Release 4B Ballot #1

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12.15 Resource NutritionOrder - Content

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

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

12.15.1 Scope and Usage

This resource is a request resource from a FHIR workflow perspective - see Workflow. It is the intent of the Orders and Observation Workgroup to align this resource with the workflow pattern for request resources.

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. It does not cover orders for parenteral (IV) nutrition which are typically filled by pharmacy. 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.

Enteral orders are distinguished from supplements because they have some unique attributes and typically include administration information whereas oral nutritional supplements may simply be supplied (e.g. home health or outpatient settings). In a simple case, the requestor may designate type of product, product name and the route of administration along with free text instructions without a having to complete the additional structured details.

This resource is intended to be used by providers from a variety of specialties such as physicians, dietitian/nutritionists, or speech therapists. One provider may simply order a base element oral diet such as General Healthful diet. Another provider, based on scope of practice, may use other elements to communicate additional therapeutic needs or patient preferences. The optionality included gives an ordering provider the capability to write a simple order for an oral diet, nutritional supplement or formula with minimal requirements beyond that of specifying the diet, supplement or formula product, but also supports the ability to provide more detailed information that may be further augmented by a dietitian or nutrition specialist. For example, a physician may order a 2 g sodium diet. A speech therapist, based on the results of a swallowing evaluation, then orders a mechanically altered texture with nectar thick liquids.

12.15.2 Boundaries and Relationships

The NutritionOrder resource is used for requesting oral diets, oral nutrition supplements and enteral feedings in an in-patient setting. The MedicationRequest 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 Task resource and its associated workflow with the Nutrition Order referenced from Task.basedOn, or by using the Nutrition Task resource in the context of a messaging or service workflow where the request is explicit or implicit.

12.15.3 References

This resource is referenced by CarePlan, DiagnosticReport, Goal and Observation.

This resource implements the Request pattern.

12.15.4 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. NutritionOrder TUDomainResourceDiet, formula or nutritional supplement request
+ Warning: Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula class
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..*IdentifierIdentifiers assigned to this order
... instantiatesCanonical Σ0..*canonical(ActivityDefinition | PlanDefinition)Instantiates FHIR protocol or definition
... instantiatesUri Σ0..*uriInstantiates external protocol or definition
... status ?!Σ1..1codedraft | active | on-hold | revoked | completed | entered-in-error | unknown
RequestStatus (Required)
... intent ?!Σ1..1codeproposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
RequestIntent (Required)
... patient Σ1..1Reference(Patient)The person who requires the diet, formula or nutritional supplement
... encounter 0..1Reference(Encounter)The encounter associated with this nutrition order
... dateTime Σ1..1dateTimeDate and time the nutrition order was requested
... orderer Σ0..1Reference(Practitioner | PractitionerRole)Who ordered the diet, formula or nutritional supplement
... allergyIntolerance 0..*Reference(AllergyIntolerance)List 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
Diet (Example)
... excludeFoodModifier 0..*CodeableConceptOrder-specific modifier about the type of food that should not be given
Food Type Codes (Example)
... oralDiet I0..1BackboneElementOral diet components
.... type Σ0..*CodeableConceptType of oral diet or diet restrictions that describe what can be consumed orally
Diet Codes (Example)
.... schedule 0..*TimingScheduled frequency of diet
.... nutrient 0..*BackboneElementRequired nutrient modifications
..... modifier 0..1CodeableConceptType of nutrient that is being modified
Nutrient Modifier Codes (Example)
..... amount 0..1SimpleQuantityQuantity of the specified nutrient
.... texture 0..*BackboneElementRequired texture modifications
..... modifier 0..1CodeableConceptCode to indicate how to alter the texture of the foods, e.g. pureed
Texture Modifier Codes (Example)
..... foodType 0..1CodeableConceptConcepts that are used to identify an entity that is ingested for nutritional purposes
Texture Modified Food Type Codes (Example)
.... fluidConsistencyType 0..*CodeableConceptThe required consistency of fluids and liquids provided to the patient
Fluid Consistency Type Codes (Example)
.... instruction Σ0..1stringInstructions or additional information about the oral diet
... supplement I0..*BackboneElementSupplement components
.... type Σ0..1CodeableConceptType of supplement product requested
Supplement Type Codes (Example)
.... productName 0..1stringProduct or brand name of the nutritional supplement
.... schedule 0..*TimingScheduled frequency of supplement
.... quantity 0..1SimpleQuantityAmount of the nutritional supplement
.... instruction Σ0..1stringInstructions or additional information about the oral supplement
... enteralFormula I0..1BackboneElementEnteral formula components
.... baseFormulaType Σ0..1CodeableConceptType of enteral or infant formula
Enteral Formula Type Codes (Example)
.... baseFormulaProductName 0..1stringProduct or brand name of the enteral or infant formula
.... additiveType 0..1CodeableConceptType of modular component to add to the feeding
Enteral Formula Additive Type Code (Example)
.... additiveProductName 0..1stringProduct or brand name of the modular additive
.... caloricDensity 0..1SimpleQuantityAmount of energy per specified volume that is required
.... routeofAdministration 0..1CodeableConceptHow the formula should enter the patient's gastrointestinal tract
Enteral Route Codes (Extensible)
.... administration 0..*BackboneElementFormula feeding instruction as structured data
..... schedule 0..1TimingScheduled frequency of enteral feeding
..... quantity 0..1SimpleQuantityThe volume of formula to provide
..... rate[x] 0..1Speed with which the formula is provided per period of time
...... rateQuantitySimpleQuantity
...... rateRatioRatio
.... maxVolumeToDeliver 0..1SimpleQuantityUpper limit on formula volume per unit of time
.... administrationInstruction Σ0..1stringFormula feeding instructions expressed as text
... note 0..*AnnotationComments

doco Documentation for this format

UML Diagram (Legend)

NutritionOrder (DomainResource)Identifiers assigned to this order by the order sender or by the order receiveridentifier : Identifier [0..*]The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this NutritionOrderinstantiatesCanonical : canonical [0..*] « ActivityDefinition| PlanDefinition »The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this NutritionOrderinstantiatesUri : uri [0..*]The URL pointing to a protocol, guideline, orderset or other definition that is adhered to in whole or in part by this NutritionOrderinstantiates : uri [0..*]The workflow status of the nutrition order/request (this element modifies the meaning of other elements)status : code [1..1] « Codes identifying the lifecycle stage of the nutrition order. (Strength=Required)RequestStatus! »Indicates the level of authority/intentionality associated with the NutrionOrder and where the request fits into the workflow chain (this element modifies the meaning of other elements)intent : code [1..1] « Codes indicating the degree of authority/intentionality associated with a nutrition order. (Strength=Required)RequestIntent! »The person (patient) who needs the nutrition order for an oral diet, nutritional supplement and/or enteral or formula feedingpatient : Reference [1..1] « Patient »An encounter that provides additional information about the healthcare context in which this request is madeencounter : Reference [0..1] « Encounter »The date and time that this nutrition order was requesteddateTime : dateTime [1..1]The practitioner that holds legal responsibility for ordering the diet, nutritional supplement, or formula feedingsorderer : Reference [0..1] « Practitioner|PractitionerRole »A link to a record of allergies or intolerances which should be included in the nutrition orderallergyIntolerance : Reference [0..*] « AllergyIntolerance »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 requirements. (Strength=Example)Diet?? »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 feedingsexcludeFoodModifier : CodeableConcept [0..*] « Codes used to indicate the type of food that should NOT be given to the patient. (Strength=Example)FoodTypeCodes?? »Comments made about the {{title}} by the requester, performer, subject or other participantsnote : Annotation [0..*]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. (Strength=Example)DietCodes?? »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 presentschedule : Timing [0..*]The 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. (Strength=Example) FluidConsistencyTypeCodes?? »Free text or additional instructions or information pertaining to the oral dietinstruction : string [0..1]NutrientThe nutrient that is being modified such as carbohydrate or sodiummodifier : CodeableConcept [0..1] « Codes for types of nutrients that are being modified such as carbohydrate or sodium. (Strength=Example)NutrientModifierCodes?? »The quantity of the specified nutrient to include in dietamount : Quantity(SimpleQuantity) [0..1]TextureAny 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. (Strength=Example)TextureModifierCodes?? »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. (Strength=Example)TextureModifiedFoodTypeCodes?? »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 patient. (Strength=Example)SupplementTypeCodes?? »The product or brand name of the nutritional supplement such as "Acme Protein Shake"productName : string [0..1]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 presentschedule : Timing [0..*]The amount of the nutritional supplement to be givenquantity : Quantity(SimpleQuantity) [0..1]Free text or additional instructions or information pertaining to the oral supplementinstruction : string [0..1]EnteralFormulaThe 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. (Strength=Example)EnteralFormulaTypeCodes?? »The product or brand name of the enteral or infant formula product such as "ACME Adult Standard Formula"baseFormulaProductName : string [0..1]Indicates 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. (Strength=Example) EnteralFormulaAdditiveTypeCode?? »The product or brand name of the type of modular component to be added to the formulaadditiveProductName : string [0..1]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/mLcaloricDensity : Quantity(SimpleQuantity) [0..1]The 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. (Strength=Extensible)EnteralRouteCodes+ »The 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(SimpleQuantity) [0..1]Free text formula administration, feeding instructions or additional instructions or informationadministrationInstruction : string [0..1]AdministrationThe time period and frequency at which the enteral formula should be delivered to the patientschedule : Timing [0..1]The volume of formula to provide to the patient per the specified administration schedulequantity : Quantity(SimpleQuantity) [0..1]The rate of administration of formula via a feeding pump, e.g. 60 mL per hour, according to the specified schedulerate[x] : Element [0..1] « Quantity(SimpleQuantity)|Ratio »Class that defines the quantity and type of nutrient modifications (for example carbohydrate, fiber or sodium) required for the oral dietnutrient[0..*]Class that describes any texture modifications required for the patient to safely consume various types of solid foodstexture[0..*]Diet given orally in contrast to enteral (tube) feedingoralDiet[0..1]Oral nutritional products given in order to add further nutritional value to the patient's dietsupplement[0..*]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 hoursadministration[0..*]Feeding provided through the gastrointestinal tract via a tube, catheter, or stoma that delivers nutrition distal to the oral cavityenteralFormula[0..1]

XML Template

<NutritionOrder xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Identifiers assigned to this order --></identifier>
 <instantiatesCanonical><!-- 0..* canonical(ActivityDefinition|PlanDefinition) Instantiates FHIR protocol or definition --></instantiatesCanonical>
 <instantiatesUri value="[uri]"/><!-- 0..* Instantiates external protocol or definition -->
 <instantiates value="[uri]"/><!-- 0..* Instantiates protocol or definition -->
 <status value="[code]"/><!-- 1..1 draft | active | on-hold | revoked | completed | entered-in-error | unknown -->
 <intent value="[code]"/><!-- 1..1 proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option -->
 <patient><!-- 1..1 Reference(Patient) The person who requires the diet, formula or nutritional supplement --></patient>
 <encounter><!-- 0..1 Reference(Encounter) The encounter associated with this nutrition order --></encounter>
 <dateTime value="[dateTime]"/><!-- 1..1 Date and time the nutrition order was requested -->
 <orderer><!-- 0..1 Reference(Practitioner|PractitionerRole) Who ordered the diet, formula or nutritional supplement --></orderer>
 <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>
  <schedule><!-- 0..* Timing Scheduled frequency of diet --></schedule>
  <nutrient>  <!-- 0..* Required  nutrient modifications -->
   <modifier><!-- 0..1 CodeableConcept Type of nutrient that is being modified --></modifier>
   <amount><!-- 0..1 Quantity(SimpleQuantity) 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 -->
  <schedule><!-- 0..* Timing Scheduled frequency of supplement --></schedule>
  <quantity><!-- 0..1 Quantity(SimpleQuantity) 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 -->
  <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 -->
  <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(SimpleQuantity) 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>
  <administration>  <!-- 0..* Formula feeding instruction as structured data -->
   <schedule><!-- 0..1 Timing Scheduled frequency of enteral feeding --></schedule>
   <quantity><!-- 0..1 Quantity(SimpleQuantity) The volume of formula to provide --></quantity>
   <rate[x]><!-- 0..1 Quantity(SimpleQuantity)|Ratio Speed with which the formula is provided per period of time --></rate[x]>
  </administration>
  <maxVolumeToDeliver><!-- 0..1 Quantity(SimpleQuantity) Upper limit on formula volume per unit of time --></maxVolumeToDeliver>
  <administrationInstruction value="[string]"/><!-- 0..1 Formula feeding instructions expressed as text -->
 </enteralFormula>
 <note><!-- 0..* Annotation Comments --></note>
</NutritionOrder>

JSON Template

{doco
  "resourceType" : "NutritionOrder",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Identifiers assigned to this order
  "instantiatesCanonical" : [{ canonical(ActivityDefinition|PlanDefinition) }], // Instantiates FHIR protocol or definition
  "instantiatesUri" : ["<uri>"], // Instantiates external protocol or definition
  "instantiates" : ["<uri>"], // Instantiates protocol or definition
  "status" : "<code>", // R!  draft | active | on-hold | revoked | completed | entered-in-error | unknown
  "intent" : "<code>", // R!  proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
  "patient" : { Reference(Patient) }, // R!  The person who requires the diet, formula or nutritional supplement
  "encounter" : { Reference(Encounter) }, // The encounter associated with this nutrition order
  "dateTime" : "<dateTime>", // R!  Date and time the nutrition order was requested
  "orderer" : { Reference(Practitioner|PractitionerRole) }, // Who ordered the diet, formula or nutritional supplement
  "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
    "schedule" : [{ Timing }], // Scheduled frequency of diet
    "nutrient" : [{ // Required  nutrient modifications
      "modifier" : { CodeableConcept }, // Type of nutrient that is being modified
      "amount" : { Quantity(SimpleQuantity) } // 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
    "schedule" : [{ Timing }], // Scheduled frequency of supplement
    "quantity" : { Quantity(SimpleQuantity) }, // Amount of the nutritional supplement
    "instruction" : "<string>" // Instructions or additional information about the oral supplement
  }],
  "enteralFormula" : { // C? Enteral formula components
    "baseFormulaType" : { CodeableConcept }, // Type of enteral or infant formula
    "baseFormulaProductName" : "<string>", // Product or brand name of the enteral or infant formula
    "additiveType" : { CodeableConcept }, // Type of modular component to add to the feeding
    "additiveProductName" : "<string>", // Product or brand name of the modular additive
    "caloricDensity" : { Quantity(SimpleQuantity) }, // Amount of energy per specified volume that is required
    "routeofAdministration" : { CodeableConcept }, // How the formula should enter the patient's gastrointestinal tract
    "administration" : [{ // Formula feeding instruction as structured data
      "schedule" : { Timing }, // Scheduled frequency of enteral feeding
      "quantity" : { Quantity(SimpleQuantity) }, // The volume of formula to provide
      // rate[x]: Speed with which the formula is provided per period of time. One of these 2:
      "rateQuantity" : { Quantity(SimpleQuantity) }
      "rateRatio" : { Ratio }
    }],
    "maxVolumeToDeliver" : { Quantity(SimpleQuantity) }, // Upper limit on formula volume per unit of time
    "administrationInstruction" : "<string>" // Formula feeding instructions expressed as text
  },
  "note" : [{ Annotation }] // Comments
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:NutritionOrder;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:NutritionOrder.identifier [ Identifier ], ... ; # 0..* Identifiers assigned to this order
  fhir:NutritionOrder.instantiatesCanonical [ canonical(ActivityDefinition|PlanDefinition) ], ... ; # 0..* Instantiates FHIR protocol or definition
  fhir:NutritionOrder.instantiatesUri [ uri ], ... ; # 0..* Instantiates external protocol or definition
  fhir:NutritionOrder.instantiates [ uri ], ... ; # 0..* Instantiates protocol or definition
  fhir:NutritionOrder.status [ code ]; # 1..1 draft | active | on-hold | revoked | completed | entered-in-error | unknown
  fhir:NutritionOrder.intent [ code ]; # 1..1 proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
  fhir:NutritionOrder.patient [ Reference(Patient) ]; # 1..1 The person who requires the diet, formula or nutritional supplement
  fhir:NutritionOrder.encounter [ Reference(Encounter) ]; # 0..1 The encounter associated with this nutrition order
  fhir:NutritionOrder.dateTime [ dateTime ]; # 1..1 Date and time the nutrition order was requested
  fhir:NutritionOrder.orderer [ Reference(Practitioner|PractitionerRole) ]; # 0..1 Who ordered the diet, formula or nutritional supplement
  fhir:NutritionOrder.allergyIntolerance [ Reference(AllergyIntolerance) ], ... ; # 0..* List of the patient's food and nutrition-related allergies and intolerances
  fhir:NutritionOrder.foodPreferenceModifier [ CodeableConcept ], ... ; # 0..* Order-specific modifier about the type of food that should be given
  fhir:NutritionOrder.excludeFoodModifier [ CodeableConcept ], ... ; # 0..* Order-specific modifier about the type of food that should not be given
  fhir:NutritionOrder.oralDiet [ # 0..1 Oral diet components
    fhir:NutritionOrder.oralDiet.type [ CodeableConcept ], ... ; # 0..* Type of oral diet or diet restrictions that describe what can be consumed orally
    fhir:NutritionOrder.oralDiet.schedule [ Timing ], ... ; # 0..* Scheduled frequency of diet
    fhir:NutritionOrder.oralDiet.nutrient [ # 0..* Required  nutrient modifications
      fhir:NutritionOrder.oralDiet.nutrient.modifier [ CodeableConcept ]; # 0..1 Type of nutrient that is being modified
      fhir:NutritionOrder.oralDiet.nutrient.amount [ Quantity(SimpleQuantity) ]; # 0..1 Quantity of the specified nutrient
    ], ...;
    fhir:NutritionOrder.oralDiet.texture [ # 0..* Required  texture modifications
      fhir:NutritionOrder.oralDiet.texture.modifier [ CodeableConcept ]; # 0..1 Code to indicate how to alter the texture of the foods, e.g. pureed
      fhir:NutritionOrder.oralDiet.texture.foodType [ CodeableConcept ]; # 0..1 Concepts that are used to identify an entity that is ingested for nutritional purposes
    ], ...;
    fhir:NutritionOrder.oralDiet.fluidConsistencyType [ CodeableConcept ], ... ; # 0..* The required consistency of fluids and liquids provided to the patient
    fhir:NutritionOrder.oralDiet.instruction [ string ]; # 0..1 Instructions or additional information about the oral diet
  ];
  fhir:NutritionOrder.supplement [ # 0..* Supplement components
    fhir:NutritionOrder.supplement.type [ CodeableConcept ]; # 0..1 Type of supplement product requested
    fhir:NutritionOrder.supplement.productName [ string ]; # 0..1 Product or brand name of the nutritional supplement
    fhir:NutritionOrder.supplement.schedule [ Timing ], ... ; # 0..* Scheduled frequency of supplement
    fhir:NutritionOrder.supplement.quantity [ Quantity(SimpleQuantity) ]; # 0..1 Amount of the nutritional supplement
    fhir:NutritionOrder.supplement.instruction [ string ]; # 0..1 Instructions or additional information about the oral supplement
  ], ...;
  fhir:NutritionOrder.enteralFormula [ # 0..1 Enteral formula components
    fhir:NutritionOrder.enteralFormula.baseFormulaType [ CodeableConcept ]; # 0..1 Type of enteral or infant formula
    fhir:NutritionOrder.enteralFormula.baseFormulaProductName [ string ]; # 0..1 Product or brand name of the enteral or infant formula
    fhir:NutritionOrder.enteralFormula.additiveType [ CodeableConcept ]; # 0..1 Type of modular component to add to the feeding
    fhir:NutritionOrder.enteralFormula.additiveProductName [ string ]; # 0..1 Product or brand name of the modular additive
    fhir:NutritionOrder.enteralFormula.caloricDensity [ Quantity(SimpleQuantity) ]; # 0..1 Amount of energy per specified volume that is required
    fhir:NutritionOrder.enteralFormula.routeofAdministration [ CodeableConcept ]; # 0..1 How the formula should enter the patient's gastrointestinal tract
    fhir:NutritionOrder.enteralFormula.administration [ # 0..* Formula feeding instruction as structured data
      fhir:NutritionOrder.enteralFormula.administration.schedule [ Timing ]; # 0..1 Scheduled frequency of enteral feeding
      fhir:NutritionOrder.enteralFormula.administration.quantity [ Quantity(SimpleQuantity) ]; # 0..1 The volume of formula to provide
      # NutritionOrder.enteralFormula.administration.rate[x] : 0..1 Speed with which the formula is provided per period of time. One of these 2
        fhir:NutritionOrder.enteralFormula.administration.rateSimpleQuantity [ Quantity(SimpleQuantity) ]
        fhir:NutritionOrder.enteralFormula.administration.rateRatio [ Ratio ]
    ], ...;
    fhir:NutritionOrder.enteralFormula.maxVolumeToDeliver [ Quantity(SimpleQuantity) ]; # 0..1 Upper limit on formula volume per unit of time
    fhir:NutritionOrder.enteralFormula.administrationInstruction [ string ]; # 0..1 Formula feeding instructions expressed as text
  ];
  fhir:NutritionOrder.note [ Annotation ], ... ; # 0..* Comments
]

Changes since R3

NutritionOrder
NutritionOrder.status
  • Change value set from http://hl7.org/fhir/ValueSet/request-status|4.0.0 to http://hl7.org/fhir/ValueSet/request-status|4.1.0
NutritionOrder.intent
  • Change value set from http://hl7.org/fhir/ValueSet/request-intent|4.0.0 to http://hl7.org/fhir/ValueSet/request-intent|4.1.0
NutritionOrder.enteralFormula.administration.rate[x]
  • Add Type Quantity()
  • Remove Type Quantity()

See the Full Difference for further information

This analysis is available as XML or JSON.

See R3 <--> R4 Conversion Maps (status = 13 tests that all execute ok. All tests pass round-trip testing and 13 r3 resources are invalid (0 errors).)

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. NutritionOrder TUDomainResourceDiet, formula or nutritional supplement request
+ Warning: Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula class
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..*IdentifierIdentifiers assigned to this order
... instantiatesCanonical Σ0..*canonical(ActivityDefinition | PlanDefinition)Instantiates FHIR protocol or definition
... instantiatesUri Σ0..*uriInstantiates external protocol or definition
... status ?!Σ1..1codedraft | active | on-hold | revoked | completed | entered-in-error | unknown
RequestStatus (Required)
... intent ?!Σ1..1codeproposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
RequestIntent (Required)
... patient Σ1..1Reference(Patient)The person who requires the diet, formula or nutritional supplement
... encounter 0..1Reference(Encounter)The encounter associated with this nutrition order
... dateTime Σ1..1dateTimeDate and time the nutrition order was requested
... orderer Σ0..1Reference(Practitioner | PractitionerRole)Who ordered the diet, formula or nutritional supplement
... allergyIntolerance 0..*Reference(AllergyIntolerance)List 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
Diet (Example)
... excludeFoodModifier 0..*CodeableConceptOrder-specific modifier about the type of food that should not be given
Food Type Codes (Example)
... oralDiet I0..1BackboneElementOral diet components
.... type Σ0..*CodeableConceptType of oral diet or diet restrictions that describe what can be consumed orally
Diet Codes (Example)
.... schedule 0..*TimingScheduled frequency of diet
.... nutrient 0..*BackboneElementRequired nutrient modifications
..... modifier 0..1CodeableConceptType of nutrient that is being modified
Nutrient Modifier Codes (Example)
..... amount 0..1SimpleQuantityQuantity of the specified nutrient
.... texture 0..*BackboneElementRequired texture modifications
..... modifier 0..1CodeableConceptCode to indicate how to alter the texture of the foods, e.g. pureed
Texture Modifier Codes (Example)
..... foodType 0..1CodeableConceptConcepts that are used to identify an entity that is ingested for nutritional purposes
Texture Modified Food Type Codes (Example)
.... fluidConsistencyType 0..*CodeableConceptThe required consistency of fluids and liquids provided to the patient
Fluid Consistency Type Codes (Example)
.... instruction Σ0..1stringInstructions or additional information about the oral diet
... supplement I0..*BackboneElementSupplement components
.... type Σ0..1CodeableConceptType of supplement product requested
Supplement Type Codes (Example)
.... productName 0..1stringProduct or brand name of the nutritional supplement
.... schedule 0..*TimingScheduled frequency of supplement
.... quantity 0..1SimpleQuantityAmount of the nutritional supplement
.... instruction Σ0..1stringInstructions or additional information about the oral supplement
... enteralFormula I0..1BackboneElementEnteral formula components
.... baseFormulaType Σ0..1CodeableConceptType of enteral or infant formula
Enteral Formula Type Codes (Example)
.... baseFormulaProductName 0..1stringProduct or brand name of the enteral or infant formula
.... additiveType 0..1CodeableConceptType of modular component to add to the feeding
Enteral Formula Additive Type Code (Example)
.... additiveProductName 0..1stringProduct or brand name of the modular additive
.... caloricDensity 0..1SimpleQuantityAmount of energy per specified volume that is required
.... routeofAdministration 0..1CodeableConceptHow the formula should enter the patient's gastrointestinal tract
Enteral Route Codes (Extensible)
.... administration 0..*BackboneElementFormula feeding instruction as structured data
..... schedule 0..1TimingScheduled frequency of enteral feeding
..... quantity 0..1SimpleQuantityThe volume of formula to provide
..... rate[x] 0..1Speed with which the formula is provided per period of time
...... rateQuantitySimpleQuantity
...... rateRatioRatio
.... maxVolumeToDeliver 0..1SimpleQuantityUpper limit on formula volume per unit of time
.... administrationInstruction Σ0..1stringFormula feeding instructions expressed as text
... note 0..*AnnotationComments

doco Documentation for this format

UML Diagram (Legend)

NutritionOrder (DomainResource)Identifiers assigned to this order by the order sender or by the order receiveridentifier : Identifier [0..*]The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this NutritionOrderinstantiatesCanonical : canonical [0..*] « ActivityDefinition| PlanDefinition »The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this NutritionOrderinstantiatesUri : uri [0..*]The URL pointing to a protocol, guideline, orderset or other definition that is adhered to in whole or in part by this NutritionOrderinstantiates : uri [0..*]The workflow status of the nutrition order/request (this element modifies the meaning of other elements)status : code [1..1] « Codes identifying the lifecycle stage of the nutrition order. (Strength=Required)RequestStatus! »Indicates the level of authority/intentionality associated with the NutrionOrder and where the request fits into the workflow chain (this element modifies the meaning of other elements)intent : code [1..1] « Codes indicating the degree of authority/intentionality associated with a nutrition order. (Strength=Required)RequestIntent! »The person (patient) who needs the nutrition order for an oral diet, nutritional supplement and/or enteral or formula feedingpatient : Reference [1..1] « Patient »An encounter that provides additional information about the healthcare context in which this request is madeencounter : Reference [0..1] « Encounter »The date and time that this nutrition order was requesteddateTime : dateTime [1..1]The practitioner that holds legal responsibility for ordering the diet, nutritional supplement, or formula feedingsorderer : Reference [0..1] « Practitioner|PractitionerRole »A link to a record of allergies or intolerances which should be included in the nutrition orderallergyIntolerance : Reference [0..*] « AllergyIntolerance »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 requirements. (Strength=Example)Diet?? »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 feedingsexcludeFoodModifier : CodeableConcept [0..*] « Codes used to indicate the type of food that should NOT be given to the patient. (Strength=Example)FoodTypeCodes?? »Comments made about the {{title}} by the requester, performer, subject or other participantsnote : Annotation [0..*]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. (Strength=Example)DietCodes?? »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 presentschedule : Timing [0..*]The 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. (Strength=Example) FluidConsistencyTypeCodes?? »Free text or additional instructions or information pertaining to the oral dietinstruction : string [0..1]NutrientThe nutrient that is being modified such as carbohydrate or sodiummodifier : CodeableConcept [0..1] « Codes for types of nutrients that are being modified such as carbohydrate or sodium. (Strength=Example)NutrientModifierCodes?? »The quantity of the specified nutrient to include in dietamount : Quantity(SimpleQuantity) [0..1]TextureAny 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. (Strength=Example)TextureModifierCodes?? »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. (Strength=Example)TextureModifiedFoodTypeCodes?? »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 patient. (Strength=Example)SupplementTypeCodes?? »The product or brand name of the nutritional supplement such as "Acme Protein Shake"productName : string [0..1]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 presentschedule : Timing [0..*]The amount of the nutritional supplement to be givenquantity : Quantity(SimpleQuantity) [0..1]Free text or additional instructions or information pertaining to the oral supplementinstruction : string [0..1]EnteralFormulaThe 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. (Strength=Example)EnteralFormulaTypeCodes?? »The product or brand name of the enteral or infant formula product such as "ACME Adult Standard Formula"baseFormulaProductName : string [0..1]Indicates 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. (Strength=Example) EnteralFormulaAdditiveTypeCode?? »The product or brand name of the type of modular component to be added to the formulaadditiveProductName : string [0..1]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/mLcaloricDensity : Quantity(SimpleQuantity) [0..1]The 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. (Strength=Extensible)EnteralRouteCodes+ »The 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(SimpleQuantity) [0..1]Free text formula administration, feeding instructions or additional instructions or informationadministrationInstruction : string [0..1]AdministrationThe time period and frequency at which the enteral formula should be delivered to the patientschedule : Timing [0..1]The volume of formula to provide to the patient per the specified administration schedulequantity : Quantity(SimpleQuantity) [0..1]The rate of administration of formula via a feeding pump, e.g. 60 mL per hour, according to the specified schedulerate[x] : Element [0..1] « Quantity(SimpleQuantity)|Ratio »Class that defines the quantity and type of nutrient modifications (for example carbohydrate, fiber or sodium) required for the oral dietnutrient[0..*]Class that describes any texture modifications required for the patient to safely consume various types of solid foodstexture[0..*]Diet given orally in contrast to enteral (tube) feedingoralDiet[0..1]Oral nutritional products given in order to add further nutritional value to the patient's dietsupplement[0..*]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 hoursadministration[0..*]Feeding provided through the gastrointestinal tract via a tube, catheter, or stoma that delivers nutrition distal to the oral cavityenteralFormula[0..1]

XML Template

<NutritionOrder xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Identifiers assigned to this order --></identifier>
 <instantiatesCanonical><!-- 0..* canonical(ActivityDefinition|PlanDefinition) Instantiates FHIR protocol or definition --></instantiatesCanonical>
 <instantiatesUri value="[uri]"/><!-- 0..* Instantiates external protocol or definition -->
 <instantiates value="[uri]"/><!-- 0..* Instantiates protocol or definition -->
 <status value="[code]"/><!-- 1..1 draft | active | on-hold | revoked | completed | entered-in-error | unknown -->
 <intent value="[code]"/><!-- 1..1 proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option -->
 <patient><!-- 1..1 Reference(Patient) The person who requires the diet, formula or nutritional supplement --></patient>
 <encounter><!-- 0..1 Reference(Encounter) The encounter associated with this nutrition order --></encounter>
 <dateTime value="[dateTime]"/><!-- 1..1 Date and time the nutrition order was requested -->
 <orderer><!-- 0..1 Reference(Practitioner|PractitionerRole) Who ordered the diet, formula or nutritional supplement --></orderer>
 <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>
  <schedule><!-- 0..* Timing Scheduled frequency of diet --></schedule>
  <nutrient>  <!-- 0..* Required  nutrient modifications -->
   <modifier><!-- 0..1 CodeableConcept Type of nutrient that is being modified --></modifier>
   <amount><!-- 0..1 Quantity(SimpleQuantity) 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 -->
  <schedule><!-- 0..* Timing Scheduled frequency of supplement --></schedule>
  <quantity><!-- 0..1 Quantity(SimpleQuantity) 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 -->
  <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 -->
  <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(SimpleQuantity) 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>
  <administration>  <!-- 0..* Formula feeding instruction as structured data -->
   <schedule><!-- 0..1 Timing Scheduled frequency of enteral feeding --></schedule>
   <quantity><!-- 0..1 Quantity(SimpleQuantity) The volume of formula to provide --></quantity>
   <rate[x]><!-- 0..1 Quantity(SimpleQuantity)|Ratio Speed with which the formula is provided per period of time --></rate[x]>
  </administration>
  <maxVolumeToDeliver><!-- 0..1 Quantity(SimpleQuantity) Upper limit on formula volume per unit of time --></maxVolumeToDeliver>
  <administrationInstruction value="[string]"/><!-- 0..1 Formula feeding instructions expressed as text -->
 </enteralFormula>
 <note><!-- 0..* Annotation Comments --></note>
</NutritionOrder>

JSON Template

{doco
  "resourceType" : "NutritionOrder",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Identifiers assigned to this order
  "instantiatesCanonical" : [{ canonical(ActivityDefinition|PlanDefinition) }], // Instantiates FHIR protocol or definition
  "instantiatesUri" : ["<uri>"], // Instantiates external protocol or definition
  "instantiates" : ["<uri>"], // Instantiates protocol or definition
  "status" : "<code>", // R!  draft | active | on-hold | revoked | completed | entered-in-error | unknown
  "intent" : "<code>", // R!  proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
  "patient" : { Reference(Patient) }, // R!  The person who requires the diet, formula or nutritional supplement
  "encounter" : { Reference(Encounter) }, // The encounter associated with this nutrition order
  "dateTime" : "<dateTime>", // R!  Date and time the nutrition order was requested
  "orderer" : { Reference(Practitioner|PractitionerRole) }, // Who ordered the diet, formula or nutritional supplement
  "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
    "schedule" : [{ Timing }], // Scheduled frequency of diet
    "nutrient" : [{ // Required  nutrient modifications
      "modifier" : { CodeableConcept }, // Type of nutrient that is being modified
      "amount" : { Quantity(SimpleQuantity) } // 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
    "schedule" : [{ Timing }], // Scheduled frequency of supplement
    "quantity" : { Quantity(SimpleQuantity) }, // Amount of the nutritional supplement
    "instruction" : "<string>" // Instructions or additional information about the oral supplement
  }],
  "enteralFormula" : { // C? Enteral formula components
    "baseFormulaType" : { CodeableConcept }, // Type of enteral or infant formula
    "baseFormulaProductName" : "<string>", // Product or brand name of the enteral or infant formula
    "additiveType" : { CodeableConcept }, // Type of modular component to add to the feeding
    "additiveProductName" : "<string>", // Product or brand name of the modular additive
    "caloricDensity" : { Quantity(SimpleQuantity) }, // Amount of energy per specified volume that is required
    "routeofAdministration" : { CodeableConcept }, // How the formula should enter the patient's gastrointestinal tract
    "administration" : [{ // Formula feeding instruction as structured data
      "schedule" : { Timing }, // Scheduled frequency of enteral feeding
      "quantity" : { Quantity(SimpleQuantity) }, // The volume of formula to provide
      // rate[x]: Speed with which the formula is provided per period of time. One of these 2:
      "rateQuantity" : { Quantity(SimpleQuantity) }
      "rateRatio" : { Ratio }
    }],
    "maxVolumeToDeliver" : { Quantity(SimpleQuantity) }, // Upper limit on formula volume per unit of time
    "administrationInstruction" : "<string>" // Formula feeding instructions expressed as text
  },
  "note" : [{ Annotation }] // Comments
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:NutritionOrder;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:NutritionOrder.identifier [ Identifier ], ... ; # 0..* Identifiers assigned to this order
  fhir:NutritionOrder.instantiatesCanonical [ canonical(ActivityDefinition|PlanDefinition) ], ... ; # 0..* Instantiates FHIR protocol or definition
  fhir:NutritionOrder.instantiatesUri [ uri ], ... ; # 0..* Instantiates external protocol or definition
  fhir:NutritionOrder.instantiates [ uri ], ... ; # 0..* Instantiates protocol or definition
  fhir:NutritionOrder.status [ code ]; # 1..1 draft | active | on-hold | revoked | completed | entered-in-error | unknown
  fhir:NutritionOrder.intent [ code ]; # 1..1 proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
  fhir:NutritionOrder.patient [ Reference(Patient) ]; # 1..1 The person who requires the diet, formula or nutritional supplement
  fhir:NutritionOrder.encounter [ Reference(Encounter) ]; # 0..1 The encounter associated with this nutrition order
  fhir:NutritionOrder.dateTime [ dateTime ]; # 1..1 Date and time the nutrition order was requested
  fhir:NutritionOrder.orderer [ Reference(Practitioner|PractitionerRole) ]; # 0..1 Who ordered the diet, formula or nutritional supplement
  fhir:NutritionOrder.allergyIntolerance [ Reference(AllergyIntolerance) ], ... ; # 0..* List of the patient's food and nutrition-related allergies and intolerances
  fhir:NutritionOrder.foodPreferenceModifier [ CodeableConcept ], ... ; # 0..* Order-specific modifier about the type of food that should be given
  fhir:NutritionOrder.excludeFoodModifier [ CodeableConcept ], ... ; # 0..* Order-specific modifier about the type of food that should not be given
  fhir:NutritionOrder.oralDiet [ # 0..1 Oral diet components
    fhir:NutritionOrder.oralDiet.type [ CodeableConcept ], ... ; # 0..* Type of oral diet or diet restrictions that describe what can be consumed orally
    fhir:NutritionOrder.oralDiet.schedule [ Timing ], ... ; # 0..* Scheduled frequency of diet
    fhir:NutritionOrder.oralDiet.nutrient [ # 0..* Required  nutrient modifications
      fhir:NutritionOrder.oralDiet.nutrient.modifier [ CodeableConcept ]; # 0..1 Type of nutrient that is being modified
      fhir:NutritionOrder.oralDiet.nutrient.amount [ Quantity(SimpleQuantity) ]; # 0..1 Quantity of the specified nutrient
    ], ...;
    fhir:NutritionOrder.oralDiet.texture [ # 0..* Required  texture modifications
      fhir:NutritionOrder.oralDiet.texture.modifier [ CodeableConcept ]; # 0..1 Code to indicate how to alter the texture of the foods, e.g. pureed
      fhir:NutritionOrder.oralDiet.texture.foodType [ CodeableConcept ]; # 0..1 Concepts that are used to identify an entity that is ingested for nutritional purposes
    ], ...;
    fhir:NutritionOrder.oralDiet.fluidConsistencyType [ CodeableConcept ], ... ; # 0..* The required consistency of fluids and liquids provided to the patient
    fhir:NutritionOrder.oralDiet.instruction [ string ]; # 0..1 Instructions or additional information about the oral diet
  ];
  fhir:NutritionOrder.supplement [ # 0..* Supplement components
    fhir:NutritionOrder.supplement.type [ CodeableConcept ]; # 0..1 Type of supplement product requested
    fhir:NutritionOrder.supplement.productName [ string ]; # 0..1 Product or brand name of the nutritional supplement
    fhir:NutritionOrder.supplement.schedule [ Timing ], ... ; # 0..* Scheduled frequency of supplement
    fhir:NutritionOrder.supplement.quantity [ Quantity(SimpleQuantity) ]; # 0..1 Amount of the nutritional supplement
    fhir:NutritionOrder.supplement.instruction [ string ]; # 0..1 Instructions or additional information about the oral supplement
  ], ...;
  fhir:NutritionOrder.enteralFormula [ # 0..1 Enteral formula components
    fhir:NutritionOrder.enteralFormula.baseFormulaType [ CodeableConcept ]; # 0..1 Type of enteral or infant formula
    fhir:NutritionOrder.enteralFormula.baseFormulaProductName [ string ]; # 0..1 Product or brand name of the enteral or infant formula
    fhir:NutritionOrder.enteralFormula.additiveType [ CodeableConcept ]; # 0..1 Type of modular component to add to the feeding
    fhir:NutritionOrder.enteralFormula.additiveProductName [ string ]; # 0..1 Product or brand name of the modular additive
    fhir:NutritionOrder.enteralFormula.caloricDensity [ Quantity(SimpleQuantity) ]; # 0..1 Amount of energy per specified volume that is required
    fhir:NutritionOrder.enteralFormula.routeofAdministration [ CodeableConcept ]; # 0..1 How the formula should enter the patient's gastrointestinal tract
    fhir:NutritionOrder.enteralFormula.administration [ # 0..* Formula feeding instruction as structured data
      fhir:NutritionOrder.enteralFormula.administration.schedule [ Timing ]; # 0..1 Scheduled frequency of enteral feeding
      fhir:NutritionOrder.enteralFormula.administration.quantity [ Quantity(SimpleQuantity) ]; # 0..1 The volume of formula to provide
      # NutritionOrder.enteralFormula.administration.rate[x] : 0..1 Speed with which the formula is provided per period of time. One of these 2
        fhir:NutritionOrder.enteralFormula.administration.rateSimpleQuantity [ Quantity(SimpleQuantity) ]
        fhir:NutritionOrder.enteralFormula.administration.rateRatio [ Ratio ]
    ], ...;
    fhir:NutritionOrder.enteralFormula.maxVolumeToDeliver [ Quantity(SimpleQuantity) ]; # 0..1 Upper limit on formula volume per unit of time
    fhir:NutritionOrder.enteralFormula.administrationInstruction [ string ]; # 0..1 Formula feeding instructions expressed as text
  ];
  fhir:NutritionOrder.note [ Annotation ], ... ; # 0..* Comments
]

Changes since Release 3

NutritionOrder
NutritionOrder.status
  • Change value set from http://hl7.org/fhir/ValueSet/request-status|4.0.0 to http://hl7.org/fhir/ValueSet/request-status|4.1.0
NutritionOrder.intent
  • Change value set from http://hl7.org/fhir/ValueSet/request-intent|4.0.0 to http://hl7.org/fhir/ValueSet/request-intent|4.1.0
NutritionOrder.enteralFormula.administration.rate[x]
  • Add Type Quantity()
  • Remove Type Quantity()

See the Full Difference for further information

This analysis is available as XML or JSON.

See R3 <--> R4 Conversion Maps (status = 13 tests that all execute ok. All tests pass round-trip testing and 13 r3 resources are invalid (0 errors).)

 

See the Profiles & Extensions and the alternate definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions & the dependency analysis

12.15.4.1 Terminology Bindings

PathDefinitionTypeReference
NutritionOrder.status Codes identifying the lifecycle stage of the nutrition order.RequiredRequestStatus
NutritionOrder.intent Codes indicating the degree of authority/intentionality associated with a nutrition order.RequiredRequestIntent
NutritionOrder.foodPreferenceModifier Medical, cultural or ethical food preferences to help with catering requirements.ExampleDiet
NutritionOrder.excludeFoodModifier Codes used to indicate the type of food that should NOT be given to the patient.ExampleFoodTypeCodes
NutritionOrder.oralDiet.type Codes used to indicate the type of diet being ordered for a patient.ExampleDietCodes
NutritionOrder.oralDiet.nutrient.modifier Codes for types of nutrients that are being modified such as carbohydrate or sodium.ExampleNutrientModifierCodes
NutritionOrder.oralDiet.texture.modifier Codes for food consistency types or texture modifications to apply to foods.ExampleTextureModifierCodes
NutritionOrder.oralDiet.texture.foodType Codes for types of foods that are texture-modified.ExampleTextureModifiedFoodTypeCodes
NutritionOrder.oralDiet.fluidConsistencyType Codes used to represent the consistency of fluids and liquids provided to the patient.ExampleFluidConsistencyTypeCodes
NutritionOrder.supplement.type Codes for nutritional supplements to be provided to the patient.ExampleSupplementTypeCodes
NutritionOrder.enteralFormula.baseFormulaType Codes for type of enteral formula to be administered to patient.ExampleEnteralFormulaTypeCodes
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.ExampleEnteralFormulaAdditiveTypeCode
NutritionOrder.enteralFormula.routeofAdministration Codes specifying the route of administration of enteral formula.ExtensibleEnteralRouteCodes

12.15.4.2 Constraints

idLevelLocationDescriptionExpression
nor-1Warning (base)Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula classoralDiet.exists() or supplement.exists() or enteralFormula.exists()

12.15.5 Notes:

12.15.5.1 Enteral continuous vs. intermittent tube feedings

Tube feedings can be administered via continuous drip using a pump or via intermittent feedings, using gravity drip or a pump. The examples Nutrition Order Enteral Bolus Feeding Example and Nutrition Order Enteral Continuous Feeding Example show how this resource can be used to order both kinds of enteral feeding using the structured data elements. The continuous feeding typically specifies rate of administration and a maximum volume of delivery using the enteralFormula.administration.rate and enteralFormula.maxVolumeToDeliver elements. On the other hand, the intermittent feeding typically specifies the amount and frequency of administration using the enteralFormula.administration.quantity and enteralFormula.schedule elements. In both cases, to vary the rate or quantity over time the enteralFormula.administration element can be repeated.

12.15.5.2 Note about the examples

The examples associated with this resource demonstrate the core elements and do not necessarily reflect real world implementations that may be constrained by future profiles for a given implementation or setting. For example, a renal diet is often comprised of pre-coordinated components including common nutrient modifications such as protein, potassium and phosphorus to assist with the speed of entry of complex diet orders.

12.15.6 Search Parameters

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

NameTypeDescriptionExpressionIn Common
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 identifierNutritionOrder.encounter
(Encounter)
formulatokenType of enteral or infant formulaNutritionOrder.enteralFormula.baseFormulaType
identifiertokenReturn nutrition orders with this external identifierNutritionOrder.identifier
instantiates-canonicalreferenceInstantiates FHIR protocol or definitionNutritionOrder.instantiatesCanonical
(PlanDefinition, ActivityDefinition)
instantiates-uriuriInstantiates external protocol or definitionNutritionOrder.instantiatesUri
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 identity of the provider who placed the nutrition orderNutritionOrder.orderer
(Practitioner, PractitionerRole)
statustokenStatus of the nutrition order.NutritionOrder.status
supplementtokenType of supplement product requestedNutritionOrder.supplement.type