R4 Draft for Comment

This page is part of the FHIR Specification (v3.2.0: R4 Ballot 1). 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

Orders and Observations Work GroupMaturity Level: 2 Trial Use Compartments: Encounter, Patient, Practitioner

Detailed Descriptions for the elements in the NutritionOrder resource.

NutritionOrder
Definition

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

Control1..1
Alternate NamesNutrition Order; Diet 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 (expression : oralDiet.exists() or supplement.exists() or enteralFormula.exists(), xpath: exists(f:oralDiet) or exists(f:supplement) or exists(f:enteralFormula))
NutritionOrder.identifier
Definition

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

NoteThis is a business identifer, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
Comments

The Identifier.type element can be to indicate filler vs. placer if needed. This is explained in further detail here.

NutritionOrder.status
Definition

The workflow status of the nutrition order/request.

Control0..1
Terminology BindingNutritionOrderStatus (Required)
Typecode
Is Modifiertrue
Summarytrue
Comments

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

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

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(Patient)
Summarytrue
NutritionOrder.encounter
Definition

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

Control0..1
TypeReference(Encounter)
NutritionOrder.dateTime
Definition

The date and time that this nutrition order was requested.

Control1..1
TypedateTime
Summarytrue
NutritionOrder.orderer
Definition

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

Control0..1
TypeReference(Practitioner | PractitionerRole)
Summarytrue
NutritionOrder.allergyIntolerance
Definition

A link to a record of allergies or intolerances which should be included in the nutrition order.

Control0..*
TypeReference(AllergyIntolerance)
Comments

Information on a patient's food allergies and intolerances to inform healthcare personnel about the type of foods that the patient shouldn't receive or consume.

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..*
Terminology BindingDiet (Example)
TypeCodeableConcept
Comments

Information on a patient's food preferences that inform healthcare personnel about the food that the patient should receive or consume.

NutritionOrder.excludeFoodModifier
Definition

This modifier is used to convey Order-specific modifier about the type of oral food or oral fluids 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. While it should not be necessary to repeat allergy or intolerance information captured in the referenced AllergyIntolerance resource in the excludeFoodModifier, this element may be used to convey additional specificity related to foods that should be eliminated from the patient’s diet for any reason. This modifier applies to the entire nutrition order inclusive of the oral diet, nutritional supplements and enteral formula feedings.

Control0..*
Terminology BindingFood Type Codes (Example)
TypeCodeableConcept
Comments

Information on a patient's food allergies, intolerances and preferences to inform healthcare personnel about the type of foods that the patient shouldn't receive or consume.

NutritionOrder.oralDiet
Definition

Diet given orally in contrast to enteral (tube) feeding.

Control0..1
InvariantsAffect this element
nor-1: Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula class (expression : oralDiet.exists() or supplement.exists() or enteralFormula.exists(), xpath: exists(f:oralDiet) or exists(f:supplement) or exists(f:enteralFormula))
NutritionOrder.oralDiet.type
Definition

The kind of diet or dietary restriction such as fiber restricted diet or diabetic diet.

Control0..*
Terminology BindingDiet Codes (Example)
TypeCodeableConcept
Summarytrue
NutritionOrder.oralDiet.schedule
Definition

The time period and frequency at which the diet should be given. The diet should be given for the combination of all schedules if more than one schedule is present.

Control0..*
TypeTiming
Alternate NamesFrequency
NutritionOrder.oralDiet.nutrient
Definition

Class that defines the quantity and type of nutrient modifications (for example carbohydrate, fiber or sodium) required for the oral diet.

Control0..*
NutritionOrder.oralDiet.nutrient.modifier
Definition

The nutrient that is being modified such as carbohydrate or sodium.

Control0..1
Terminology BindingNutrient Modifier Codes (Example)
TypeCodeableConcept
NutritionOrder.oralDiet.nutrient.amount
Definition

The quantity of the specified nutrient to include in diet.

Control0..1
TypeSimpleQuantity
NutritionOrder.oralDiet.texture
Definition

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

Control0..*
NutritionOrder.oralDiet.texture.modifier
Definition

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

Control0..1
Terminology BindingTexture Modifier Codes (Example)
TypeCodeableConcept
Comments

Coupled with the foodType (Meat).

NutritionOrder.oralDiet.texture.foodType
Definition

The food type(s) (e.g. meats, all foods) that the texture modification applies to. This could be all foods types.

Control0..1
Terminology BindingTexture Modified Food Type Codes (Example)
TypeCodeableConcept
Comments

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

NutritionOrder.oralDiet.fluidConsistencyType
Definition

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

Control0..*
Terminology BindingFluid Consistency Type Codes (Example)
TypeCodeableConcept
NutritionOrder.oralDiet.instruction
Definition

Free text or additional instructions or information pertaining to the oral diet.

Control0..1
Typestring
Summarytrue
Comments

Free text dosage instructions can be used for cases where the instructions are too complex to code.

NutritionOrder.supplement
Definition

Oral nutritional products given in order to add further nutritional value to the patient's diet.

Control0..*
InvariantsAffect this element
nor-1: Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula class (expression : oralDiet.exists() or supplement.exists() or enteralFormula.exists(), xpath: exists(f:oralDiet) or exists(f:supplement) or exists(f:enteralFormula))
NutritionOrder.supplement.type
Definition

The kind of nutritional supplement product required such as a high protein or pediatric clear liquid supplement.

Control0..1
Terminology BindingSupplement Type Codes (Example)
TypeCodeableConcept
Summarytrue
NutritionOrder.supplement.productName
Definition

The product or brand name of the nutritional supplement such as "Acme Protein Shake".

Control0..1
Typestring
NutritionOrder.supplement.schedule
Definition

The time period and frequency at which the supplement(s) should be given. The supplement should be given for the combination of all schedules if more than one schedule is present.

Control0..*
TypeTiming
Alternate NamesFrequency
NutritionOrder.supplement.quantity
Definition

The amount of the nutritional supplement to be given.

Control0..1
TypeSimpleQuantity
NutritionOrder.supplement.instruction
Definition

Free text or additional instructions or information pertaining to the oral supplement.

Control0..1
Typestring
Summarytrue
Comments

Free text dosage instructions can be used for cases where the instructions are too complex to code.

NutritionOrder.enteralFormula
Definition

Feeding provided through the gastrointestinal tract via a tube, catheter, or stoma that delivers nutrition distal to the oral cavity.

Control0..1
InvariantsAffect this element
nor-1: Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula class (expression : oralDiet.exists() or supplement.exists() or enteralFormula.exists(), xpath: exists(f:oralDiet) or exists(f:supplement) or exists(f:enteralFormula))
NutritionOrder.enteralFormula.baseFormulaType
Definition

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

Control0..1
Terminology BindingEnteral Formula Type Codes (Example)
TypeCodeableConcept
Summarytrue
NutritionOrder.enteralFormula.baseFormulaProductName
Definition

The product or brand name of the enteral or infant formula product such as "ACME Adult Standard Formula".

Control0..1
Typestring
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
Terminology BindingEnteral Formula Additive Type Code (Example)
TypeCodeableConcept
NutritionOrder.enteralFormula.additiveProductName
Definition

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

Control0..1
Typestring
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 that provides 24 calories per fluid ounce or an adult may require an enteral formula that provides 1.5 calorie/mL.

Control0..1
TypeSimpleQuantity
NutritionOrder.enteralFormula.routeofAdministration
Definition

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
Terminology BindingEnteral Route Codes (Extensible)
TypeCodeableConcept
NutritionOrder.enteralFormula.administration
Definition

Formula administration instructions as structured data. This repeating structure allows for changing the administration rate or volume over time for both bolus and continuous feeding. An example of this would be an instruction to increase the rate of continuous feeding every 2 hours.

Control0..*
Comments

See implementation notes below for further discussion on how to order continuous vs bolus enteral feeding using this resource.

NutritionOrder.enteralFormula.administration.schedule
Definition

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

Control0..1
TypeTiming
Alternate NamesFrequency
NutritionOrder.enteralFormula.administration.quantity
Definition

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

Control0..1
TypeSimpleQuantity
NutritionOrder.enteralFormula.administration.rate[x]
Definition

The rate of administration of formula via a feeding pump, e.g. 60 mL per hour, according to the specified schedule.

Control0..1
TypeSimpleQuantity|Ratio
[x] NoteSee Choice of Data Types for further information about how to use [x]
Comments

Ratio is used when the quantity value in the denominator is not "1", otherwise use Quantity. For example, the Ratio datatype is used for "200 mL/4 hrs" versus the Quantity datatype for "50 mL/hr".

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
TypeSimpleQuantity
NutritionOrder.enteralFormula.administrationInstruction
Definition

Free text formula administration, feeding instructions or additional instructions or information.

Control0..1
Typestring
Summarytrue
Comments

Free text dosage instructions can be used for cases where the instructions are too complex to code.

NutritionOrder.note
Definition

Comments made about the {{title}} by the requester, performer, subject or other participants.

Control0..*
TypeAnnotation
Comments

This element SHALL NOT be used to supply free text instructions for the diet which are represented in the .oralDiet.instructionsupplement.instruction, or enteralFormula.administrationInstruction elements.