounter>
 <dateTime value="[dateTime]"/><!-- 1..1 Date and time the nutrition order was requested -->
 <status value="[code]"/><!-- 0..1 proposed | draft | planned | requested | active | on-hold | completed | cancelled -->
 <allergyIntolerance><!-- 0..* Reference(AllergyIntolerance) 
     List of the patient's food and nutrition-related allergies and intolerances --></allergyIntolerance>
 <foodPreferenceModifier><!-- 0..* CodeableConcept Order-specific modifier about the type of food that should be given --></foodPreferenceModifier>
 <excludeFoodModifier><!-- 0..* CodeableConcept Order-specific modifier about the type of food that should not be given --></excludeFoodModifier>
 <oralDiet>  <!-- ?? 0..1 Oral diet components -->
  <type><!-- 0..* CodeableConcept Type of oral diet or diet restrictions that describe what can be consumed orally --></type>
  <scheduled><!-- 0..1 Timing Scheduled frequency of diet --></scheduled>
  <nutrient>  <!-- 0..* Required  nutrient modifications -->
   <modifier><!-- 0..1 CodeableConcept Type of nutrient that is being modified --></modifier>
   <amount><!-- 0..1 Quantity Quantity of the specified nutrient --></amount>
  </nutrient>
  <texture>  <!-- 0..* Required  texture modifications -->
   <modifier><!-- 0..1 CodeableConcept Code to indicate how to alter the texture of the foods, e.g., pureed --></modifier>
   <foodType><!-- 0..1 CodeableConcept Concepts that are used to identify an entity that is ingested for nutritional purposes --></foodType>
  </texture>
  <fluidConsistencyType><!-- 0..* CodeableConcept The required consistency of fluids and liquids provided to the patient --></fluidConsistencyType>
  <instruction value="[string]"/><!-- 0..1 Instructions or additional information about the oral diet -->
 </oralDiet>
 <supplement>  <!-- ?? 0..* Supplement components -->
  <type><!-- 0..1 CodeableConcept Type of supplement product requested --></type>
  <productName value="[string]"/><!-- 0..1 Product or brand name of the nutritional supplement -->
  <scheduled><!-- 0..1 Timing Scheduled frequency of supplement --></scheduled>
  <quantity><!-- 0..1 Quantity Amount of the nutritional supplement --></quantity>
  <instruction value="[string]"/><!-- 0..1 Instructions or additional information about the oral supplement -->
 </supplement>
 <enteralFormula>  <!-- ?? 0..1 Enteral formula components -->
  <administrationInstructions value="[string]"/><!-- 0..1 Formula feeding instructions expressed as text -->
  <baseFormulaType><!-- 0..1 CodeableConcept Type of enteral or infant formula --></baseFormulaType>
  <baseFormulaProductName value="[string]"/><!-- 0..1 Product or brand name of the enteral or infant formula -->
  <scheduled><!-- 0..1 Timing Scheduled frequency of enteral feeding --></scheduled>
  <additiveType><!-- 0..1 CodeableConcept Type of modular component to add to the feeding --></additiveType>
  <additiveProductName value="[string]"/><!-- 0..1 Product or brand name of the modular additive -->
  <caloricDensity><!-- 0..1 Quantity 
      Amount of energy per specified volume that is required --></caloricDensity>
  <routeofAdministration><!-- 0..1 CodeableConcept How the formula should enter the patient's gastrointestinal tract --></routeofAdministration>
  <quantity><!-- 0..1 Quantity The volume of formula to provide --></quantity>
  <rate><!-- 0..1 Ratio Speed with which the formula is provided per period of time --></rate>
  <rateAdjustment><!-- 0..1 Quantity 
      Change in the rate of administration over a given time --></rateAdjustment>
  <maxVolumeToDeliver><!-- 0..1 Quantity 
      Upper limit on formula volume per unit of time --></maxVolumeToDeliver>
 </enteralFormula>
</NutritionOrder>

JSON Template

{doco
  "resourceType" : "NutritionOrder",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "patient" : { Reference(Patient) }, // R!  
     The person who requires the diet, formula or nutritional supplement
  "orderer" : { Reference(Practitioner) }, // 
     Who ordered the diet, formula or nutritional supplement
  "identifier" : [{ Identifier }], // Identifiers assigned to this order
  "encounter" : { Reference(Encounter) }, // 
     The encounter associated with that this nutrition order
  "dateTime" : "<dateTime>", // R!  Date and time the nutrition order was requested
  "status" : "<code>", // proposed | draft | planned | requested | active | on-hold | completed | cancelled
  "allergyIntolerance" : [{ Reference(AllergyIntolerance) }], // 
     List of the patient's food and nutrition-related allergies and intolerances
  "foodPreferenceModifier" : [{ CodeableConcept }], // Order-specific modifier about the type of food that should be given
  "excludeFoodModifier" : [{ CodeableConcept }], // Order-specific modifier about the type of food that should not be given
  "oralDiet" : { // C? Oral diet components
    "type" : [{ CodeableConcept }], // Type of oral diet or diet restrictions that describe what can be consumed orally
    "scheduled" : { Timing }, // Scheduled frequency of diet
    "nutrient" : [{ // Required  nutrient modifications
      "modifier" : { CodeableConcept }, // Type of nutrient that is being modified
      "amount" : { Quantity } // Quantity of the specified nutrient
    }],
    "texture" : [{ // Required  texture modifications
      "modifier" : { CodeableConcept }, // Code to indicate how to alter the texture of the foods, e.g., pureed
      "foodType" : { CodeableConcept } // Concepts that are used to identify an entity that is ingested for nutritional purposes
    }],
    "fluidConsistencyType" : [{ CodeableConcept }], // The required consistency of fluids and liquids provided to the patient
    "instruction" : "<string>" // Instructions or additional information about the oral diet
  },
  "supplement" : [{ // C? Supplement components
    "type" : { CodeableConcept }, // Type of supplement product requested
    "productName" : "<string>", // Product or brand name of the nutritional supplement
    "scheduled" : { Timing }, // Scheduled frequency of supplement
    "quantity" : { Quantity }, // Amount of the nutritional supplement
    "instruction" : "<string>" // Instructions or additional information about the oral supplement
  }],
  "enteralFormula" : { // C? Enteral formula components
    "administrationInstructions" : "<string>", // Formula feeding instructions expressed as text
    "baseFormulaType" : { CodeableConcept }, // Type of enteral or infant formula
    "baseFormulaProductName" : "<string>", // Product or brand name of the enteral or infant formula
    "scheduled" : { Timing }, // Scheduled frequency of enteral feeding
    "additiveType" : { CodeableConcept }, // Type of modular component to add to the feeding
    "additiveProductName" : "<string>", // Product or brand name of the modular additive
    "caloricDensity" : { Quantity }, // 
      Amount of energy per specified volume that is required
    "routeofAdministration" : { CodeableConcept }, // How the formula should enter the patient's gastrointestinal tract
    "quantity" : { Quantity }, // The volume of formula to provide
    "rate" : { Ratio }, // Speed with which the formula is provided per period of time
    "rateAdjustment" : { Quantity }, // 
      Change in the rate of administration over a given time
    "maxVolumeToDeliver" : { Quantity } // 
      Upper limit on formula volume per unit of time
  }
}

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. NutritionOrder IDomainResourceA request for a diet, formula or nutritional supplement
Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula class
... patient Σ1..1PatientThe person who requires the diet, formula or nutritional supplement
... orderer Σ0..1PractitionerWho ordered the diet, formula or nutritional supplement
... identifier 0..*IdentifierIdentifiers assigned to this order
... encounter 0..1EncounterThe encounter associated with that this nutrition order
... dateTime Σ1..1dateTimeDate and time the nutrition order was requested
... status ?! Σ0..1codeproposed | draft | planned | requested | active | on-hold | completed | cancelled
NutritionOrderStatus (Required)
... allergyIntolerance 0..*AllergyIntoleranceList of the patient's food and nutrition-related allergies and intolerances
... foodPreferenceModifier 0..*CodeableConceptOrder-specific modifier about the type of food that should be given
PatientDiet (Example)
... excludeFoodModifier 0..*CodeableConceptOrder-specific modifier about the type of food that should not be given
FoodType (Example)
... oralDiet I0..1ElementOral diet components
.... type Σ0..*CodeableConceptType of oral diet or diet restrictions that describe what can be consumed orally
OralDiet (Example)
.... scheduled 0..1TimingScheduled frequency of diet
.... nutrient 0..*ElementRequired nutrient modifications
..... modifier 0..1CodeableConceptType of nutrient that is being modified
NutrientModifier (Example)
..... amount 0..1QuantityQuantity of the specified nutrient
.... texture 0..*ElementRequired texture modifications
..... modifier 0..1CodeableConceptCode to indicate how to alter the texture of the foods, e.g., pureed
TextureModifier (Example)
..... foodType 0..1CodeableConceptConcepts that are used to identify an entity that is ingested for nutritional purposes
TextureModifiedFoodType (Example)
.... fluidConsistencyType 0..*CodeableConceptThe required consistency of fluids and liquids provided to the patient
FluidConsistencyType (Example)
.... instruction 0..1stringInstructions or additional information about the oral diet
... supplement I0..*ElementSupplement components
.... type Σ0..1CodeableConceptType of supplement product requested
SupplementType (Example)
.... productName 0..1stringProduct or brand name of the nutritional supplement
.... scheduled 0..1TimingScheduled frequency of supplement
.... quantity 0..1QuantityAmount of the nutritional supplement
.... instruction 0..1stringInstructions or additional information about the oral supplement
... enteralFormula I0..1ElementEnteral formula components
.... administrationInstructions 0..1stringFormula feeding instructions expressed as text
.... baseFormulaType Σ0..1CodeableConceptType of enteral or infant formula
EnteralFormulaType (Example)
.... baseFormulaProductName 0..1stringProduct or brand name of the enteral or infant formula
.... scheduled 0..1TimingScheduled frequency of enteral feeding
.... additiveType 0..1CodeableConceptType of modular component to add to the feeding
EnteralFormulaAdditiveType (Example)
.... additiveProductName 0..1stringProduct or brand name of the modular additive
.... caloricDensity 0..1QuantityAmount of energy per specified volume that is required
.... routeofAdministration 0..1CodeableConceptHow the formula should enter the patient's gastrointestinal tract
EnteralRouteOfAdministration (Required)
.... quantity 0..1QuantityThe volume of formula to provide
.... rate 0..1RatioSpeed with which the formula is provided per period of time
.... rateAdjustment 0..1QuantityChange in the rate of administration over a given time
.... maxVolumeToDeliver 0..1QuantityUpper limit on formula volume per unit of time

UML Diagram

NutritionOrder (DomainResource)The person (patient) who needs the nutrition order for an oral diet, nutritional supplement and/or enteral or formula feedingpatient : Reference(Patient) 1..1The practitioner that holds legal responsibility for ordering the diet, nutritional supplement, or formula feedingsorderer : Reference(Practitioner) 0..1Identifiers assigned to this order by the order sender or by the order receiveridentifier : Identifier 0..*An encounter that provides additional information about the healthcare context in which this request is madeencounter : Reference(Encounter) 0..1The date and time that this nutrition order was requesteddateTime : dateTime 1..1The workflow status of the nutrition order/request (this element modifies the meaning of other elements)status : code 0..1 « Codes specifying the state of the request. Describes the lifecycle of the nutrition order.NutritionOrderStatus »A link to a record of allergies or Intolerances which should be included in the nutrition orderallergyIntolerance : Reference(AllergyIntolerance) 0..*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 feedingsfoodPreferenceModifier : CodeableConcept 0..* « (Medical, cultural or ethical food preferences to help with catering requirementsPatientDiet) »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 feedingsexcludeFoodModifier : CodeableConcept 0..* « (Codes used to indicate the type of food that should NOT be given to the patient.FoodType) »OralDietThe kind of diet or dietary restriction such as fiber restricted diet or diabetic diettype : CodeableConcept 0..* « (Codes used to indicate the type of diet being ordered for a patient.OralDiet) »The time period and frequency at which the diet should be givenscheduled : Timing 0..1The required consistency (e.g., honey-thick, nectar-thick, thin, thickened.) of liquids or fluids served to the patientfluidConsistencyType : CodeableConcept 0..* « (Codes used to represent the consistency of fluids and liquids provided to the patient.FluidConsistencyType) »Free text or additional instructions or information pertaining to the oral dietinstruction : string 0..1NutrientThe nutrient that is being modified such as carbohydrate or sodiummodifier : CodeableConcept 0..1 « (Codes for types of nutrient that is being modified such as carbohydrate or sodium.NutrientModifier) »The quantity of the specified nutrient to include in dietamount : Quantity 0..1TextureAny texture modifications (for solid foods) that should be made, e.g. easy to chew, chopped, ground, and pureedmodifier : CodeableConcept 0..1 « (Codes for food consistency types or texture modifications to apply to foods.TextureModifier) »The food type(s) (e.g., meats, all foods) that the texture modification applies to. This could be all foods typesfoodType : CodeableConcept 0..1 « (Codes for types of foods that are texture modified.TextureModifiedFoodType) »SupplementThe kind of nutritional supplement product required such as a high protein or pediatric clear liquid supplementtype : CodeableConcept 0..1 « (Codes for nutritional supplements to be provided to the patientSupplementType) »The product or brand name of the nutritional supplement such as "Acme Protein Shake"productName : string 0..1The time period and frequency at which the supplement(s) should be givenscheduled : Timing 0..1The amount of the nutritional supplement to be givenquantity : Quantity 0..1Free text or additional instructions or information pertaining to the oral supplementinstruction : string 0..1EnteralFormulaFree text formula administration, feeding instructions or additional instructions or informationadministrationInstructions : string 0..1The type of enteral or infant formula such as an adult standard formula with fiber or a soy-based infant formulabaseFormulaType : CodeableConcept 0..1 « (Codes for type of enteral formula to be administered to patient.EnteralFormulaType) »The product or brand name of the enteral or infant formula product such as "ACME Adult Standard Formula"baseFormulaProductName : string 0..1The time period and frequency at which the enteral formula should be delivered to the patientscheduled : Timing 0..1Indicates the type of modular component such as protein, carbohydrate, fat or fiber to be provided in addition to or mixed with the base formulaadditiveType : CodeableConcept 0..1 « (Codes for the type of modular component such as protein, carbohydrate or fiber to be provided in addition to or mixed with the base formula.EnteralFormulaAdditiveType) »The product or brand name of the type of modular component to be added to the formulaadditiveProductName : string 0..1The 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/mLcaloricDensity : Quantity 0..1The route or physiological path of administration into the patient 's gastrointestinal tract for purposes of providing the formula feeding, e.g., nasogastric tuberouteofAdministration : CodeableConcept 0..1 « Codes specifying the route of administration of enteral formula.EnteralRouteOfAdministration »The volume of formula to provide to the patient per the specified administration schedulequantity : Quantity 0..1The rate of administration of formula via a feeding pump, e.g., 60 mL per hour, according to the specified schedulerate : Ratio 0..1The change in the rate of administration over a given time, e.g. increase by 10 mL/hour every 4 hoursrateAdjustment : Quantity 0..1The maximum total quantity of formula that may be administered to a subject over the period of time, e.g., 1440 mL over 24 hoursmaxVolumeToDeliver : Quantity 0..1Class that defines the quantity and type of nutrient modifications required for the oral dietnutrient0..*Class that describes any texture modifications required for the patient to safely consume various types of solid foodstexture0..*Diet given orally in contrast to enteral (tube) feedingoralDiet0..1Oral nutritional products given in order to add further nutritional value to the patient's dietsupplement0..*Feeding provided through the gastrointestinal tract via a tube, catheter, or stoma that delivers nutrition distal to the oral cavityenteralFormula0..1

XML Template

<NutritionOrder xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <patient><!-- 1..1 Reference(Patient) 
     The person who requires the diet, formula or nutritional supplement --></patient>
 <orderer><!-- 0..1 Reference(Practitioner) 
     Who ordered the diet, formula or nutritional supplement --></orderer>
 <identifier><!-- 0..* Identifier Identifiers assigned to this order --></identifier>
 <encounter><!-- 0..1 Reference(Encounter) 
     The encounter associated with that this nutrition order --></encounter>
 <dateTime value="[dateTime]"/><!-- 1..1 Date and time the nutrition order was requested -->
 <status value="[code]"/><!-- 0..1 proposed | draft | planned | requested | active | on-hold | completed | cancelled -->
 <allergyIntolerance><!-- 0..* Reference(AllergyIntolerance) 
     List of the patient's food and nutrition-related allergies and intolerances --></allergyIntolerance>
 <foodPreferenceModifier><!-- 0..* CodeableConcept Order-specific modifier about the type of food that should be given --></foodPreferenceModifier>
 <excludeFoodModifier><!-- 0..* CodeableConcept Order-specific modifier about the type of food that should not be given --></excludeFoodModifier>
 <oralDiet>  <!-- ?? 0..1 Oral diet components -->
  <type><!-- 0..* CodeableConcept Type of oral diet or diet restrictions that describe what can be consumed orally --></type>
  <scheduled><!-- 0..1 Timing Scheduled frequency of diet --></scheduled>
  <nutrient>  <!-- 0..* Required  nutrient modifications -->
   <modifier><!-- 0..1 CodeableConcept Type of nutrient that is being modified --></modifier>
   <amount><!-- 0..1 Quantity Quantity of the specified nutrient --></amount>
  </nutrient>
  <texture>  <!-- 0..* Required  texture modifications -->
   <modifier><!-- 0..1 CodeableConcept Code to indicate how to alter the texture of the foods, e.g., pureed --></modifier>
   <foodType><!-- 0..1 CodeableConcept Concepts that are used to identify an entity that is ingested for nutritional purposes --></foodType>
  </texture>
  <fluidConsistencyType><!-- 0..* CodeableConcept The required consistency of fluids and liquids provided to the patient --></fluidConsistencyType>
  <instruction value="[string]"/><!-- 0..1 Instructions or additional information about the oral diet -->
 </oralDiet>
 <supplement>  <!-- ?? 0..* Supplement components -->
  <type><!-- 0..1 CodeableConcept Type of supplement product requested --></type>
  <productName value="[string]"/><!-- 0..1 Product or brand name of the nutritional supplement -->
  <scheduled><!-- 0..1 Timing Scheduled frequency of supplement --></scheduled>
  <quantity><!-- 0..1 Quantity Amount of the nutritional supplement --></quantity>
  <instruction value="[string]"/><!-- 0..1 Instructions or additional information about the oral supplement -->
 </supplement>
 <enteralFormula>  <!-- ?? 0..1 Enteral formula components -->
  <administrationInstructions value="[string]"/><!-- 0..1 Formula feeding instructions expressed as text -->
  <baseFormulaType><!-- 0..1 CodeableConcept Type of enteral or infant formula --></baseFormulaType>
  <baseFormulaProductName value="[string]"/><!-- 0..1 Product or brand name of the enteral or infant formula -->
  <scheduled><!-- 0..1 Timing Scheduled frequency of enteral feeding --></scheduled>
  <additiveType><!-- 0..1 CodeableConcept Type of modular component to add to the feeding --></additiveType>
  <additiveProductName value="[string]"/><!-- 0..1 Product or brand name of the modular additive -->
  <caloricDensity><!-- 0..1 Quantity 
      Amount of energy per specified volume that is required --></caloricDensity>
  <routeofAdministration><!-- 0..1 CodeableConcept How the formula should enter the patient's gastrointestinal tract --></routeofAdministration>
  <quantity><!-- 0..1 Quantity The volume of formula to provide --></quantity>
  <rate><!-- 0..1 Ratio Speed with which the formula is provided per period of time --></rate>
  <rateAdjustment><!-- 0..1 Quantity 
      Change in the rate of administration over a given time --></rateAdjustment>
  <maxVolumeToDeliver><!-- 0..1 Quantity 
      Upper limit on formula volume per unit of time --></maxVolumeToDeliver>
 </enteralFormula>
</NutritionOrder>

JSON Template

{doco
  "resourceType" : "NutritionOrder",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "patient" : { Reference(Patient) }, // R!  
     The person who requires the diet, formula or nutritional supplement
  "orderer" : { Reference(Practitioner) }, // 
     Who ordered the diet, formula or nutritional supplement
  "identifier" : [{ Identifier }], // Identifiers assigned to this order
  "encounter" : { Reference(Encounter) }, // 
     The encounter associated with that this nutrition order
  "dateTime" : "<dateTime>", // R!  Date and time the nutrition order was requested
  "status" : "<code>", // proposed | draft | planned | requested | active | on-hold | completed | cancelled
  "allergyIntolerance" : [{ Reference(AllergyIntolerance) }], // 
     List of the patient's food and nutrition-related allergies and intolerances
  "foodPreferenceModifier" : [{ CodeableConcept }], // Order-specific modifier about the type of food that should be given
  "excludeFoodModifier" : [{ CodeableConcept }], // Order-specific modifier about the type of food that should not be given
  "oralDiet" : { // C? Oral diet components
    "type" : [{ CodeableConcept }], // Type of oral diet or diet restrictions that describe what can be consumed orally
    "scheduled" : { Timing }, // Scheduled frequency of diet
    "nutrient" : [{ // Required  nutrient modifications
      "modifier" : { CodeableConcept }, // Type of nutrient that is being modified
      "amount" : { Quantity } // Quantity of the specified nutrient
    }],
    "texture" : [{ // Required  texture modifications
      "modifier" : { CodeableConcept }, // Code to indicate how to alter the texture of the foods, e.g., pureed
      "foodType" : { CodeableConcept } // Concepts that are used to identify an entity that is ingested for nutritional purposes
    }],
    "fluidConsistencyType" : [{ CodeableConcept }], // The required consistency of fluids and liquids provided to the patient
    "instruction" : "<string>" // Instructions or additional information about the oral diet
  },
  "supplement" : [{ // C? Supplement components
    "type" : { CodeableConcept }, // Type of supplement product requested
    "productName" : "<string>", // Product or brand name of the nutritional supplement
    "scheduled" : { Timing }, // Scheduled frequency of supplement
    "quantity" : { Quantity }, // Amount of the nutritional supplement
    "instruction" : "<string>" // Instructions or additional information about the oral supplement
  }],
  "enteralFormula" : { // C? Enteral formula components
    "administrationInstructions" : "<string>", // Formula feeding instructions expressed as text
    "baseFormulaType" : { CodeableConcept }, // Type of enteral or infant formula
    "baseFormulaProductName" : "<string>", // Product or brand name of the enteral or infant formula
    "scheduled" : { Timing }, // Scheduled frequency of enteral feeding
    "additiveType" : { CodeableConcept }, // Type of modular component to add to the feeding
    "additiveProductName" : "<string>", // Product or brand name of the modular additive
    "caloricDensity" : { Quantity }, // 
      Amount of energy per specified volume that is required
    "routeofAdministration" : { CodeableConcept }, // How the formula should enter the patient's gastrointestinal tract
    "quantity" : { Quantity }, // The volume of formula to provide
    "rate" : { Ratio }, // Speed with which the formula is provided per period of time
    "rateAdjustment" : { Quantity }, // 
      Change in the rate of administration over a given time
    "maxVolumeToDeliver" : { Quantity } // 
      Upper limit on formula volume per unit of time
  }
}

 

Alternate definitions: Schema/Schematron, Resource Profile (XML, JSON)

4.17.3.1 Terminology Bindings

PathDefinitionTypeReference
NutritionOrder.status Codes specifying the state of the request. Describes the lifecycle of the nutrition order.Requiredhttp://hl7.org/fhir/nutrition-order-status
NutritionOrder.foodPreferenceModifier Medical, cultural or ethical food preferences to help with catering requirementsExamplehttp://hl7.org/fhir/vs/encounter-diet
NutritionOrder.excludeFoodModifier Codes used to indicate the type of food that should NOT be given to the patient.Examplehttp://hl7.org/fhir/vs/food-type
NutritionOrder.oralDiet.type Codes used to indicate the type of diet being ordered for a patient.Examplehttp://hl7.org/fhir/vs/diet-type
NutritionOrder.oralDiet.nutrient.modifier Codes for types of nutrient that is being modified such as carbohydrate or sodium.Examplehttp://hl7.org/fhir/vs/nutrient-code
NutritionOrder.oralDiet.texture.modifier Codes for food consistency types or texture modifications to apply to foods.Examplehttp://hl7.org/fhir/vs/texture-code
NutritionOrder.oralDiet.texture.foodType Codes for types of foods that are texture modified.Examplehttp://hl7.org/fhir/vs/modified-foodtype
NutritionOrder.oralDiet.fluidConsistencyType Codes used to represent the consistency of fluids and liquids provided to the patient.Examplehttp://hl7.org/fhir/vs/consistency-type
NutritionOrder.supplement.type Codes for nutritional supplements to be provided to the patientExamplehttp://hl7.org/fhir/vs/supplement-type
NutritionOrder.enteralFormula.baseFormulaType Codes for type of enteral formula to be administered to patient.Examplehttp://hl7.org/fhir/vs/entformula-type
NutritionOrder.enteralFormula.additiveType Codes for the type of modular component such as protein, carbohydrate or fiber to be provided in addition to or mixed with the base formula.Examplehttp://hl7.org/fhir/vs/entformula-additive
NutritionOrder.enteralFormula.routeofAdministration Codes specifying the route of administration of enteral formula.Requiredhttp://hl7.org/fhir/vs/enteral-route

4.17.3.2 Constraints

  • 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))

4.17.4 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionPaths
additivetokenType of module component to add to the feedingNutritionOrder.enteralFormula.additiveType
datetimedateReturn nutrition orders requested on this dateNutritionOrder.dateTime
encounterreferenceReturn nutrition orders with this encounter identityNutritionOrder.encounter
(Encounter)
formulatokenType of enteral or infant formulaNutritionOrder.enteralFormula.baseFormulaType
identifiertokenReturn nutrition orders with this external identityNutritionOrder.identifier
oraldiettokenType of diet that can be consumed orally (i.e., take via the mouth).NutritionOrder.oralDiet.type
patientreferenceThe identity of the person who requires the diet, formula or nutritional supplementNutritionOrder.patient
(Patient)
providerreferenceThe identify of the provider who placed the nutrition orderNutritionOrder.orderer
(Practitioner)
statustokenStatus of the nutrition order.NutritionOrder.status
supplementtokenType of supplement product requestedNutritionOrder.supplement.type