Release 5 Ballot

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12.20 Resource NutritionIntake - Content

Orders and Observations Work GroupMaturity Level: 1 Trial UseSecurity Category: Patient Compartments: Encounter, Patient, Practitioner, RelatedPerson

A record of food or fluid that is being consumed by a patient. A NutritionIntake may indicate that the patient may be consuming the food or fluid now or has consumed the food or fluid in the past. The source of this information can be the patient, significant other (such as a family member or spouse), or a clinician. A common scenario where this information is captured is during the history taking process during a patient visit or stay or through an app that tracks food or fluids consumed. The consumption information may come from sources such as the patient's memory, from a nutrition label, or from a clinician documenting observed intake.

12.20.1 Scope and Usage

This resource is an event 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 event resources.

The NutritionIntake resource, in conjunction with the NutritionProduct resource, is utilized to capture details about the consumption of foods, fluids, and enteral nutrition. Dietitians and other clinicians use the data to calculate how much nutrition a patient has taken in. NutritionIntake represents the event of consuming food, fluid, etc. and NutritionProduct represents the actual food items.

NutritionIntake can also be used to record a person’s intake through uses of food tracking apps (e.g.MyFitnessPal), any grocery store purchases, or a student’s meal consumption in a school district.

NutritionIntake can be utilized in many environments where food is served, consumed or purchased: hospitals/acute care, meal tracking systems, school districts, grocery stores, outpatient settings, LTC, etc. NutritionIntake should be general enough to capture intake regardless of country or region.

Parenteral nutrition is out of scope as this ordering is handled through MedicationRequest, thus administration of parenteral nutrition should also be captured through MedicationAdministration.

12.20.2 Boundaries and Relationships

  • Oral intake of food, fluids, oral nutritional supplements (i.e. Ensure), or enteral nutrition should be recorded using the NutritionIntake resource.
  • Supplements, such as vitamins, minerals, herbals, should be recorded using the medication resources
  • Parenteral nutrition should be recorded using the medication resources

12.20.3 Background and Context

As a dietitian, it is important to be able to know what a person is consuming and assess the adequacy of the patient’s diet. Capturing a patient’s intake is important to establish a baseline, determine care, track trends, and see improvement of that patient. Dietitians might use intake data to see patterns, such as when a diabetic patient’s blood glucose is consistently high due to over consumption of carbohydrates. Other clinicians have the need to monitor intake as well; for example, a nurse might need to know intake for administering insulin prior to meals or a physician may need to ensure a patient on a fluid restriction is following orders.

Having intake documented within its own resource allows for consistency in documentation acrossmultiple disciplines and settings. In some instances, the Observation resource has been extended to capture intake; while this allows for a quick way to document intake, the Observation resource does not provide all the detail necessary, such as capturing all the nutrients ( including calories, vitamins, minerals, carbohydrates, etc.). Previous implementation attempts of using the Observation resourcehave noted this is cumbersome and has required too many extensions without being able to documentall the necessary details tied to ingredients in food and fluid products.

12.20.4 References to this Resource

  • Implements: and Event
  • Resource References: : and itself

12.20.5 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. NutritionIntake TUDomainResourceRecord of food or fluid being taken by a patient

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ0..*IdentifierExternal identifier

... instantiatesCanonical 0..*canonical(Definition)Instantiates FHIR protocol or definition

... instantiatesUri 0..*uriInstantiates external protocol or definition

... partOf Σ0..*Reference(NutritionIntake | Procedure | Observation)Part of referenced event

... status ?!Σ1..1codepreparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
EventStatus (Required)
... statusReason 0..*CodeableConceptReason for current status
ClinicalImpression Status Reason (Example)

... code Σ0..1CodeableConceptCode representing an overall type of nutrition intake
Diet Codes (Example)
... subject Σ1..1Reference(Patient | Group)Who is/was consuming the food or fluid
... encounter Σ0..1Reference(Encounter)Encounter associated with NutritionIntake
... occurrence[x] Σ0..1The date/time or interval when the food or fluid is/was consumed
.... occurrenceDateTimedateTime
.... occurrencePeriodPeriod
... recorded Σ0..1dateTimeWhen the intake was recorded
... reported[x] 0..1Person or organization that provided the information about the consumption of this food or fluid
.... reportedBooleanboolean
.... reportedReferenceReference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization)
... consumedItem 1..*BackboneElementWhat food or fluid product or item was consumed

.... type Σ1..1CodeableConceptThe type of food or fluid product
Types of Edible Substances (Example)
.... nutritionProduct Σ1..1CodeableReference(NutritionProduct)Code that identifies the food or fluid product that was consumed
Food Type Codes (Example)
.... schedule 0..1TimingScheduled frequency of consumption
.... amount Σ0..1SimpleQuantityQuantity of the specified food
.... rate Σ0..1SimpleQuantityRate at which enteral feeding was administered
.... notConsumed 0..1booleanFlag to indicate if the food or fluid item was refused or otherwise not consumed
.... notConsumedReason 0..1CodeableConceptReason food or fluid was not consumed
Reasons for why a food item was not consumed (Example)
... ingredientLabel 0..*BackboneElementTotal nutrient for the whole meal, product, serving

.... nutrient 1..1CodeableReference(Substance)Total nutrient consumed
Nutrient Modifier Codes (Example)
.... amount 1..1SimpleQuantityTotal amount of nutrient consumed
... performer 0..*BackboneElementWho was performed in the intake

.... function 0..1CodeableConceptType of performer
Procedure Performer Role Codes (Example)
.... actor 1..1Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson)Who performed the intake
... location 0..1Reference(Location)Where the intake occurred
... derivedFrom 0..*Reference(Any)Additional supporting information

... reason 0..*CodeableReference(Condition | Observation | DiagnosticReport | DocumentReference)Reason for why the food or fluid is /was consumed
Condition/Problem/Diagnosis Codes (Example)

... note 0..*AnnotationFurther information about the consumption


doco Documentation for this format

See the Extensions for this resource

UML Diagram (Legend)

NutritionIntake (DomainResource)Identifiers associated with this Nutrition Intake that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to serveridentifier : Identifier [0..*]Instantiates FHIR protocol or definitioninstantiatesCanonical : canonical [0..*] « Definition »Instantiates external protocol or definitioninstantiatesUri : uri [0..*]A plan, proposal or order that is fulfilled in whole or in part by this eventbasedOn : Reference [0..*] « NutritionOrder|CarePlan|ServiceRequest »A larger event of which this particular event is a component or steppartOf : Reference [0..*] « NutritionIntake|Procedure|Observation »A code representing the patient or other source's judgment about the state of the intake that this assertion is about. Generally, this will be active or completed (this element modifies the meaning of other elements)status : code [1..1] « null (Strength=Required)EventStatus! »Captures the reason for the current state of the NutritionIntakestatusReason : CodeableConcept [0..*] « null (Strength=Example) ClinicalImpressionStatusReason?? »Overall type of nutrition intakecode : CodeableConcept [0..1] « null (Strength=Example)DietCodes?? »The person, animal or group who is/was consuming the food or fluidsubject : Reference [1..1] « Patient|Group »The encounter that establishes the context for this NutritionIntakeencounter : Reference [0..1] « Encounter »The interval of time during which it is being asserted that the patient is/was consuming the food or fluidoccurrence[x] : DataType [0..1] « dateTime|Period »The date when the Nutrition Intake was asserted by the information sourcerecorded : dateTime [0..1]The person or organization that provided the information about the consumption of this food or fluid. Note: Use derivedFrom when a NutritionIntake is derived from other resourcesreported[x] : DataType [0..1] « boolean|Reference(Patient| RelatedPerson|Practitioner|PractitionerRole|Organization) »Where the intake occurredlocation : Reference [0..1] « Location »Allows linking the NutritionIntake to the underlying NutritionOrder, or to other information, such as AllergyIntolerance, that supports or is used to derive the NutritionIntakederivedFrom : Reference [0..*] « Any »A reason, Condition or observation for why the food or fluid is /was consumedreason : CodeableReference [0..*] « Condition|Observation| DiagnosticReport|DocumentReference; null (Strength=Example) Condition/Problem/DiagnosisCo...?? »Provides extra information about the Nutrition Intake that is not conveyed by the other attributesnote : Annotation [0..*]ConsumedItemIndicates what a category of item that was consumed: eg., food, fluid, enteral, etctype : CodeableConcept [1..1] « null (Strength=Example)Types of Edible Substances?? »Identifies the food or fluid product that was consumed. This is potentially a link to a resource representing the details of the food product (TBD) or a simple attribute carrying a code that identifies the food from a known list of foodsnutritionProduct : CodeableReference [1..1] « NutritionProduct; null (Strength=Example) FoodTypeCodes?? »Scheduled frequency of consumptionschedule : Timing [0..1]Quantity of the specified foodamount : Quantity(SimpleQuantity) [0..1]Rate at which enteral feeding was administeredrate : Quantity(SimpleQuantity) [0..1]Indicator when a patient is in a setting where it is helpful to know if food was not consumed, such as it was refused, held (as in tube feedings), or otherwise not provided. If a consumption is being recorded from an app, such as MyFitnessPal, this indicator will likely not be usednotConsumed : boolean [0..1]Document the reason the food or fluid was not consumed, such as refused, held, etcnotConsumedReason : CodeableConcept [0..1] « null (Strength=Example)Reasons for why a food item w...?? »IngredientLabelTotal nutrient consumed. This could be a macronutrient (protein, fat, carbohydrate), or a vitamin and mineralnutrient : CodeableReference [1..1] « Substance; null (Strength=Example) NutrientModifierCodes?? »Total amount of nutrient consumedamount : Quantity(SimpleQuantity) [1..1]PerformerType of performerfunction : CodeableConcept [0..1] « null (Strength=Example)ProcedurePerformerRoleCodes?? »Who performed the intakeactor : Reference [1..1] « Practitioner|PractitionerRole| Organization|CareTeam|Patient|Device|RelatedPerson »What food or fluid product or item was consumedconsumedItem[1..*]Total nutrient amounts for the whole meal, product, serving, etcingredientLabel[0..*]Who performed the intake and how they were involvedperformer[0..*]

XML Template

<NutritionIntake xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier External identifier --></identifier>
 <instantiatesCanonical><!-- 0..* canonical(ActivityDefinition|
   ChargeItemDefinition|EventDefinition|Measure|MessageDefinition|
   ObservationDefinition|OperationDefinition|PlanDefinition|Questionnaire|
   SubscriptionTopic|TestScript) Instantiates FHIR protocol or definition --></instantiatesCanonical>
 <instantiatesUri value="[uri]"/><!-- 0..* Instantiates external protocol or definition -->
 <basedOn><!-- 0..* Reference(CarePlan|NutritionOrder|ServiceRequest) Fulfils plan, proposal or order --></basedOn>
 <partOf><!-- 0..* Reference(NutritionIntake|Observation|Procedure) Part of referenced event --></partOf>
 <status value="[code]"/><!-- 1..1 preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown -->
 <statusReason><!-- 0..* CodeableConcept Reason for current status --></statusReason>
 <code><!-- 0..1 CodeableConcept Code representing an overall type of nutrition intake --></code>
 <subject><!-- 1..1 Reference(Group|Patient) Who is/was consuming the food or fluid --></subject>
 <encounter><!-- 0..1 Reference(Encounter) Encounter associated with NutritionIntake --></encounter>
 <occurrence[x]><!-- 0..1 dateTime|Period The date/time or interval when the food or fluid is/was consumed --></occurrence[x]>
 <recorded value="[dateTime]"/><!-- 0..1 When the intake was recorded -->
 <reported[x]><!-- 0..1 boolean|Reference(Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) Person or organization that provided the information about the consumption of this food or fluid --></reported[x]>
 <consumedItem>  <!-- 1..* What food or fluid product or item was consumed -->
  <type><!-- 1..1 CodeableConcept The type of food or fluid product --></type>
  <nutritionProduct><!-- 1..1 CodeableReference(NutritionProduct) Code that identifies the food or fluid product that was consumed --></nutritionProduct>
  <schedule><!-- 0..1 Timing Scheduled frequency of consumption --></schedule>
  <amount><!-- 0..1 Quantity(SimpleQuantity) Quantity of the specified food --></amount>
  <rate><!-- 0..1 Quantity(SimpleQuantity) Rate at which enteral feeding was administered --></rate>
  <notConsumed value="[boolean]"/><!-- 0..1 Flag to indicate if the food or fluid item was refused or otherwise not consumed -->
  <notConsumedReason><!-- 0..1 CodeableConcept Reason food or fluid was not consumed --></notConsumedReason>
 </consumedItem>
 <ingredientLabel>  <!-- 0..* Total nutrient for the whole meal, product, serving -->
  <nutrient><!-- 1..1 CodeableReference(Substance) Total nutrient consumed --></nutrient>
  <amount><!-- 1..1 Quantity(SimpleQuantity) Total amount of nutrient consumed --></amount>
 </ingredientLabel>
 <performer>  <!-- 0..* Who was performed in the intake -->
  <function><!-- 0..1 CodeableConcept Type of performer --></function>
  <actor><!-- 1..1 Reference(CareTeam|Device|Organization|Patient|Practitioner|
    PractitionerRole|RelatedPerson) Who performed the intake --></actor>
 </performer>
 <location><!-- 0..1 Reference(Location) Where the intake occurred --></location>
 <derivedFrom><!-- 0..* Reference(Any) Additional supporting information --></derivedFrom>
 <reason><!-- 0..* CodeableReference(Condition|DiagnosticReport|DocumentReference|
   Observation) Reason for why the food or fluid is /was consumed --></reason>
 <note><!-- 0..* Annotation Further information about the consumption --></note>
</NutritionIntake>

JSON Template

{doco
  "resourceType" : "NutritionIntake",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External identifier
  "instantiatesCanonical" : ["<canonical(Definition)>"], // Instantiates FHIR protocol or definition
  "instantiatesUri" : ["<uri>"], // Instantiates external protocol or definition
  "basedOn" : [{ Reference(CarePlan|NutritionOrder|ServiceRequest) }], // Fulfils plan, proposal or order
  "partOf" : [{ Reference(NutritionIntake|Observation|Procedure) }], // Part of referenced event
  "status" : "<code>", // R!  preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
  "statusReason" : [{ CodeableConcept }], // Reason for current status
  "code" : { CodeableConcept }, // Code representing an overall type of nutrition intake
  "subject" : { Reference(Group|Patient) }, // R!  Who is/was consuming the food or fluid
  "encounter" : { Reference(Encounter) }, // Encounter associated with NutritionIntake
  // occurrence[x]: The date/time or interval when the food or fluid is/was consumed. One of these 2:
  "occurrenceDateTime" : "<dateTime>",
  "occurrencePeriod" : { Period },
  "recorded" : "<dateTime>", // When the intake was recorded
  // reported[x]: 
     Person or organization that provided the information about the consumption of this food or fluid. One of these 2:
  "reportedBoolean" : <boolean>,
  "reportedReference" : { Reference(Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) },
  "consumedItem" : [{ // R!  What food or fluid product or item was consumed
    "type" : { CodeableConcept }, // R!  The type of food or fluid product
    "nutritionProduct" : { CodeableReference(NutritionProduct) }, // R!  Code that identifies the food or fluid product that was consumed
    "schedule" : { Timing }, // Scheduled frequency of consumption
    "amount" : { Quantity(SimpleQuantity) }, // Quantity of the specified food
    "rate" : { Quantity(SimpleQuantity) }, // Rate at which enteral feeding was administered
    "notConsumed" : <boolean>, // Flag to indicate if the food or fluid item was refused or otherwise not consumed
    "notConsumedReason" : { CodeableConcept } // Reason food or fluid was not consumed
  }],
  "ingredientLabel" : [{ // Total nutrient for the whole meal, product, serving
    "nutrient" : { CodeableReference(Substance) }, // R!  Total nutrient consumed
    "amount" : { Quantity(SimpleQuantity) } // R!  Total amount of nutrient consumed
  }],
  "performer" : [{ // Who was performed in the intake
    "function" : { CodeableConcept }, // Type of performer
    "actor" : { Reference(CareTeam|Device|Organization|Patient|Practitioner|
    PractitionerRole|RelatedPerson) } // R!  Who performed the intake
  }],
  "location" : { Reference(Location) }, // Where the intake occurred
  "derivedFrom" : [{ Reference(Any) }], // Additional supporting information
  "reason" : [{ CodeableReference(Condition|DiagnosticReport|DocumentReference|
   Observation) }], // Reason for why the food or fluid is /was consumed
  "note" : [{ Annotation }] // Further information about the consumption
}

Turtle Template

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


[ a fhir:NutritionIntake;
  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:NutritionIntake.identifier [ Identifier ], ... ; # 0..* External identifier
  fhir:NutritionIntake.instantiatesCanonical [ canonical(ActivityDefinition|ChargeItemDefinition|EventDefinition|Measure|
  MessageDefinition|ObservationDefinition|OperationDefinition|PlanDefinition|
  Questionnaire|SubscriptionTopic|TestScript) ], ... ; # 0..* Instantiates FHIR protocol or definition
  fhir:NutritionIntake.instantiatesUri [ uri ], ... ; # 0..* Instantiates external protocol or definition
  fhir:NutritionIntake.basedOn [ Reference(CarePlan|NutritionOrder|ServiceRequest) ], ... ; # 0..* Fulfils plan, proposal or order
  fhir:NutritionIntake.partOf [ Reference(NutritionIntake|Observation|Procedure) ], ... ; # 0..* Part of referenced event
  fhir:NutritionIntake.status [ code ]; # 1..1 preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
  fhir:NutritionIntake.statusReason [ CodeableConcept ], ... ; # 0..* Reason for current status
  fhir:NutritionIntake.code [ CodeableConcept ]; # 0..1 Code representing an overall type of nutrition intake
  fhir:NutritionIntake.subject [ Reference(Group|Patient) ]; # 1..1 Who is/was consuming the food or fluid
  fhir:NutritionIntake.encounter [ Reference(Encounter) ]; # 0..1 Encounter associated with NutritionIntake
  # NutritionIntake.occurrence[x] : 0..1 The date/time or interval when the food or fluid is/was consumed. One of these 2
    fhir:NutritionIntake.occurrenceDateTime [ dateTime ]
    fhir:NutritionIntake.occurrencePeriod [ Period ]
  fhir:NutritionIntake.recorded [ dateTime ]; # 0..1 When the intake was recorded
  # NutritionIntake.reported[x] : 0..1 Person or organization that provided the information about the consumption of this food or fluid. One of these 2
    fhir:NutritionIntake.reportedBoolean [ boolean ]
    fhir:NutritionIntake.reportedReference [ Reference(Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ]
  fhir:NutritionIntake.consumedItem [ # 1..* What food or fluid product or item was consumed
    fhir:NutritionIntake.consumedItem.type [ CodeableConcept ]; # 1..1 The type of food or fluid product
    fhir:NutritionIntake.consumedItem.nutritionProduct [ CodeableReference(NutritionProduct) ]; # 1..1 Code that identifies the food or fluid product that was consumed
    fhir:NutritionIntake.consumedItem.schedule [ Timing ]; # 0..1 Scheduled frequency of consumption
    fhir:NutritionIntake.consumedItem.amount [ Quantity(SimpleQuantity) ]; # 0..1 Quantity of the specified food
    fhir:NutritionIntake.consumedItem.rate [ Quantity(SimpleQuantity) ]; # 0..1 Rate at which enteral feeding was administered
    fhir:NutritionIntake.consumedItem.notConsumed [ boolean ]; # 0..1 Flag to indicate if the food or fluid item was refused or otherwise not consumed
    fhir:NutritionIntake.consumedItem.notConsumedReason [ CodeableConcept ]; # 0..1 Reason food or fluid was not consumed
  ], ...;
  fhir:NutritionIntake.ingredientLabel [ # 0..* Total nutrient for the whole meal, product, serving
    fhir:NutritionIntake.ingredientLabel.nutrient [ CodeableReference(Substance) ]; # 1..1 Total nutrient consumed
    fhir:NutritionIntake.ingredientLabel.amount [ Quantity(SimpleQuantity) ]; # 1..1 Total amount of nutrient consumed
  ], ...;
  fhir:NutritionIntake.performer [ # 0..* Who was performed in the intake
    fhir:NutritionIntake.performer.function [ CodeableConcept ]; # 0..1 Type of performer
    fhir:NutritionIntake.performer.actor [ Reference(CareTeam|Device|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ]; # 1..1 Who performed the intake
  ], ...;
  fhir:NutritionIntake.location [ Reference(Location) ]; # 0..1 Where the intake occurred
  fhir:NutritionIntake.derivedFrom [ Reference(Any) ], ... ; # 0..* Additional supporting information
  fhir:NutritionIntake.reason [ CodeableReference(Condition|DiagnosticReport|DocumentReference|Observation) ], ... ; # 0..* Reason for why the food or fluid is /was consumed
  fhir:NutritionIntake.note [ Annotation ], ... ; # 0..* Further information about the consumption
]

Changes since R4

This resource did not exist in Release 3

This analysis is available as XML or JSON.

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. NutritionIntake TUDomainResourceRecord of food or fluid being taken by a patient

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ0..*IdentifierExternal identifier

... instantiatesCanonical 0..*canonical(Definition)Instantiates FHIR protocol or definition

... instantiatesUri 0..*uriInstantiates external protocol or definition

... partOf Σ0..*Reference(NutritionIntake | Procedure | Observation)Part of referenced event

... status ?!Σ1..1codepreparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
EventStatus (Required)
... statusReason 0..*CodeableConceptReason for current status
ClinicalImpression Status Reason (Example)

... code Σ0..1CodeableConceptCode representing an overall type of nutrition intake
Diet Codes (Example)
... subject Σ1..1Reference(Patient | Group)Who is/was consuming the food or fluid
... encounter Σ0..1Reference(Encounter)Encounter associated with NutritionIntake
... occurrence[x] Σ0..1The date/time or interval when the food or fluid is/was consumed
.... occurrenceDateTimedateTime
.... occurrencePeriodPeriod
... recorded Σ0..1dateTimeWhen the intake was recorded
... reported[x] 0..1Person or organization that provided the information about the consumption of this food or fluid
.... reportedBooleanboolean
.... reportedReferenceReference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization)
... consumedItem 1..*BackboneElementWhat food or fluid product or item was consumed

.... type Σ1..1CodeableConceptThe type of food or fluid product
Types of Edible Substances (Example)
.... nutritionProduct Σ1..1CodeableReference(NutritionProduct)Code that identifies the food or fluid product that was consumed
Food Type Codes (Example)
.... schedule 0..1TimingScheduled frequency of consumption
.... amount Σ0..1SimpleQuantityQuantity of the specified food
.... rate Σ0..1SimpleQuantityRate at which enteral feeding was administered
.... notConsumed 0..1booleanFlag to indicate if the food or fluid item was refused or otherwise not consumed
.... notConsumedReason 0..1CodeableConceptReason food or fluid was not consumed
Reasons for why a food item was not consumed (Example)
... ingredientLabel 0..*BackboneElementTotal nutrient for the whole meal, product, serving

.... nutrient 1..1CodeableReference(Substance)Total nutrient consumed
Nutrient Modifier Codes (Example)
.... amount 1..1SimpleQuantityTotal amount of nutrient consumed
... performer 0..*BackboneElementWho was performed in the intake

.... function 0..1CodeableConceptType of performer
Procedure Performer Role Codes (Example)
.... actor 1..1Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson)Who performed the intake
... location 0..1Reference(Location)Where the intake occurred
... derivedFrom 0..*Reference(Any)Additional supporting information

... reason 0..*CodeableReference(Condition | Observation | DiagnosticReport | DocumentReference)Reason for why the food or fluid is /was consumed
Condition/Problem/Diagnosis Codes (Example)

... note 0..*AnnotationFurther information about the consumption


doco Documentation for this format

See the Extensions for this resource

UML Diagram (Legend)

NutritionIntake (DomainResource)Identifiers associated with this Nutrition Intake that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate. They are business identifiers assigned to this resource by the performer or other systems and remain constant as the resource is updated and propagates from server to serveridentifier : Identifier [0..*]Instantiates FHIR protocol or definitioninstantiatesCanonical : canonical [0..*] « Definition »Instantiates external protocol or definitioninstantiatesUri : uri [0..*]A plan, proposal or order that is fulfilled in whole or in part by this eventbasedOn : Reference [0..*] « NutritionOrder|CarePlan|ServiceRequest »A larger event of which this particular event is a component or steppartOf : Reference [0..*] « NutritionIntake|Procedure|Observation »A code representing the patient or other source's judgment about the state of the intake that this assertion is about. Generally, this will be active or completed (this element modifies the meaning of other elements)status : code [1..1] « null (Strength=Required)EventStatus! »Captures the reason for the current state of the NutritionIntakestatusReason : CodeableConcept [0..*] « null (Strength=Example) ClinicalImpressionStatusReason?? »Overall type of nutrition intakecode : CodeableConcept [0..1] « null (Strength=Example)DietCodes?? »The person, animal or group who is/was consuming the food or fluidsubject : Reference [1..1] « Patient|Group »The encounter that establishes the context for this NutritionIntakeencounter : Reference [0..1] « Encounter »The interval of time during which it is being asserted that the patient is/was consuming the food or fluidoccurrence[x] : DataType [0..1] « dateTime|Period »The date when the Nutrition Intake was asserted by the information sourcerecorded : dateTime [0..1]The person or organization that provided the information about the consumption of this food or fluid. Note: Use derivedFrom when a NutritionIntake is derived from other resourcesreported[x] : DataType [0..1] « boolean|Reference(Patient| RelatedPerson|Practitioner|PractitionerRole|Organization) »Where the intake occurredlocation : Reference [0..1] « Location »Allows linking the NutritionIntake to the underlying NutritionOrder, or to other information, such as AllergyIntolerance, that supports or is used to derive the NutritionIntakederivedFrom : Reference [0..*] « Any »A reason, Condition or observation for why the food or fluid is /was consumedreason : CodeableReference [0..*] « Condition|Observation| DiagnosticReport|DocumentReference; null (Strength=Example) Condition/Problem/DiagnosisCo...?? »Provides extra information about the Nutrition Intake that is not conveyed by the other attributesnote : Annotation [0..*]ConsumedItemIndicates what a category of item that was consumed: eg., food, fluid, enteral, etctype : CodeableConcept [1..1] « null (Strength=Example)Types of Edible Substances?? »Identifies the food or fluid product that was consumed. This is potentially a link to a resource representing the details of the food product (TBD) or a simple attribute carrying a code that identifies the food from a known list of foodsnutritionProduct : CodeableReference [1..1] « NutritionProduct; null (Strength=Example) FoodTypeCodes?? »Scheduled frequency of consumptionschedule : Timing [0..1]Quantity of the specified foodamount : Quantity(SimpleQuantity) [0..1]Rate at which enteral feeding was administeredrate : Quantity(SimpleQuantity) [0..1]Indicator when a patient is in a setting where it is helpful to know if food was not consumed, such as it was refused, held (as in tube feedings), or otherwise not provided. If a consumption is being recorded from an app, such as MyFitnessPal, this indicator will likely not be usednotConsumed : boolean [0..1]Document the reason the food or fluid was not consumed, such as refused, held, etcnotConsumedReason : CodeableConcept [0..1] « null (Strength=Example)Reasons for why a food item w...?? »IngredientLabelTotal nutrient consumed. This could be a macronutrient (protein, fat, carbohydrate), or a vitamin and mineralnutrient : CodeableReference [1..1] « Substance; null (Strength=Example) NutrientModifierCodes?? »Total amount of nutrient consumedamount : Quantity(SimpleQuantity) [1..1]PerformerType of performerfunction : CodeableConcept [0..1] « null (Strength=Example)ProcedurePerformerRoleCodes?? »Who performed the intakeactor : Reference [1..1] « Practitioner|PractitionerRole| Organization|CareTeam|Patient|Device|RelatedPerson »What food or fluid product or item was consumedconsumedItem[1..*]Total nutrient amounts for the whole meal, product, serving, etcingredientLabel[0..*]Who performed the intake and how they were involvedperformer[0..*]

XML Template

<NutritionIntake xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier External identifier --></identifier>
 <instantiatesCanonical><!-- 0..* canonical(ActivityDefinition|
   ChargeItemDefinition|EventDefinition|Measure|MessageDefinition|
   ObservationDefinition|OperationDefinition|PlanDefinition|Questionnaire|
   SubscriptionTopic|TestScript) Instantiates FHIR protocol or definition --></instantiatesCanonical>
 <instantiatesUri value="[uri]"/><!-- 0..* Instantiates external protocol or definition -->
 <basedOn><!-- 0..* Reference(CarePlan|NutritionOrder|ServiceRequest) Fulfils plan, proposal or order --></basedOn>
 <partOf><!-- 0..* Reference(NutritionIntake|Observation|Procedure) Part of referenced event --></partOf>
 <status value="[code]"/><!-- 1..1 preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown -->
 <statusReason><!-- 0..* CodeableConcept Reason for current status --></statusReason>
 <code><!-- 0..1 CodeableConcept Code representing an overall type of nutrition intake --></code>
 <subject><!-- 1..1 Reference(Group|Patient) Who is/was consuming the food or fluid --></subject>
 <encounter><!-- 0..1 Reference(Encounter) Encounter associated with NutritionIntake --></encounter>
 <occurrence[x]><!-- 0..1 dateTime|Period The date/time or interval when the food or fluid is/was consumed --></occurrence[x]>
 <recorded value="[dateTime]"/><!-- 0..1 When the intake was recorded -->
 <reported[x]><!-- 0..1 boolean|Reference(Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) Person or organization that provided the information about the consumption of this food or fluid --></reported[x]>
 <consumedItem>  <!-- 1..* What food or fluid product or item was consumed -->
  <type><!-- 1..1 CodeableConcept The type of food or fluid product --></type>
  <nutritionProduct><!-- 1..1 CodeableReference(NutritionProduct) Code that identifies the food or fluid product that was consumed --></nutritionProduct>
  <schedule><!-- 0..1 Timing Scheduled frequency of consumption --></schedule>
  <amount><!-- 0..1 Quantity(SimpleQuantity) Quantity of the specified food --></amount>
  <rate><!-- 0..1 Quantity(SimpleQuantity) Rate at which enteral feeding was administered --></rate>
  <notConsumed value="[boolean]"/><!-- 0..1 Flag to indicate if the food or fluid item was refused or otherwise not consumed -->
  <notConsumedReason><!-- 0..1 CodeableConcept Reason food or fluid was not consumed --></notConsumedReason>
 </consumedItem>
 <ingredientLabel>  <!-- 0..* Total nutrient for the whole meal, product, serving -->
  <nutrient><!-- 1..1 CodeableReference(Substance) Total nutrient consumed --></nutrient>
  <amount><!-- 1..1 Quantity(SimpleQuantity) Total amount of nutrient consumed --></amount>
 </ingredientLabel>
 <performer>  <!-- 0..* Who was performed in the intake -->
  <function><!-- 0..1 CodeableConcept Type of performer --></function>
  <actor><!-- 1..1 Reference(CareTeam|Device|Organization|Patient|Practitioner|
    PractitionerRole|RelatedPerson) Who performed the intake --></actor>
 </performer>
 <location><!-- 0..1 Reference(Location) Where the intake occurred --></location>
 <derivedFrom><!-- 0..* Reference(Any) Additional supporting information --></derivedFrom>
 <reason><!-- 0..* CodeableReference(Condition|DiagnosticReport|DocumentReference|
   Observation) Reason for why the food or fluid is /was consumed --></reason>
 <note><!-- 0..* Annotation Further information about the consumption --></note>
</NutritionIntake>

JSON Template

{doco
  "resourceType" : "NutritionIntake",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External identifier
  "instantiatesCanonical" : ["<canonical(Definition)>"], // Instantiates FHIR protocol or definition
  "instantiatesUri" : ["<uri>"], // Instantiates external protocol or definition
  "basedOn" : [{ Reference(CarePlan|NutritionOrder|ServiceRequest) }], // Fulfils plan, proposal or order
  "partOf" : [{ Reference(NutritionIntake|Observation|Procedure) }], // Part of referenced event
  "status" : "<code>", // R!  preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
  "statusReason" : [{ CodeableConcept }], // Reason for current status
  "code" : { CodeableConcept }, // Code representing an overall type of nutrition intake
  "subject" : { Reference(Group|Patient) }, // R!  Who is/was consuming the food or fluid
  "encounter" : { Reference(Encounter) }, // Encounter associated with NutritionIntake
  // occurrence[x]: The date/time or interval when the food or fluid is/was consumed. One of these 2:
  "occurrenceDateTime" : "<dateTime>",
  "occurrencePeriod" : { Period },
  "recorded" : "<dateTime>", // When the intake was recorded
  // reported[x]: 
     Person or organization that provided the information about the consumption of this food or fluid. One of these 2:
  "reportedBoolean" : <boolean>,
  "reportedReference" : { Reference(Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) },
  "consumedItem" : [{ // R!  What food or fluid product or item was consumed
    "type" : { CodeableConcept }, // R!  The type of food or fluid product
    "nutritionProduct" : { CodeableReference(NutritionProduct) }, // R!  Code that identifies the food or fluid product that was consumed
    "schedule" : { Timing }, // Scheduled frequency of consumption
    "amount" : { Quantity(SimpleQuantity) }, // Quantity of the specified food
    "rate" : { Quantity(SimpleQuantity) }, // Rate at which enteral feeding was administered
    "notConsumed" : <boolean>, // Flag to indicate if the food or fluid item was refused or otherwise not consumed
    "notConsumedReason" : { CodeableConcept } // Reason food or fluid was not consumed
  }],
  "ingredientLabel" : [{ // Total nutrient for the whole meal, product, serving
    "nutrient" : { CodeableReference(Substance) }, // R!  Total nutrient consumed
    "amount" : { Quantity(SimpleQuantity) } // R!  Total amount of nutrient consumed
  }],
  "performer" : [{ // Who was performed in the intake
    "function" : { CodeableConcept }, // Type of performer
    "actor" : { Reference(CareTeam|Device|Organization|Patient|Practitioner|
    PractitionerRole|RelatedPerson) } // R!  Who performed the intake
  }],
  "location" : { Reference(Location) }, // Where the intake occurred
  "derivedFrom" : [{ Reference(Any) }], // Additional supporting information
  "reason" : [{ CodeableReference(Condition|DiagnosticReport|DocumentReference|
   Observation) }], // Reason for why the food or fluid is /was consumed
  "note" : [{ Annotation }] // Further information about the consumption
}

Turtle Template

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


[ a fhir:NutritionIntake;
  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:NutritionIntake.identifier [ Identifier ], ... ; # 0..* External identifier
  fhir:NutritionIntake.instantiatesCanonical [ canonical(ActivityDefinition|ChargeItemDefinition|EventDefinition|Measure|
  MessageDefinition|ObservationDefinition|OperationDefinition|PlanDefinition|
  Questionnaire|SubscriptionTopic|TestScript) ], ... ; # 0..* Instantiates FHIR protocol or definition
  fhir:NutritionIntake.instantiatesUri [ uri ], ... ; # 0..* Instantiates external protocol or definition
  fhir:NutritionIntake.basedOn [ Reference(CarePlan|NutritionOrder|ServiceRequest) ], ... ; # 0..* Fulfils plan, proposal or order
  fhir:NutritionIntake.partOf [ Reference(NutritionIntake|Observation|Procedure) ], ... ; # 0..* Part of referenced event
  fhir:NutritionIntake.status [ code ]; # 1..1 preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
  fhir:NutritionIntake.statusReason [ CodeableConcept ], ... ; # 0..* Reason for current status
  fhir:NutritionIntake.code [ CodeableConcept ]; # 0..1 Code representing an overall type of nutrition intake
  fhir:NutritionIntake.subject [ Reference(Group|Patient) ]; # 1..1 Who is/was consuming the food or fluid
  fhir:NutritionIntake.encounter [ Reference(Encounter) ]; # 0..1 Encounter associated with NutritionIntake
  # NutritionIntake.occurrence[x] : 0..1 The date/time or interval when the food or fluid is/was consumed. One of these 2
    fhir:NutritionIntake.occurrenceDateTime [ dateTime ]
    fhir:NutritionIntake.occurrencePeriod [ Period ]
  fhir:NutritionIntake.recorded [ dateTime ]; # 0..1 When the intake was recorded
  # NutritionIntake.reported[x] : 0..1 Person or organization that provided the information about the consumption of this food or fluid. One of these 2
    fhir:NutritionIntake.reportedBoolean [ boolean ]
    fhir:NutritionIntake.reportedReference [ Reference(Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ]
  fhir:NutritionIntake.consumedItem [ # 1..* What food or fluid product or item was consumed
    fhir:NutritionIntake.consumedItem.type [ CodeableConcept ]; # 1..1 The type of food or fluid product
    fhir:NutritionIntake.consumedItem.nutritionProduct [ CodeableReference(NutritionProduct) ]; # 1..1 Code that identifies the food or fluid product that was consumed
    fhir:NutritionIntake.consumedItem.schedule [ Timing ]; # 0..1 Scheduled frequency of consumption
    fhir:NutritionIntake.consumedItem.amount [ Quantity(SimpleQuantity) ]; # 0..1 Quantity of the specified food
    fhir:NutritionIntake.consumedItem.rate [ Quantity(SimpleQuantity) ]; # 0..1 Rate at which enteral feeding was administered
    fhir:NutritionIntake.consumedItem.notConsumed [ boolean ]; # 0..1 Flag to indicate if the food or fluid item was refused or otherwise not consumed
    fhir:NutritionIntake.consumedItem.notConsumedReason [ CodeableConcept ]; # 0..1 Reason food or fluid was not consumed
  ], ...;
  fhir:NutritionIntake.ingredientLabel [ # 0..* Total nutrient for the whole meal, product, serving
    fhir:NutritionIntake.ingredientLabel.nutrient [ CodeableReference(Substance) ]; # 1..1 Total nutrient consumed
    fhir:NutritionIntake.ingredientLabel.amount [ Quantity(SimpleQuantity) ]; # 1..1 Total amount of nutrient consumed
  ], ...;
  fhir:NutritionIntake.performer [ # 0..* Who was performed in the intake
    fhir:NutritionIntake.performer.function [ CodeableConcept ]; # 0..1 Type of performer
    fhir:NutritionIntake.performer.actor [ Reference(CareTeam|Device|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ]; # 1..1 Who performed the intake
  ], ...;
  fhir:NutritionIntake.location [ Reference(Location) ]; # 0..1 Where the intake occurred
  fhir:NutritionIntake.derivedFrom [ Reference(Any) ], ... ; # 0..* Additional supporting information
  fhir:NutritionIntake.reason [ CodeableReference(Condition|DiagnosticReport|DocumentReference|Observation) ], ... ; # 0..* Reason for why the food or fluid is /was consumed
  fhir:NutritionIntake.note [ Annotation ], ... ; # 0..* Further information about the consumption
]

Changes since Release 4

This resource did not exist in Release 3

This analysis is available as XML or JSON.

 

Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis

12.20.5.1 Terminology Bindings

PathDefinitionTypeReference
NutritionIntake.status

Codes identifying the lifecycle stage of an event.

RequiredEventStatus
NutritionIntake.statusReason

Example codes indicating the reason why a ClinicalImpression is on hold or stopped. Note that these are in no way complete and might not even be appropriate for some uses.

ExampleClinicalImpressionStatusReason
NutritionIntake.code

Codes that can be used to indicate the type of food being ordered for a patient. This value set is provided as a suggestive example. It includes codes from SNOMED CT where concept is-a 182922004 (Dietary regime (regime/therapy))

ExampleDietCodes
NutritionIntake.consumedItem.type

This value set represents codes for types of edible substances and is provided as a suggestive example. It include codes from SNOMED CT where concept is-a 762766007 Edible Substance (substance).

ExampleTypes of Edible Substances
NutritionIntake.consumedItem.nutritionProduct

This value set represents codes for types of foods and is provided as a suggestive example. It include codes from SNOMED CT where concept is-a 255620007 (Foods (substance)).

ExampleFoodTypeCodes
NutritionIntake.consumedItem.notConsumedReason

This value set represents codes for types of edible substances and is provided as a suggestive example. It include codes from SNOMED CT where concept is-a 762766007 Edible Substance (substance).

ExampleReasons for why a food item was not consumed
NutritionIntake.ingredientLabel.nutrient

NutrientModifier : Codes for types of nutrients that are being modified such as carbohydrate or sodium. This value set includes codes from SNOMED CT where concept is-a 226355009 (Nutrients(substance)), and the concepts for Sodium, Potassium and Fluid. This is provided as a suggestive example.

ExampleNutrientModifierCodes
NutritionIntake.performer.function

This example value set defines the set of codes that can be used to indicate a role of a procedure performer.

ExampleProcedurePerformerRoleCodes
NutritionIntake.reason

Example value set for Condition/Problem/Diagnosis codes.

ExampleCondition/Problem/DiagnosisCodes

12.20.6 Notes:

12.20.7 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
codetokenReturns statements of this code of NutritionIntakeNutritionIntake.code
datedateDate when patient was taking (or not taking) the medicationNutritionIntake.occurrence
encounterreferenceReturns statements for a specific encounterNutritionIntake.encounter
(Encounter)
identifiertokenReturn statements with this external identifierNutritionIntake.identifier
nutrition DtokenReturn intakes for a specific consumed itemNutritionIntake.consumedItem.nutritionProduct.concept
patientreferenceReturns statements for a specific patient.NutritionIntake.subject.where(resolve() is Patient)
(Patient)
sourcereferenceWho or where the information in the statement came from(NutritionIntake.reported as Reference)
(Practitioner, Organization, Patient, PractitionerRole, RelatedPerson)
status NtokenReturn statements that match the given statusNutritionIntake.status
subjectreferenceThe identity of a patient, animal or group to list statements forNutritionIntake.subject
(Group, Patient)