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12.19 Resource NutritionOrder - Content

Orders and Observations icon Work GroupMaturity Level: 3 Trial UseSecurity Category: Patient Compartments: Encounter, Patient, Practitioner

A request to supply a diet, formula feeding (enteral) or oral nutritional supplement to an individual or group.

12.19.1 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 a 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 the type of product, product name, and the route of administration along with free text instructions without having to complete the additional structured details.

This resource is intended to be used by practitioners from a variety of specialties such as physicians, dietitians/nutritionists, or speech therapists. One practitioner may simply order a base element oral diet such as General Healthful diet. Another practitioner, based on the scope of practice, may use other elements to communicate additional therapeutic needs or patient preferences. The optionality included gives an ordering practitioner 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 an International Dysphagia Diet Standardisation Initiative Framework - Soft and Bite-Sized Level 6 food (regime/therapy).

12.19.2 Boundaries and Relationships

The NutritionOrder resource is used for requesting oral diets, oral nutrition supplements, enteral feedings, and infant formula. 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, enteral formulas, and infant formula 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. For further information about this separation of responsibilities, refer to the Fulfillment/Execution section of the Request pattern.

12.19.3 References to this Resource

12.19.4 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. NutritionOrder TU DomainResource Diet, 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..* Identifier Identifiers assigned to this order

... instantiatesCanonical Σ 0..* canonical(ActivityDefinition | PlanDefinition) Instantiates FHIR protocol or definition

... instantiatesUri Σ 0..* uri Instantiates external protocol or definition

... basedOn 0..* Reference(CarePlan | NutritionOrder | ServiceRequest | RequestOrchestration) What this order fulfills

... groupIdentifier Σ 0..1 Identifier Composite Request ID
... status ?!Σ 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
Binding: RequestStatus (Required)
... intent ?!Σ 1..1 code proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
Binding: RequestIntent (Required)
... priority 0..1 code routine | urgent | asap | stat
Binding: RequestPriority (Required)
... subject Σ 1..1 Reference(Patient | Group) Who requires the diet, formula or nutritional supplement
... encounter 0..1 Reference(Encounter) The encounter associated with this nutrition order
... supportingInformation 0..* Reference(Any) Information to support fulfilling of the nutrition order

... dateTime Σ 1..1 dateTime Date and time the nutrition order was requested
... orderer Σ 0..1 Reference(Practitioner | PractitionerRole) Who ordered the diet, formula or nutritional supplement
... performer 0..* CodeableReference(CareTeam | Practitioner | PractitionerRole | RelatedPerson | Patient | Organization | Group) Who is intended to perform the administration of the nutrition order

... allergyIntolerance 0..* Reference(AllergyIntolerance) List of the patient's food and nutrition-related allergies and intolerances

... foodPreferenceModifier 0..* CodeableConcept Order-specific modifier about the type of food that should be given
Binding: Types of Edible Substances (Preferred)

... excludeFoodModifier 0..* CodeableConcept Food that should not be given
Binding: Types of Edible Substances (Preferred)

... outsideFoodAllowed 0..1 boolean Capture if patient is permitted to consume food from outside of current setting brought by the patient, family, and/or caregiver
... oralDiet C 0..1 BackboneElement Oral diet components
.... type Σ 0..* CodeableConcept Type of oral diet or diet restrictions that can be consumed orally
Binding: Diet Codes (Preferred)

.... schedule 0..1 BackboneElement Scheduling information for oral diets
..... timing 0..* Timing Scheduled frequency of diet

..... asNeeded 0..1 boolean Take 'as needed'
..... asNeededFor 0..1 CodeableConcept Take 'as needed' for x
Binding: SNOMED CT Medication As Needed Reason Codes (Example)
.... nutrient 0..* BackboneElement The nutrient that is modified and the quantity in the diet

..... modifier 0..1 CodeableConcept Nutrient modified in the oral diet type
Binding: Nutrient Codes (Preferred)
..... amount 0..1 SimpleQuantity Quantity of the specified nutrient
.... texture 0..* BackboneElement Texture modifications in addition to the oral diet type

..... modifier 0..1 CodeableConcept Food (i.e. solid and/or liquid) texture modifications in addition to those in the oral diet type
Binding: Categories of Nutrition Products (Preferred)
..... type 0..1 CodeableConcept Food (i.e. solid and/or liquid) types that undergo texture alteration
Binding: Texture Modified Food Type Codes (Example)
.... instruction Σ 0..1 string Instructions or additional information about the oral diet
.... caloricDensity 0..1 SimpleQuantity Amount of energy per specified volume of oral diet
... supplement C 0..* BackboneElement Supplement components

.... type Σ 0..1 CodeableReference(NutritionProduct) Type of supplement product requested
Binding: Supplement Type Codes (Preferred)
.... productName 0..1 string Product or brand name of the nutritional supplement
.... schedule 0..1 BackboneElement Scheduling information for supplements
..... timing 0..* Timing Scheduled frequency of supplement

..... asNeeded 0..1 boolean Take 'as needed'
..... asNeededFor 0..1 CodeableConcept Take 'as needed' for x
Binding: SNOMED CT Medication As Needed Reason Codes (Example)
.... quantity 0..1 SimpleQuantity Amount of the nutritional supplement
.... instruction Σ 0..1 string Instructions or additional information about the oral supplement
.... caloricDensity 0..1 SimpleQuantity Amount of energy per specified volume of supplement that is required
... enteralFormula C 0..1 BackboneElement Enteral formula product
.... type Σ 0..1 CodeableReference(NutritionProduct) Type of patient enteral feeding
Binding: Enteral Formula Type Codes (Preferred)
.... productName 0..1 string Product or brand name of the enteral feeding
.... deliveryDevice 0..* CodeableReference(DeviceDefinition) Intended type of device for the enteral feeding administration

.... caloricDensity 0..1 SimpleQuantity Amount of energy per specified volume of feeding that is required
.... routeOfAdministration 0..* CodeableConcept How the enteral feeding should enter the patient's gastrointestinal tract
Binding: Enteral Route Codes (Extensible)

.... administration 0..* BackboneElement Formula feeding instruction as structured data

..... schedule 0..1 BackboneElement Scheduling information for enteral feeding products
...... timing 0..* Timing Scheduled frequency of enteral feeding

...... asNeeded 0..1 boolean Take 'as needed'
...... asNeededFor 0..1 CodeableConcept Take 'as needed' for x
Binding: SNOMED CT Medication As Needed Reason Codes (Example)
..... quantity 0..1 SimpleQuantity The volume of formula feeding to provide
..... rate[x] 0..1 Speed with which the formula feeding is provided per period of time
...... rateQuantity SimpleQuantity
...... rateRatio Ratio
.... maxVolumeToAdminister 0..1 SimpleQuantity Upper limit on formula feeding volume per unit of time
.... administrationInstruction Σ 0..1 markdown Formula feeding instructions expressed as text
... additive 0..* BackboneElement Modular additive to add to the oral diet, supplement, and/or enteral feeding

.... modularType 0..1 CodeableReference(NutritionProduct) Type of modular component to add to the oral diet, supplement, and/or enteral feeding
Binding: Enteral Formula Additive Type Code (Preferred)
.... productName 0..1 string Product or brand name of the modular additive
.... quantity 0..1 SimpleQuantity Amount of additive to be given or mixed in with the oral diet, supplement, and/or enteral feeding
... note 0..* Annotation Comments


doco Documentation for this format icon

See the Extensions for this resource

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..*]A plan or request that is fulfilled in whole or in part by this nutrition orderbasedOn : Reference [0..*] « CarePlan|NutritionOrder|ServiceRequest| RequestOrchestration »A shared identifier common to all nutrition orders that were authorized more or less simultaneously by a single author, representing the composite or group identifiergroupIdentifier : Identifier [0..1]The workflow status of the nutrition order/request (this element modifies the meaning of other elements)status : code [1..1] « null (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] « null (Strength=Required)RequestIntent! »Indicates how quickly the Nutrition Order should be addressed with respect to other requestspriority : code [0..1] « null (Strength=Required)RequestPriority! »The person or set of individuals who needs the nutrition order for an oral diet, nutritional supplement and/or enteral or formula feedingsubject : Reference [1..1] « Patient|Group »An encounter that provides additional information about the healthcare context in which this request is madeencounter : Reference [0..1] « Encounter »Information to support fulfilling (i.e. dispensing or administering) of the nutrition, for example, patient height and weight)supportingInformation : Reference [0..*] « Any »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 »The specified desired performer of the nutrition orderperformer : CodeableReference [0..*] « CareTeam|Practitioner| PractitionerRole|RelatedPerson|Patient|Organization|Group »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 (i.e. solid and/or liquid) 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..*] « null (Strength=Preferred) TypesOfEdibleSubstances? »This modifier is used to convey Order-specific modifier about the type of oral food (i.e. solid and/or liquid) 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..*] « null (Strength=Preferred) TypesOfEdibleSubstances? »This modifier is used to convey whether a food item, brought in by the patient, family, and/or caregiver, can be consumed by the patient. If set to true, indicates that the receiving system does not need to supply the food itemoutsideFoodAllowed : boolean [0..1]Comments made about the nutrition order by the requester, performer, subject or other participantsnote : Annotation [0..*]OralDietThe kind of diet or dietary restriction such as fiber restricted diet or diet for diabetestype : CodeableConcept [0..*] « null (Strength=Preferred)DietCodes? »Free text or additional instructions or information pertaining to the oral dietinstruction : string [0..1]The amount of energy (calories or kilojoules) that the oral diet should provide. For example, an infant formula feeding of 30 ounces of 20 kcal/ounce (67 kcal/100 mL) formula per daycaloricDensity : Quantity(SimpleQuantity) [0..1]OralDietScheduleThe 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 presenttiming : Timing [0..*]Indicates whether the diet is only taken when needed within a specific administration scheduleasNeeded : boolean [0..1]Indicates whether the diet is only taken based on a precondition for taking the dietasNeededFor : CodeableConcept [0..1] « A coded concept identifying the precondition that should be met or evaluated prior to consuming a nutrition product. (Strength=Example) SNOMEDCTMedicationAsNeededRea...?? »NutrientThe nutrient that is being modified such as carbohydrate or sodiummodifier : CodeableConcept [0..1] « null (Strength=Preferred)NutrientCodes? »The quantity of the specified nutrient to include in dietamount : Quantity(SimpleQuantity) [0..1]TextureTexture modifications in the addition to the oral diet type that should be made, e.g. easy to chew, chopped, ground, and pureedmodifier : CodeableConcept [0..1] « null (Strength=Preferred)CategoriesOfNutritionProducts? »The food (i.e. solid and/or liquid) type(s) (e.g. meats, all foods) that the texture modification applies totype : CodeableConcept [0..1] « null (Strength=Example)TextureModifiedFoodTypeCodes?? »SupplementThe kind of nutritional supplement product required such as a high protein or pediatric clear liquid supplementtype : CodeableReference [0..1] « NutritionProduct; null (Strength=Preferred) SupplementTypeCodes? »The product or brand name of the nutritional supplement such as "Acme Protein Shake"productName : string [0..1]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]The amount of energy (calories or kilojoules) that the supplement should provide per specified volume, typically per ml or fluid oz. For example, a patient may required a supplement that provides 24 calories per fluid ouncecaloricDensity : Quantity(SimpleQuantity) [0..1]SupplementScheduleThe time period and frequency at which the supplement should be given. The supplement should be given for the combination of all schedules if more than one schedule is presenttiming : Timing [0..*]Indicates whether the supplement is only taken when needed within a specific dosing scheduleasNeeded : boolean [0..1]Indicates whether the supplement is only taken based on a precondition for taking the supplementasNeededFor : CodeableConcept [0..1] « A coded concept identifying the precondition that should be met or evaluated prior to consuming a supplement. (Strength=Example) SNOMEDCTMedicationAsNeededRea...?? »EnteralFormulaThe type of adult or pediatric enteral feeding such as an adult standard formula with fiber or a soy-based infant feedingtype : CodeableReference [0..1] « NutritionProduct; null (Strength=Preferred) EnteralFormulaTypeCodes? »The product or brand name of the enteral feeding product such as "ACME Adult Standard Formula"productName : string [0..1]The intended type of device that is to be used for the administration of the enteral formuladeliveryDevice : CodeableReference [0..*] « DeviceDefinition »The amount of energy (calories or kilojoules) that the feeding 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 administration into the patient's gastrointestinal tract for purposes of providing the formula feeding, e.g. nasogastric tube, oralrouteOfAdministration : CodeableConcept [0..*] « null (Strength=Extensible)EnteralRouteCodes+ »The maximum total quantity of formula feeding that may be administered to a subject over the period of time, e.g. 1440 mL over 24 hoursmaxVolumeToAdminister : Quantity(SimpleQuantity) [0..1]Free text formula administration, feeding instructions or additional instructions or informationadministrationInstruction : markdown [0..1]AdministrationThe volume of formula feeding to provide to the patient per the specified administration schedulequantity : Quantity(SimpleQuantity) [0..1]The rate of administration of formula feeding via a feeding pump, e.g. 60 mL per hour, according to the specified schedulerate[x] : DataType [0..1] « Quantity(SimpleQuantity)|Ratio »EnteralFormulaScheduleThe time period and frequency at which the enteral feeding should be given. The enteral feeding should be given for the combination of all schedules if more than one schedule is presenttiming : Timing [0..*]Indicates whether the enteral feeding is only taken when needed within a specific dosing scheduleasNeeded : boolean [0..1]Indicates whether the enteral feeding is only taken based on a precondition for taking the enteral feedingasNeededFor : CodeableConcept [0..1] « A coded concept identifying the precondition that should be met or evaluated prior to consuming an enteral formula. (Strength=Example) SNOMEDCTMedicationAsNeededRea...?? »AdditiveIndicates the type of modular component such as protein, carbohydrate, fat or fiber to be provided in addition to or mixed with the oral diet, supplement, and/or enteral feedingmodularType : CodeableReference [0..1] « NutritionProduct; null (Strength=Preferred) EnteralFormulaAdditiveTypeCode? »The product or brand name of the type of modular additive to be added to the oral diet, supplement, and/or enteral feedingproductName : string [0..1]The amount of additive to be given in addition or to be mixed in with the oral diet, supplement, and/or enteral feedingquantity : Quantity(SimpleQuantity) [0..1]Schedule information for an oral dietschedule[0..1]Defines the quantity and the nutrient modified (for example carbohydrate, fiber or sodium) in the oral dietnutrient[0..*]Class that describes any texture modifications in addition to the oral diet type required for the patient to safely consume various types of foods (i.e. solid and/or liquid)texture[0..*]Diet given orally that may include texture modification, such as International Dysphagia Diet Standardisation Initiative Framework - Slightly Thick Level 1 drinks and Minced and International Dysphagia Diet Standardisation Initiative Framework - Minced and Moist Level 5 food as well as, for example, Decreased potassium diet (ie, nutrient modification), Halal diet (ie, cultural modification), and/or Low microbial diet (eg, other modification)oralDiet[0..1]Schedule information for a supplementschedule[0..1]Oral nutritional products given in order to add further nutritional value to the patient's dietsupplement[0..*]Schedule information for an enteral feedingschedule[0..1]Formula feeding 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]Indicates modular components to be provided in addition or mixed with the oral diet, supplement, and/or enteral feedingadditive[0..*]

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 -->
 <basedOn><!-- 0..* Reference(CarePlan|NutritionOrder|RequestOrchestration|
   ServiceRequest) What this order fulfills --></basedOn>
 <groupIdentifier><!-- 0..1 Identifier Composite Request ID --></groupIdentifier>
 <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 -->
 <priority value="[code]"/><!-- 0..1 routine | urgent | asap | stat -->
 <subject><!-- 1..1 Reference(Group|Patient) Who requires the diet, formula or nutritional supplement --></subject>
 <encounter><!-- 0..1 Reference(Encounter) The encounter associated with this nutrition order --></encounter>
 <supportingInformation><!-- 0..* Reference(Any) Information to support fulfilling of the nutrition order --></supportingInformation>
 <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>
 <performer><!-- 0..* CodeableReference(CareTeam|Group|Organization|Patient|
   Practitioner|PractitionerRole|RelatedPerson) Who is intended to perform the administration of the nutrition order --></performer>
 <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 Food that should not be given --></excludeFoodModifier>
 <outsideFoodAllowed value="[boolean]"/><!-- 0..1 Capture if patient is permitted to consume food from outside of current setting brought by the patient, family, and/or caregiver -->
 <oralDiet>  <!-- I 0..1 Oral diet components -->
  <type><!-- 0..* CodeableConcept Type of oral diet or diet restrictions that can be consumed orally --></type>
  <schedule>  <!-- 0..1 Scheduling information for oral diets -->
   <timing><!-- 0..* Timing Scheduled frequency of diet --></timing>
   <asNeeded value="[boolean]"/><!-- 0..1 Take 'as needed' -->
   <asNeededFor><!-- 0..1 CodeableConcept Take 'as needed' for x --></asNeededFor>
  </schedule>
  <nutrient>  <!-- 0..* The nutrient that is modified and the quantity in the diet -->
   <modifier><!-- 0..1 CodeableConcept Nutrient modified in the oral diet type --></modifier>
   <amount><!-- 0..1 Quantity(SimpleQuantity) Quantity of the specified nutrient --></amount>
  </nutrient>
  <texture>  <!-- 0..* Texture modifications in addition to the oral diet type -->
   <modifier><!-- 0..1 CodeableConcept Food (i.e. solid and/or liquid) texture modifications in addition to those in the oral diet type --></modifier>
   <type><!-- 0..1 CodeableConcept Food (i.e. solid and/or liquid) types that undergo texture alteration --></type>
  </texture>
  <instruction value="[string]"/><!-- 0..1 Instructions or additional information about the oral diet -->
  <caloricDensity><!-- 0..1 Quantity(SimpleQuantity) Amount of energy per specified volume of oral diet --></caloricDensity>
 </oralDiet>
 <supplement>  <!-- I 0..* Supplement components -->
  <type><!-- 0..1 CodeableReference(NutritionProduct) Type of supplement product requested --></type>
  <productName value="[string]"/><!-- 0..1 Product or brand name of the nutritional supplement -->
  <schedule>  <!-- 0..1 Scheduling information for supplements -->
   <timing><!-- 0..* Timing Scheduled frequency of supplement --></timing>
   <asNeeded value="[boolean]"/><!-- 0..1 Take 'as needed' -->
   <asNeededFor><!-- 0..1 CodeableConcept Take 'as needed' for x --></asNeededFor>
  </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 -->
  <caloricDensity><!-- 0..1 Quantity(SimpleQuantity) Amount of energy per specified volume of supplement that is required --></caloricDensity>
 </supplement>
 <enteralFormula>  <!-- I 0..1 Enteral formula product -->
  <type><!-- 0..1 CodeableReference(NutritionProduct) Type of patient enteral feeding --></type>
  <productName value="[string]"/><!-- 0..1 Product or brand name of the enteral feeding -->
  <deliveryDevice><!-- 0..* CodeableReference(DeviceDefinition) Intended type of device for the enteral feeding administration --></deliveryDevice>
  <caloricDensity><!-- 0..1 Quantity(SimpleQuantity) Amount of energy per specified volume of feeding that is required --></caloricDensity>
  <routeOfAdministration><!-- 0..* CodeableConcept How the enteral feeding should enter the patient's gastrointestinal tract --></routeOfAdministration>
  <administration>  <!-- 0..* Formula feeding instruction as structured data -->
   <schedule>  <!-- 0..1 Scheduling information for enteral feeding products -->
    <timing><!-- 0..* Timing Scheduled frequency of enteral feeding --></timing>
    <asNeeded value="[boolean]"/><!-- 0..1 Take 'as needed' -->
    <asNeededFor><!-- 0..1 CodeableConcept Take 'as needed' for x --></asNeededFor>
   </schedule>
   <quantity><!-- 0..1 Quantity(SimpleQuantity) The volume of formula feeding to provide --></quantity>
   <rate[x]><!-- 0..1 Quantity(SimpleQuantity)|Ratio Speed with which the formula feeding is provided per period of time --></rate[x]>
  </administration>
  <maxVolumeToAdminister><!-- 0..1 Quantity(SimpleQuantity) Upper limit on formula feeding volume per unit of time --></maxVolumeToAdminister>
  <administrationInstruction value="[markdown]"/><!-- 0..1 Formula feeding instructions expressed as text -->
 </enteralFormula>
 <additive>  <!-- 0..* Modular additive to add to the oral diet, supplement, and/or enteral feeding -->
  <modularType><!-- 0..1 CodeableReference(NutritionProduct) Type of modular component to add to the oral diet, supplement, and/or enteral feeding --></modularType>
  <productName value="[string]"/><!-- 0..1 Product or brand name of the modular additive -->
  <quantity><!-- 0..1 Quantity(SimpleQuantity) Amount of additive to be given or mixed in with the oral diet, supplement, and/or enteral feeding --></quantity>
 </additive>
 <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
  "basedOn" : [{ Reference(CarePlan|NutritionOrder|RequestOrchestration|
   ServiceRequest) }], // What this order fulfills
  "groupIdentifier" : { Identifier }, // Composite Request ID
  "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
  "priority" : "<code>", // routine | urgent | asap | stat
  "subject" : { Reference(Group|Patient) }, // R!  Who requires the diet, formula or nutritional supplement
  "encounter" : { Reference(Encounter) }, // The encounter associated with this nutrition order
  "supportingInformation" : [{ Reference(Any) }], // Information to support fulfilling of the 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
  "performer" : [{ CodeableReference(CareTeam|Group|Organization|Patient|
   Practitioner|PractitionerRole|RelatedPerson) }], // Who is intended to perform the administration of the nutrition order
  "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 }], // Food that should not be given
  "outsideFoodAllowed" : <boolean>, // Capture if patient is permitted to consume food from outside of current setting brought by the patient, family, and/or caregiver
  "oralDiet" : { // I Oral diet components
    "type" : [{ CodeableConcept }], // Type of oral diet or diet restrictions that can be consumed orally
    "schedule" : { // Scheduling information for oral diets
      "timing" : [{ Timing }], // Scheduled frequency of diet
      "asNeeded" : <boolean>, // Take 'as needed'
      "asNeededFor" : { CodeableConcept } // Take 'as needed' for x
    },
    "nutrient" : [{ // The nutrient that is modified and the quantity in the diet
      "modifier" : { CodeableConcept }, // Nutrient modified in the oral diet type
      "amount" : { Quantity(SimpleQuantity) } // Quantity of the specified nutrient
    }],
    "texture" : [{ // Texture modifications in addition to the oral diet type
      "modifier" : { CodeableConcept }, // Food (i.e. solid and/or liquid) texture modifications in addition to those in the oral diet type
      "type" : { CodeableConcept } // Food (i.e. solid and/or liquid) types that undergo texture alteration
    }],
    "instruction" : "<string>", // Instructions or additional information about the oral diet
    "caloricDensity" : { Quantity(SimpleQuantity) } // Amount of energy per specified volume of oral diet
  },
  "supplement" : [{ // I Supplement components
    "type" : { CodeableReference(NutritionProduct) }, // Type of supplement product requested
    "productName" : "<string>", // Product or brand name of the nutritional supplement
    "schedule" : { // Scheduling information for supplements
      "timing" : [{ Timing }], // Scheduled frequency of supplement
      "asNeeded" : <boolean>, // Take 'as needed'
      "asNeededFor" : { CodeableConcept } // Take 'as needed' for x
    },
    "quantity" : { Quantity(SimpleQuantity) }, // Amount of the nutritional supplement
    "instruction" : "<string>", // Instructions or additional information about the oral supplement
    "caloricDensity" : { Quantity(SimpleQuantity) } // Amount of energy per specified volume of supplement that is required
  }],
  "enteralFormula" : { // I Enteral formula product
    "type" : { CodeableReference(NutritionProduct) }, // Type of patient enteral feeding
    "productName" : "<string>", // Product or brand name of the enteral feeding
    "deliveryDevice" : [{ CodeableReference(DeviceDefinition) }], // Intended type of device for the enteral feeding administration
    "caloricDensity" : { Quantity(SimpleQuantity) }, // Amount of energy per specified volume of feeding that is required
    "routeOfAdministration" : [{ CodeableConcept }], // How the enteral feeding should enter the patient's gastrointestinal tract
    "administration" : [{ // Formula feeding instruction as structured data
      "schedule" : { // Scheduling information for enteral feeding products
        "timing" : [{ Timing }], // Scheduled frequency of enteral feeding
        "asNeeded" : <boolean>, // Take 'as needed'
        "asNeededFor" : { CodeableConcept } // Take 'as needed' for x
      },
      "quantity" : { Quantity(SimpleQuantity) }, // The volume of formula feeding to provide
      // rate[x]: Speed with which the formula feeding is provided per period of time. One of these 2:
      "rateQuantity" : { Quantity(SimpleQuantity) },
      "rateRatio" : { Ratio }
    }],
    "maxVolumeToAdminister" : { Quantity(SimpleQuantity) }, // Upper limit on formula feeding volume per unit of time
    "administrationInstruction" : "<markdown>" // Formula feeding instructions expressed as text
  },
  "additive" : [{ // Modular additive to add to the oral diet, supplement, and/or enteral feeding
    "modularType" : { CodeableReference(NutritionProduct) }, // Type of modular component to add to the oral diet, supplement, and/or enteral feeding
    "productName" : "<string>", // Product or brand name of the modular additive
    "quantity" : { Quantity(SimpleQuantity) } // Amount of additive to be given or mixed in with the oral diet, supplement, and/or enteral feeding
  }],
  "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:identifier  ( [ Identifier ] ... ) ; # 0..* Identifiers assigned to this order
  fhir:instantiatesCanonical  ( [ canonical(ActivityDefinition|PlanDefinition) ] ... ) ; # 0..* Instantiates FHIR protocol or definition
  fhir:instantiatesUri  ( [ uri ] ... ) ; # 0..* Instantiates external protocol or definition
  fhir:instantiates  ( [ uri ] ... ) ; # 0..* Instantiates protocol or definition
  fhir:basedOn  ( [ Reference(CarePlan|NutritionOrder|RequestOrchestration|ServiceRequest) ] ... ) ; # 0..* What this order fulfills
  fhir:groupIdentifier [ Identifier ] ; # 0..1 Composite Request ID
  fhir:status [ code ] ; # 1..1 draft | active | on-hold | revoked | completed | entered-in-error | unknown
  fhir:intent [ code ] ; # 1..1 proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
  fhir:priority [ code ] ; # 0..1 routine | urgent | asap | stat
  fhir:subject [ Reference(Group|Patient) ] ; # 1..1 Who requires the diet, formula or nutritional supplement
  fhir:encounter [ Reference(Encounter) ] ; # 0..1 The encounter associated with this nutrition order
  fhir:supportingInformation  ( [ Reference(Any) ] ... ) ; # 0..* Information to support fulfilling of the nutrition order
  fhir:dateTime [ dateTime ] ; # 1..1 Date and time the nutrition order was requested
  fhir:orderer [ Reference(Practitioner|PractitionerRole) ] ; # 0..1 Who ordered the diet, formula or nutritional supplement
  fhir:performer  ( [ CodeableReference(CareTeam|Group|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ... ) ; # 0..* Who is intended to perform the administration of the nutrition order
  fhir:allergyIntolerance  ( [ Reference(AllergyIntolerance) ] ... ) ; # 0..* List of the patient's food and nutrition-related allergies and intolerances
  fhir:foodPreferenceModifier  ( [ CodeableConcept ] ... ) ; # 0..* Order-specific modifier about the type of food that should be given
  fhir:excludeFoodModifier  ( [ CodeableConcept ] ... ) ; # 0..* Food that should not be given
  fhir:outsideFoodAllowed [ boolean ] ; # 0..1 Capture if patient is permitted to consume food from outside of current setting brought by the patient, family, and/or caregiver
  fhir:oralDiet [ # 0..1 I Oral diet components
    fhir:type  ( [ CodeableConcept ] ... ) ; # 0..* Type of oral diet or diet restrictions that can be consumed orally
    fhir:schedule [ # 0..1 Scheduling information for oral diets
      fhir:timing  ( [ Timing ] ... ) ; # 0..* Scheduled frequency of diet
      fhir:asNeeded [ boolean ] ; # 0..1 Take 'as needed'
      fhir:asNeededFor [ CodeableConcept ] ; # 0..1 Take 'as needed' for x
    ] ;
    fhir:nutrient ( [ # 0..* The nutrient that is modified and the quantity in the diet
      fhir:modifier [ CodeableConcept ] ; # 0..1 Nutrient modified in the oral diet type
      fhir:amount [ Quantity(SimpleQuantity) ] ; # 0..1 Quantity of the specified nutrient
    ] ... ) ;
    fhir:texture ( [ # 0..* Texture modifications in addition to the oral diet type
      fhir:modifier [ CodeableConcept ] ; # 0..1 Food (i.e. solid and/or liquid) texture modifications in addition to those in the oral diet type
      fhir:type [ CodeableConcept ] ; # 0..1 Food (i.e. solid and/or liquid) types that undergo texture alteration
    ] ... ) ;
    fhir:instruction [ string ] ; # 0..1 Instructions or additional information about the oral diet
    fhir:caloricDensity [ Quantity(SimpleQuantity) ] ; # 0..1 Amount of energy per specified volume of oral diet
  ] ;
  fhir:supplement ( [ # 0..* I Supplement components
    fhir:type [ CodeableReference(NutritionProduct) ] ; # 0..1 Type of supplement product requested
    fhir:productName [ string ] ; # 0..1 Product or brand name of the nutritional supplement
    fhir:schedule [ # 0..1 Scheduling information for supplements
      fhir:timing  ( [ Timing ] ... ) ; # 0..* Scheduled frequency of supplement
      fhir:asNeeded [ boolean ] ; # 0..1 Take 'as needed'
      fhir:asNeededFor [ CodeableConcept ] ; # 0..1 Take 'as needed' for x
    ] ;
    fhir:quantity [ Quantity(SimpleQuantity) ] ; # 0..1 Amount of the nutritional supplement
    fhir:instruction [ string ] ; # 0..1 Instructions or additional information about the oral supplement
    fhir:caloricDensity [ Quantity(SimpleQuantity) ] ; # 0..1 Amount of energy per specified volume of supplement that is required
  ] ... ) ;
  fhir:enteralFormula [ # 0..1 I Enteral formula product
    fhir:type [ CodeableReference(NutritionProduct) ] ; # 0..1 Type of patient enteral feeding
    fhir:productName [ string ] ; # 0..1 Product or brand name of the enteral feeding
    fhir:deliveryDevice  ( [ CodeableReference(DeviceDefinition) ] ... ) ; # 0..* Intended type of device for the enteral feeding administration
    fhir:caloricDensity [ Quantity(SimpleQuantity) ] ; # 0..1 Amount of energy per specified volume of feeding that is required
    fhir:routeOfAdministration  ( [ CodeableConcept ] ... ) ; # 0..* How the enteral feeding should enter the patient's gastrointestinal tract
    fhir:administration ( [ # 0..* Formula feeding instruction as structured data
      fhir:schedule [ # 0..1 Scheduling information for enteral feeding products
        fhir:timing  ( [ Timing ] ... ) ; # 0..* Scheduled frequency of enteral feeding
        fhir:asNeeded [ boolean ] ; # 0..1 Take 'as needed'
        fhir:asNeededFor [ CodeableConcept ] ; # 0..1 Take 'as needed' for x
      ] ;
      fhir:quantity [ Quantity(SimpleQuantity) ] ; # 0..1 The volume of formula feeding to provide
      # rate[x] : 0..1 Speed with which the formula feeding is provided per period of time. One of these 2
        fhir:rate [  a fhir:SimpleQuantity ; Quantity(SimpleQuantity) ]
        fhir:rate [  a fhir:Ratio ; Ratio ]
    ] ... ) ;
    fhir:maxVolumeToAdminister [ Quantity(SimpleQuantity) ] ; # 0..1 Upper limit on formula feeding volume per unit of time
    fhir:administrationInstruction [ markdown ] ; # 0..1 Formula feeding instructions expressed as text
  ] ;
  fhir:additive ( [ # 0..* Modular additive to add to the oral diet, supplement, and/or enteral feeding
    fhir:modularType [ CodeableReference(NutritionProduct) ] ; # 0..1 Type of modular component to add to the oral diet, supplement, and/or enteral feeding
    fhir:productName [ string ] ; # 0..1 Product or brand name of the modular additive
    fhir:quantity [ Quantity(SimpleQuantity) ] ; # 0..1 Amount of additive to be given or mixed in with the oral diet, supplement, and/or enteral feeding
  ] ... ) ;
  fhir:note  ( [ Annotation ] ... ) ; # 0..* Comments
]

Changes from both R4 and R4B

NutritionOrder
NutritionOrder.basedOn
  • Added Element
NutritionOrder.groupIdentifier
  • Added Element
NutritionOrder.priority
  • Added Element
NutritionOrder.subject
  • Added Mandatory Element
NutritionOrder.supportingInformation
  • Added Element
NutritionOrder.performer
  • Added Element
NutritionOrder.outsideFoodAllowed
  • Added Element
NutritionOrder.oralDiet.schedule
  • Max Cardinality changed from * to 1
  • Type changed from Timing to BackboneElement
NutritionOrder.oralDiet.schedule.timing
  • Added Element
NutritionOrder.oralDiet.schedule.asNeeded
  • Added Element
NutritionOrder.oralDiet.schedule.asNeededFor
  • Added Element
NutritionOrder.oralDiet.texture.type
  • Added Element
NutritionOrder.oralDiet.caloricDensity
  • Added Element
NutritionOrder.supplement.type
  • Type changed from CodeableConcept to CodeableReference
NutritionOrder.supplement.schedule
  • Max Cardinality changed from * to 1
  • Type changed from Timing to BackboneElement
NutritionOrder.supplement.schedule.timing
  • Added Element
NutritionOrder.supplement.schedule.asNeeded
  • Added Element
NutritionOrder.supplement.schedule.asNeededFor
  • Added Element
NutritionOrder.supplement.caloricDensity
  • Added Element
NutritionOrder.enteralFormula.type
  • Added Element
NutritionOrder.enteralFormula.productName
  • Added Element
NutritionOrder.enteralFormula.deliveryDevice
  • Added Element
NutritionOrder.enteralFormula.routeOfAdministration
  • Added Element
NutritionOrder.enteralFormula.administration.schedule
  • Type changed from Timing to BackboneElement
NutritionOrder.enteralFormula.administration.schedule.timing
  • Added Element
NutritionOrder.enteralFormula.administration.schedule.asNeeded
  • Added Element
NutritionOrder.enteralFormula.administration.schedule.asNeededFor
  • Added Element
NutritionOrder.enteralFormula.maxVolumeToAdminister
  • Added Element
NutritionOrder.enteralFormula.administrationInstruction
  • Type changed from string to markdown
NutritionOrder.additive
  • Added Element
NutritionOrder.additive.modularType
  • Added Element
NutritionOrder.additive.productName
  • Added Element
NutritionOrder.additive.quantity
  • Added Element
NutritionOrder.patient
  • Deleted
NutritionOrder.oralDiet.texture.foodType
  • Deleted
NutritionOrder.oralDiet.fluidConsistencyType
  • Deleted
NutritionOrder.enteralFormula.baseFormulaType
  • Deleted
NutritionOrder.enteralFormula.baseFormulaProductName
  • Deleted
NutritionOrder.enteralFormula.additiveType
  • Deleted
NutritionOrder.enteralFormula.additiveProductName
  • Deleted
NutritionOrder.enteralFormula.routeofAdministration
  • Deleted
NutritionOrder.enteralFormula.maxVolumeToDeliver
  • Deleted

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. NutritionOrder TU DomainResource Diet, 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..* Identifier Identifiers assigned to this order

... instantiatesCanonical Σ 0..* canonical(ActivityDefinition | PlanDefinition) Instantiates FHIR protocol or definition

... instantiatesUri Σ 0..* uri Instantiates external protocol or definition

... basedOn 0..* Reference(CarePlan | NutritionOrder | ServiceRequest | RequestOrchestration) What this order fulfills

... groupIdentifier Σ 0..1 Identifier Composite Request ID
... status ?!Σ 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
Binding: RequestStatus (Required)
... intent ?!Σ 1..1 code proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
Binding: RequestIntent (Required)
... priority 0..1 code routine | urgent | asap | stat
Binding: RequestPriority (Required)
... subject Σ 1..1 Reference(Patient | Group) Who requires the diet, formula or nutritional supplement
... encounter 0..1 Reference(Encounter) The encounter associated with this nutrition order
... supportingInformation 0..* Reference(Any) Information to support fulfilling of the nutrition order

... dateTime Σ 1..1 dateTime Date and time the nutrition order was requested
... orderer Σ 0..1 Reference(Practitioner | PractitionerRole) Who ordered the diet, formula or nutritional supplement
... performer 0..* CodeableReference(CareTeam | Practitioner | PractitionerRole | RelatedPerson | Patient | Organization | Group) Who is intended to perform the administration of the nutrition order

... allergyIntolerance 0..* Reference(AllergyIntolerance) List of the patient's food and nutrition-related allergies and intolerances

... foodPreferenceModifier 0..* CodeableConcept Order-specific modifier about the type of food that should be given
Binding: Types of Edible Substances (Preferred)

... excludeFoodModifier 0..* CodeableConcept Food that should not be given
Binding: Types of Edible Substances (Preferred)

... outsideFoodAllowed 0..1 boolean Capture if patient is permitted to consume food from outside of current setting brought by the patient, family, and/or caregiver
... oralDiet C 0..1 BackboneElement Oral diet components
.... type Σ 0..* CodeableConcept Type of oral diet or diet restrictions that can be consumed orally
Binding: Diet Codes (Preferred)

.... schedule 0..1 BackboneElement Scheduling information for oral diets
..... timing 0..* Timing Scheduled frequency of diet

..... asNeeded 0..1 boolean Take 'as needed'
..... asNeededFor 0..1 CodeableConcept Take 'as needed' for x
Binding: SNOMED CT Medication As Needed Reason Codes (Example)
.... nutrient 0..* BackboneElement The nutrient that is modified and the quantity in the diet

..... modifier 0..1 CodeableConcept Nutrient modified in the oral diet type
Binding: Nutrient Codes (Preferred)
..... amount 0..1 SimpleQuantity Quantity of the specified nutrient
.... texture 0..* BackboneElement Texture modifications in addition to the oral diet type

..... modifier 0..1 CodeableConcept Food (i.e. solid and/or liquid) texture modifications in addition to those in the oral diet type
Binding: Categories of Nutrition Products (Preferred)
..... type 0..1 CodeableConcept Food (i.e. solid and/or liquid) types that undergo texture alteration
Binding: Texture Modified Food Type Codes (Example)
.... instruction Σ 0..1 string Instructions or additional information about the oral diet
.... caloricDensity 0..1 SimpleQuantity Amount of energy per specified volume of oral diet
... supplement C 0..* BackboneElement Supplement components

.... type Σ 0..1 CodeableReference(NutritionProduct) Type of supplement product requested
Binding: Supplement Type Codes (Preferred)
.... productName 0..1 string Product or brand name of the nutritional supplement
.... schedule 0..1 BackboneElement Scheduling information for supplements
..... timing 0..* Timing Scheduled frequency of supplement

..... asNeeded 0..1 boolean Take 'as needed'
..... asNeededFor 0..1 CodeableConcept Take 'as needed' for x
Binding: SNOMED CT Medication As Needed Reason Codes (Example)
.... quantity 0..1 SimpleQuantity Amount of the nutritional supplement
.... instruction Σ 0..1 string Instructions or additional information about the oral supplement
.... caloricDensity 0..1 SimpleQuantity Amount of energy per specified volume of supplement that is required
... enteralFormula C 0..1 BackboneElement Enteral formula product
.... type Σ 0..1 CodeableReference(NutritionProduct) Type of patient enteral feeding
Binding: Enteral Formula Type Codes (Preferred)
.... productName 0..1 string Product or brand name of the enteral feeding
.... deliveryDevice 0..* CodeableReference(DeviceDefinition) Intended type of device for the enteral feeding administration

.... caloricDensity 0..1 SimpleQuantity Amount of energy per specified volume of feeding that is required
.... routeOfAdministration 0..* CodeableConcept How the enteral feeding should enter the patient's gastrointestinal tract
Binding: Enteral Route Codes (Extensible)

.... administration 0..* BackboneElement Formula feeding instruction as structured data

..... schedule 0..1 BackboneElement Scheduling information for enteral feeding products
...... timing 0..* Timing Scheduled frequency of enteral feeding

...... asNeeded 0..1 boolean Take 'as needed'
...... asNeededFor 0..1 CodeableConcept Take 'as needed' for x
Binding: SNOMED CT Medication As Needed Reason Codes (Example)
..... quantity 0..1 SimpleQuantity The volume of formula feeding to provide
..... rate[x] 0..1 Speed with which the formula feeding is provided per period of time
...... rateQuantity SimpleQuantity
...... rateRatio Ratio
.... maxVolumeToAdminister 0..1 SimpleQuantity Upper limit on formula feeding volume per unit of time
.... administrationInstruction Σ 0..1 markdown Formula feeding instructions expressed as text
... additive 0..* BackboneElement Modular additive to add to the oral diet, supplement, and/or enteral feeding

.... modularType 0..1 CodeableReference(NutritionProduct) Type of modular component to add to the oral diet, supplement, and/or enteral feeding
Binding: Enteral Formula Additive Type Code (Preferred)
.... productName 0..1 string Product or brand name of the modular additive
.... quantity 0..1 SimpleQuantity Amount of additive to be given or mixed in with the oral diet, supplement, and/or enteral feeding
... note 0..* Annotation Comments


doco Documentation for this format icon

See the Extensions for this resource

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..*]A plan or request that is fulfilled in whole or in part by this nutrition orderbasedOn : Reference [0..*] « CarePlan|NutritionOrder|ServiceRequest| RequestOrchestration »A shared identifier common to all nutrition orders that were authorized more or less simultaneously by a single author, representing the composite or group identifiergroupIdentifier : Identifier [0..1]The workflow status of the nutrition order/request (this element modifies the meaning of other elements)status : code [1..1] « null (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] « null (Strength=Required)RequestIntent! »Indicates how quickly the Nutrition Order should be addressed with respect to other requestspriority : code [0..1] « null (Strength=Required)RequestPriority! »The person or set of individuals who needs the nutrition order for an oral diet, nutritional supplement and/or enteral or formula feedingsubject : Reference [1..1] « Patient|Group »An encounter that provides additional information about the healthcare context in which this request is madeencounter : Reference [0..1] « Encounter »Information to support fulfilling (i.e. dispensing or administering) of the nutrition, for example, patient height and weight)supportingInformation : Reference [0..*] « Any »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 »The specified desired performer of the nutrition orderperformer : CodeableReference [0..*] « CareTeam|Practitioner| PractitionerRole|RelatedPerson|Patient|Organization|Group »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 (i.e. solid and/or liquid) 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..*] « null (Strength=Preferred) TypesOfEdibleSubstances? »This modifier is used to convey Order-specific modifier about the type of oral food (i.e. solid and/or liquid) 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..*] « null (Strength=Preferred) TypesOfEdibleSubstances? »This modifier is used to convey whether a food item, brought in by the patient, family, and/or caregiver, can be consumed by the patient. If set to true, indicates that the receiving system does not need to supply the food itemoutsideFoodAllowed : boolean [0..1]Comments made about the nutrition order by the requester, performer, subject or other participantsnote : Annotation [0..*]OralDietThe kind of diet or dietary restriction such as fiber restricted diet or diet for diabetestype : CodeableConcept [0..*] « null (Strength=Preferred)DietCodes? »Free text or additional instructions or information pertaining to the oral dietinstruction : string [0..1]The amount of energy (calories or kilojoules) that the oral diet should provide. For example, an infant formula feeding of 30 ounces of 20 kcal/ounce (67 kcal/100 mL) formula per daycaloricDensity : Quantity(SimpleQuantity) [0..1]OralDietScheduleThe 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 presenttiming : Timing [0..*]Indicates whether the diet is only taken when needed within a specific administration scheduleasNeeded : boolean [0..1]Indicates whether the diet is only taken based on a precondition for taking the dietasNeededFor : CodeableConcept [0..1] « A coded concept identifying the precondition that should be met or evaluated prior to consuming a nutrition product. (Strength=Example) SNOMEDCTMedicationAsNeededRea...?? »NutrientThe nutrient that is being modified such as carbohydrate or sodiummodifier : CodeableConcept [0..1] « null (Strength=Preferred)NutrientCodes? »The quantity of the specified nutrient to include in dietamount : Quantity(SimpleQuantity) [0..1]TextureTexture modifications in the addition to the oral diet type that should be made, e.g. easy to chew, chopped, ground, and pureedmodifier : CodeableConcept [0..1] « null (Strength=Preferred)CategoriesOfNutritionProducts? »The food (i.e. solid and/or liquid) type(s) (e.g. meats, all foods) that the texture modification applies totype : CodeableConcept [0..1] « null (Strength=Example)TextureModifiedFoodTypeCodes?? »SupplementThe kind of nutritional supplement product required such as a high protein or pediatric clear liquid supplementtype : CodeableReference [0..1] « NutritionProduct; null (Strength=Preferred) SupplementTypeCodes? »The product or brand name of the nutritional supplement such as "Acme Protein Shake"productName : string [0..1]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]The amount of energy (calories or kilojoules) that the supplement should provide per specified volume, typically per ml or fluid oz. For example, a patient may required a supplement that provides 24 calories per fluid ouncecaloricDensity : Quantity(SimpleQuantity) [0..1]SupplementScheduleThe time period and frequency at which the supplement should be given. The supplement should be given for the combination of all schedules if more than one schedule is presenttiming : Timing [0..*]Indicates whether the supplement is only taken when needed within a specific dosing scheduleasNeeded : boolean [0..1]Indicates whether the supplement is only taken based on a precondition for taking the supplementasNeededFor : CodeableConcept [0..1] « A coded concept identifying the precondition that should be met or evaluated prior to consuming a supplement. (Strength=Example) SNOMEDCTMedicationAsNeededRea...?? »EnteralFormulaThe type of adult or pediatric enteral feeding such as an adult standard formula with fiber or a soy-based infant feedingtype : CodeableReference [0..1] « NutritionProduct; null (Strength=Preferred) EnteralFormulaTypeCodes? »The product or brand name of the enteral feeding product such as "ACME Adult Standard Formula"productName : string [0..1]The intended type of device that is to be used for the administration of the enteral formuladeliveryDevice : CodeableReference [0..*] « DeviceDefinition »The amount of energy (calories or kilojoules) that the feeding 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 administration into the patient's gastrointestinal tract for purposes of providing the formula feeding, e.g. nasogastric tube, oralrouteOfAdministration : CodeableConcept [0..*] « null (Strength=Extensible)EnteralRouteCodes+ »The maximum total quantity of formula feeding that may be administered to a subject over the period of time, e.g. 1440 mL over 24 hoursmaxVolumeToAdminister : Quantity(SimpleQuantity) [0..1]Free text formula administration, feeding instructions or additional instructions or informationadministrationInstruction : markdown [0..1]AdministrationThe volume of formula feeding to provide to the patient per the specified administration schedulequantity : Quantity(SimpleQuantity) [0..1]The rate of administration of formula feeding via a feeding pump, e.g. 60 mL per hour, according to the specified schedulerate[x] : DataType [0..1] « Quantity(SimpleQuantity)|Ratio »EnteralFormulaScheduleThe time period and frequency at which the enteral feeding should be given. The enteral feeding should be given for the combination of all schedules if more than one schedule is presenttiming : Timing [0..*]Indicates whether the enteral feeding is only taken when needed within a specific dosing scheduleasNeeded : boolean [0..1]Indicates whether the enteral feeding is only taken based on a precondition for taking the enteral feedingasNeededFor : CodeableConcept [0..1] « A coded concept identifying the precondition that should be met or evaluated prior to consuming an enteral formula. (Strength=Example) SNOMEDCTMedicationAsNeededRea...?? »AdditiveIndicates the type of modular component such as protein, carbohydrate, fat or fiber to be provided in addition to or mixed with the oral diet, supplement, and/or enteral feedingmodularType : CodeableReference [0..1] « NutritionProduct; null (Strength=Preferred) EnteralFormulaAdditiveTypeCode? »The product or brand name of the type of modular additive to be added to the oral diet, supplement, and/or enteral feedingproductName : string [0..1]The amount of additive to be given in addition or to be mixed in with the oral diet, supplement, and/or enteral feedingquantity : Quantity(SimpleQuantity) [0..1]Schedule information for an oral dietschedule[0..1]Defines the quantity and the nutrient modified (for example carbohydrate, fiber or sodium) in the oral dietnutrient[0..*]Class that describes any texture modifications in addition to the oral diet type required for the patient to safely consume various types of foods (i.e. solid and/or liquid)texture[0..*]Diet given orally that may include texture modification, such as International Dysphagia Diet Standardisation Initiative Framework - Slightly Thick Level 1 drinks and Minced and International Dysphagia Diet Standardisation Initiative Framework - Minced and Moist Level 5 food as well as, for example, Decreased potassium diet (ie, nutrient modification), Halal diet (ie, cultural modification), and/or Low microbial diet (eg, other modification)oralDiet[0..1]Schedule information for a supplementschedule[0..1]Oral nutritional products given in order to add further nutritional value to the patient's dietsupplement[0..*]Schedule information for an enteral feedingschedule[0..1]Formula feeding 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]Indicates modular components to be provided in addition or mixed with the oral diet, supplement, and/or enteral feedingadditive[0..*]

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 -->
 <basedOn><!-- 0..* Reference(CarePlan|NutritionOrder|RequestOrchestration|
   ServiceRequest) What this order fulfills --></basedOn>
 <groupIdentifier><!-- 0..1 Identifier Composite Request ID --></groupIdentifier>
 <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 -->
 <priority value="[code]"/><!-- 0..1 routine | urgent | asap | stat -->
 <subject><!-- 1..1 Reference(Group|Patient) Who requires the diet, formula or nutritional supplement --></subject>
 <encounter><!-- 0..1 Reference(Encounter) The encounter associated with this nutrition order --></encounter>
 <supportingInformation><!-- 0..* Reference(Any) Information to support fulfilling of the nutrition order --></supportingInformation>
 <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>
 <performer><!-- 0..* CodeableReference(CareTeam|Group|Organization|Patient|
   Practitioner|PractitionerRole|RelatedPerson) Who is intended to perform the administration of the nutrition order --></performer>
 <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 Food that should not be given --></excludeFoodModifier>
 <outsideFoodAllowed value="[boolean]"/><!-- 0..1 Capture if patient is permitted to consume food from outside of current setting brought by the patient, family, and/or caregiver -->
 <oralDiet>  <!-- I 0..1 Oral diet components -->
  <type><!-- 0..* CodeableConcept Type of oral diet or diet restrictions that can be consumed orally --></type>
  <schedule>  <!-- 0..1 Scheduling information for oral diets -->
   <timing><!-- 0..* Timing Scheduled frequency of diet --></timing>
   <asNeeded value="[boolean]"/><!-- 0..1 Take 'as needed' -->
   <asNeededFor><!-- 0..1 CodeableConcept Take 'as needed' for x --></asNeededFor>
  </schedule>
  <nutrient>  <!-- 0..* The nutrient that is modified and the quantity in the diet -->
   <modifier><!-- 0..1 CodeableConcept Nutrient modified in the oral diet type --></modifier>
   <amount><!-- 0..1 Quantity(SimpleQuantity) Quantity of the specified nutrient --></amount>
  </nutrient>
  <texture>  <!-- 0..* Texture modifications in addition to the oral diet type -->
   <modifier><!-- 0..1 CodeableConcept Food (i.e. solid and/or liquid) texture modifications in addition to those in the oral diet type --></modifier>
   <type><!-- 0..1 CodeableConcept Food (i.e. solid and/or liquid) types that undergo texture alteration --></type>
  </texture>
  <instruction value="[string]"/><!-- 0..1 Instructions or additional information about the oral diet -->
  <caloricDensity><!-- 0..1 Quantity(SimpleQuantity) Amount of energy per specified volume of oral diet --></caloricDensity>
 </oralDiet>
 <supplement>  <!-- I 0..* Supplement components -->
  <type><!-- 0..1 CodeableReference(NutritionProduct) Type of supplement product requested --></type>
  <productName value="[string]"/><!-- 0..1 Product or brand name of the nutritional supplement -->
  <schedule>  <!-- 0..1 Scheduling information for supplements -->
   <timing><!-- 0..* Timing Scheduled frequency of supplement --></timing>
   <asNeeded value="[boolean]"/><!-- 0..1 Take 'as needed' -->
   <asNeededFor><!-- 0..1 CodeableConcept Take 'as needed' for x --></asNeededFor>
  </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 -->
  <caloricDensity><!-- 0..1 Quantity(SimpleQuantity) Amount of energy per specified volume of supplement that is required --></caloricDensity>
 </supplement>
 <enteralFormula>  <!-- I 0..1 Enteral formula product -->
  <type><!-- 0..1 CodeableReference(NutritionProduct) Type of patient enteral feeding --></type>
  <productName value="[string]"/><!-- 0..1 Product or brand name of the enteral feeding -->
  <deliveryDevice><!-- 0..* CodeableReference(DeviceDefinition) Intended type of device for the enteral feeding administration --></deliveryDevice>
  <caloricDensity><!-- 0..1 Quantity(SimpleQuantity) Amount of energy per specified volume of feeding that is required --></caloricDensity>
  <routeOfAdministration><!-- 0..* CodeableConcept How the enteral feeding should enter the patient's gastrointestinal tract --></routeOfAdministration>
  <administration>  <!-- 0..* Formula feeding instruction as structured data -->
   <schedule>  <!-- 0..1 Scheduling information for enteral feeding products -->
    <timing><!-- 0..* Timing Scheduled frequency of enteral feeding --></timing>
    <asNeeded value="[boolean]"/><!-- 0..1 Take 'as needed' -->
    <asNeededFor><!-- 0..1 CodeableConcept Take 'as needed' for x --></asNeededFor>
   </schedule>
   <quantity><!-- 0..1 Quantity(SimpleQuantity) The volume of formula feeding to provide --></quantity>
   <rate[x]><!-- 0..1 Quantity(SimpleQuantity)|Ratio Speed with which the formula feeding is provided per period of time --></rate[x]>
  </administration>
  <maxVolumeToAdminister><!-- 0..1 Quantity(SimpleQuantity) Upper limit on formula feeding volume per unit of time --></maxVolumeToAdminister>
  <administrationInstruction value="[markdown]"/><!-- 0..1 Formula feeding instructions expressed as text -->
 </enteralFormula>
 <additive>  <!-- 0..* Modular additive to add to the oral diet, supplement, and/or enteral feeding -->
  <modularType><!-- 0..1 CodeableReference(NutritionProduct) Type of modular component to add to the oral diet, supplement, and/or enteral feeding --></modularType>
  <productName value="[string]"/><!-- 0..1 Product or brand name of the modular additive -->
  <quantity><!-- 0..1 Quantity(SimpleQuantity) Amount of additive to be given or mixed in with the oral diet, supplement, and/or enteral feeding --></quantity>
 </additive>
 <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
  "basedOn" : [{ Reference(CarePlan|NutritionOrder|RequestOrchestration|
   ServiceRequest) }], // What this order fulfills
  "groupIdentifier" : { Identifier }, // Composite Request ID
  "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
  "priority" : "<code>", // routine | urgent | asap | stat
  "subject" : { Reference(Group|Patient) }, // R!  Who requires the diet, formula or nutritional supplement
  "encounter" : { Reference(Encounter) }, // The encounter associated with this nutrition order
  "supportingInformation" : [{ Reference(Any) }], // Information to support fulfilling of the 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
  "performer" : [{ CodeableReference(CareTeam|Group|Organization|Patient|
   Practitioner|PractitionerRole|RelatedPerson) }], // Who is intended to perform the administration of the nutrition order
  "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 }], // Food that should not be given
  "outsideFoodAllowed" : <boolean>, // Capture if patient is permitted to consume food from outside of current setting brought by the patient, family, and/or caregiver
  "oralDiet" : { // I Oral diet components
    "type" : [{ CodeableConcept }], // Type of oral diet or diet restrictions that can be consumed orally
    "schedule" : { // Scheduling information for oral diets
      "timing" : [{ Timing }], // Scheduled frequency of diet
      "asNeeded" : <boolean>, // Take 'as needed'
      "asNeededFor" : { CodeableConcept } // Take 'as needed' for x
    },
    "nutrient" : [{ // The nutrient that is modified and the quantity in the diet
      "modifier" : { CodeableConcept }, // Nutrient modified in the oral diet type
      "amount" : { Quantity(SimpleQuantity) } // Quantity of the specified nutrient
    }],
    "texture" : [{ // Texture modifications in addition to the oral diet type
      "modifier" : { CodeableConcept }, // Food (i.e. solid and/or liquid) texture modifications in addition to those in the oral diet type
      "type" : { CodeableConcept } // Food (i.e. solid and/or liquid) types that undergo texture alteration
    }],
    "instruction" : "<string>", // Instructions or additional information about the oral diet
    "caloricDensity" : { Quantity(SimpleQuantity) } // Amount of energy per specified volume of oral diet
  },
  "supplement" : [{ // I Supplement components
    "type" : { CodeableReference(NutritionProduct) }, // Type of supplement product requested
    "productName" : "<string>", // Product or brand name of the nutritional supplement
    "schedule" : { // Scheduling information for supplements
      "timing" : [{ Timing }], // Scheduled frequency of supplement
      "asNeeded" : <boolean>, // Take 'as needed'
      "asNeededFor" : { CodeableConcept } // Take 'as needed' for x
    },
    "quantity" : { Quantity(SimpleQuantity) }, // Amount of the nutritional supplement
    "instruction" : "<string>", // Instructions or additional information about the oral supplement
    "caloricDensity" : { Quantity(SimpleQuantity) } // Amount of energy per specified volume of supplement that is required
  }],
  "enteralFormula" : { // I Enteral formula product
    "type" : { CodeableReference(NutritionProduct) }, // Type of patient enteral feeding
    "productName" : "<string>", // Product or brand name of the enteral feeding
    "deliveryDevice" : [{ CodeableReference(DeviceDefinition) }], // Intended type of device for the enteral feeding administration
    "caloricDensity" : { Quantity(SimpleQuantity) }, // Amount of energy per specified volume of feeding that is required
    "routeOfAdministration" : [{ CodeableConcept }], // How the enteral feeding should enter the patient's gastrointestinal tract
    "administration" : [{ // Formula feeding instruction as structured data
      "schedule" : { // Scheduling information for enteral feeding products
        "timing" : [{ Timing }], // Scheduled frequency of enteral feeding
        "asNeeded" : <boolean>, // Take 'as needed'
        "asNeededFor" : { CodeableConcept } // Take 'as needed' for x
      },
      "quantity" : { Quantity(SimpleQuantity) }, // The volume of formula feeding to provide
      // rate[x]: Speed with which the formula feeding is provided per period of time. One of these 2:
      "rateQuantity" : { Quantity(SimpleQuantity) },
      "rateRatio" : { Ratio }
    }],
    "maxVolumeToAdminister" : { Quantity(SimpleQuantity) }, // Upper limit on formula feeding volume per unit of time
    "administrationInstruction" : "<markdown>" // Formula feeding instructions expressed as text
  },
  "additive" : [{ // Modular additive to add to the oral diet, supplement, and/or enteral feeding
    "modularType" : { CodeableReference(NutritionProduct) }, // Type of modular component to add to the oral diet, supplement, and/or enteral feeding
    "productName" : "<string>", // Product or brand name of the modular additive
    "quantity" : { Quantity(SimpleQuantity) } // Amount of additive to be given or mixed in with the oral diet, supplement, and/or enteral feeding
  }],
  "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:identifier  ( [ Identifier ] ... ) ; # 0..* Identifiers assigned to this order
  fhir:instantiatesCanonical  ( [ canonical(ActivityDefinition|PlanDefinition) ] ... ) ; # 0..* Instantiates FHIR protocol or definition
  fhir:instantiatesUri  ( [ uri ] ... ) ; # 0..* Instantiates external protocol or definition
  fhir:instantiates  ( [ uri ] ... ) ; # 0..* Instantiates protocol or definition
  fhir:basedOn  ( [ Reference(CarePlan|NutritionOrder|RequestOrchestration|ServiceRequest) ] ... ) ; # 0..* What this order fulfills
  fhir:groupIdentifier [ Identifier ] ; # 0..1 Composite Request ID
  fhir:status [ code ] ; # 1..1 draft | active | on-hold | revoked | completed | entered-in-error | unknown
  fhir:intent [ code ] ; # 1..1 proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
  fhir:priority [ code ] ; # 0..1 routine | urgent | asap | stat
  fhir:subject [ Reference(Group|Patient) ] ; # 1..1 Who requires the diet, formula or nutritional supplement
  fhir:encounter [ Reference(Encounter) ] ; # 0..1 The encounter associated with this nutrition order
  fhir:supportingInformation  ( [ Reference(Any) ] ... ) ; # 0..* Information to support fulfilling of the nutrition order
  fhir:dateTime [ dateTime ] ; # 1..1 Date and time the nutrition order was requested
  fhir:orderer [ Reference(Practitioner|PractitionerRole) ] ; # 0..1 Who ordered the diet, formula or nutritional supplement
  fhir:performer  ( [ CodeableReference(CareTeam|Group|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ... ) ; # 0..* Who is intended to perform the administration of the nutrition order
  fhir:allergyIntolerance  ( [ Reference(AllergyIntolerance) ] ... ) ; # 0..* List of the patient's food and nutrition-related allergies and intolerances
  fhir:foodPreferenceModifier  ( [ CodeableConcept ] ... ) ; # 0..* Order-specific modifier about the type of food that should be given
  fhir:excludeFoodModifier  ( [ CodeableConcept ] ... ) ; # 0..* Food that should not be given
  fhir:outsideFoodAllowed [ boolean ] ; # 0..1 Capture if patient is permitted to consume food from outside of current setting brought by the patient, family, and/or caregiver
  fhir:oralDiet [ # 0..1 I Oral diet components
    fhir:type  ( [ CodeableConcept ] ... ) ; # 0..* Type of oral diet or diet restrictions that can be consumed orally
    fhir:schedule [ # 0..1 Scheduling information for oral diets
      fhir:timing  ( [ Timing ] ... ) ; # 0..* Scheduled frequency of diet
      fhir:asNeeded [ boolean ] ; # 0..1 Take 'as needed'
      fhir:asNeededFor [ CodeableConcept ] ; # 0..1 Take 'as needed' for x
    ] ;
    fhir:nutrient ( [ # 0..* The nutrient that is modified and the quantity in the diet
      fhir:modifier [ CodeableConcept ] ; # 0..1 Nutrient modified in the oral diet type
      fhir:amount [ Quantity(SimpleQuantity) ] ; # 0..1 Quantity of the specified nutrient
    ] ... ) ;
    fhir:texture ( [ # 0..* Texture modifications in addition to the oral diet type
      fhir:modifier [ CodeableConcept ] ; # 0..1 Food (i.e. solid and/or liquid) texture modifications in addition to those in the oral diet type
      fhir:type [ CodeableConcept ] ; # 0..1 Food (i.e. solid and/or liquid) types that undergo texture alteration
    ] ... ) ;
    fhir:instruction [ string ] ; # 0..1 Instructions or additional information about the oral diet
    fhir:caloricDensity [ Quantity(SimpleQuantity) ] ; # 0..1 Amount of energy per specified volume of oral diet
  ] ;
  fhir:supplement ( [ # 0..* I Supplement components
    fhir:type [ CodeableReference(NutritionProduct) ] ; # 0..1 Type of supplement product requested
    fhir:productName [ string ] ; # 0..1 Product or brand name of the nutritional supplement
    fhir:schedule [ # 0..1 Scheduling information for supplements
      fhir:timing  ( [ Timing ] ... ) ; # 0..* Scheduled frequency of supplement
      fhir:asNeeded [ boolean ] ; # 0..1 Take 'as needed'
      fhir:asNeededFor [ CodeableConcept ] ; # 0..1 Take 'as needed' for x
    ] ;
    fhir:quantity [ Quantity(SimpleQuantity) ] ; # 0..1 Amount of the nutritional supplement
    fhir:instruction [ string ] ; # 0..1 Instructions or additional information about the oral supplement
    fhir:caloricDensity [ Quantity(SimpleQuantity) ] ; # 0..1 Amount of energy per specified volume of supplement that is required
  ] ... ) ;
  fhir:enteralFormula [ # 0..1 I Enteral formula product
    fhir:type [ CodeableReference(NutritionProduct) ] ; # 0..1 Type of patient enteral feeding
    fhir:productName [ string ] ; # 0..1 Product or brand name of the enteral feeding
    fhir:deliveryDevice  ( [ CodeableReference(DeviceDefinition) ] ... ) ; # 0..* Intended type of device for the enteral feeding administration
    fhir:caloricDensity [ Quantity(SimpleQuantity) ] ; # 0..1 Amount of energy per specified volume of feeding that is required
    fhir:routeOfAdministration  ( [ CodeableConcept ] ... ) ; # 0..* How the enteral feeding should enter the patient's gastrointestinal tract
    fhir:administration ( [ # 0..* Formula feeding instruction as structured data
      fhir:schedule [ # 0..1 Scheduling information for enteral feeding products
        fhir:timing  ( [ Timing ] ... ) ; # 0..* Scheduled frequency of enteral feeding
        fhir:asNeeded [ boolean ] ; # 0..1 Take 'as needed'
        fhir:asNeededFor [ CodeableConcept ] ; # 0..1 Take 'as needed' for x
      ] ;
      fhir:quantity [ Quantity(SimpleQuantity) ] ; # 0..1 The volume of formula feeding to provide
      # rate[x] : 0..1 Speed with which the formula feeding is provided per period of time. One of these 2
        fhir:rate [  a fhir:SimpleQuantity ; Quantity(SimpleQuantity) ]
        fhir:rate [  a fhir:Ratio ; Ratio ]
    ] ... ) ;
    fhir:maxVolumeToAdminister [ Quantity(SimpleQuantity) ] ; # 0..1 Upper limit on formula feeding volume per unit of time
    fhir:administrationInstruction [ markdown ] ; # 0..1 Formula feeding instructions expressed as text
  ] ;
  fhir:additive ( [ # 0..* Modular additive to add to the oral diet, supplement, and/or enteral feeding
    fhir:modularType [ CodeableReference(NutritionProduct) ] ; # 0..1 Type of modular component to add to the oral diet, supplement, and/or enteral feeding
    fhir:productName [ string ] ; # 0..1 Product or brand name of the modular additive
    fhir:quantity [ Quantity(SimpleQuantity) ] ; # 0..1 Amount of additive to be given or mixed in with the oral diet, supplement, and/or enteral feeding
  ] ... ) ;
  fhir:note  ( [ Annotation ] ... ) ; # 0..* Comments
]

Changes from both R4 and R4B

NutritionOrder
NutritionOrder.basedOn
  • Added Element
NutritionOrder.groupIdentifier
  • Added Element
NutritionOrder.priority
  • Added Element
NutritionOrder.subject
  • Added Mandatory Element
NutritionOrder.supportingInformation
  • Added Element
NutritionOrder.performer
  • Added Element
NutritionOrder.outsideFoodAllowed
  • Added Element
NutritionOrder.oralDiet.schedule
  • Max Cardinality changed from * to 1
  • Type changed from Timing to BackboneElement
NutritionOrder.oralDiet.schedule.timing
  • Added Element
NutritionOrder.oralDiet.schedule.asNeeded
  • Added Element
NutritionOrder.oralDiet.schedule.asNeededFor
  • Added Element
NutritionOrder.oralDiet.texture.type
  • Added Element
NutritionOrder.oralDiet.caloricDensity
  • Added Element
NutritionOrder.supplement.type
  • Type changed from CodeableConcept to CodeableReference
NutritionOrder.supplement.schedule
  • Max Cardinality changed from * to 1
  • Type changed from Timing to BackboneElement
NutritionOrder.supplement.schedule.timing
  • Added Element
NutritionOrder.supplement.schedule.asNeeded
  • Added Element
NutritionOrder.supplement.schedule.asNeededFor
  • Added Element
NutritionOrder.supplement.caloricDensity
  • Added Element
NutritionOrder.enteralFormula.type
  • Added Element
NutritionOrder.enteralFormula.productName
  • Added Element
NutritionOrder.enteralFormula.deliveryDevice
  • Added Element
NutritionOrder.enteralFormula.routeOfAdministration
  • Added Element
NutritionOrder.enteralFormula.administration.schedule
  • Type changed from Timing to BackboneElement
NutritionOrder.enteralFormula.administration.schedule.timing
  • Added Element
NutritionOrder.enteralFormula.administration.schedule.asNeeded
  • Added Element
NutritionOrder.enteralFormula.administration.schedule.asNeededFor
  • Added Element
NutritionOrder.enteralFormula.maxVolumeToAdminister
  • Added Element
NutritionOrder.enteralFormula.administrationInstruction
  • Type changed from string to markdown
NutritionOrder.additive
  • Added Element
NutritionOrder.additive.modularType
  • Added Element
NutritionOrder.additive.productName
  • Added Element
NutritionOrder.additive.quantity
  • Added Element
NutritionOrder.patient
  • Deleted
NutritionOrder.oralDiet.texture.foodType
  • Deleted
NutritionOrder.oralDiet.fluidConsistencyType
  • Deleted
NutritionOrder.enteralFormula.baseFormulaType
  • Deleted
NutritionOrder.enteralFormula.baseFormulaProductName
  • Deleted
NutritionOrder.enteralFormula.additiveType
  • Deleted
NutritionOrder.enteralFormula.additiveProductName
  • Deleted
NutritionOrder.enteralFormula.routeofAdministration
  • Deleted
NutritionOrder.enteralFormula.maxVolumeToDeliver
  • Deleted

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B 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

12.19.4.1 Terminology Bindings

Path ValueSet Type Documentation
NutritionOrder.status RequestStatus Required

Codes identifying the lifecycle stage of a request.
NutritionOrder.intent RequestIntent Required

Codes indicating the degree of authority/intentionality associated with a request.
NutritionOrder.priority RequestPriority Required

Identifies the level of importance to be assigned to actioning the request.
NutritionOrder.foodPreferenceModifier TypesOfEdibleSubstances Preferred

This value set represents codes for types of edible substances. It include codes from SNOMED CT icon where concept 762766007 Edible Substance (substance) and its sub-concepts, Infant Formula (412413001) and its sub-concepts, Enteral and Supplement Feeds (346415002) and its sub-concepts, Water (11713004), Potable Water (890302005) and its sub-concepts, and Tap Water (444923006).
NutritionOrder.excludeFoodModifier TypesOfEdibleSubstances Preferred

This value set represents codes for types of edible substances. It include codes from SNOMED CT icon where concept 762766007 Edible Substance (substance) and its sub-concepts, Infant Formula (412413001) and its sub-concepts, Enteral and Supplement Feeds (346415002) and its sub-concepts, Water (11713004), Potable Water (890302005) and its sub-concepts, and Tap Water (444923006).
NutritionOrder.oralDiet.type DietCodes Preferred

Codes that can be used to indicate the type of food being ordered for a patient. It includes codes from SNOMED CT icon where concept is Dietary Regime (182922004) and its sub-concepts, Enteral Feeding (229912004) and its sub-concepts, Mixed Breast Milk and Bottle Feeding (35011000087100), Breast Milk Feeding (1297276008), Bottle Feeding of Patient (40043006).
NutritionOrder.oralDiet.schedule.asNeededFor SNOMEDCTMedicationAsNeededReasonCodes Example

This value set includes all clinical findings from SNOMED CT - provided as an exemplar value set.
NutritionOrder.oralDiet.nutrient.modifier NutrientCodes Preferred

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

This value set represents codes for categories of nutrition products. It includes all of the codes from the Food Type Modifiers valueset. It include codes from SNOMED CT icon where concept is Breast Milk (226789007) and its sub-concepts, Infant Formula (412413001) and its sub-concepts, Enteral and Supplement Feeds (346415002) and its sub-concepts, Drinks (226465004) and its sub-concepts, Water (11713004), Potable Water (890302005) and its sub-concepts, and 444923006 (Tap Water).
NutritionOrder.oralDiet.texture.type TextureModifiedFoodTypeCodes Example

TextureModifiedFoodType: Codes for types of foods that are texture-modified. This value set is composed SNOMED CT Concepts from SCTID 255620007 Foods (substance) and is provided as a suggestive example.
NutritionOrder.supplement.type SupplementTypeCodes Preferred

SupplementType : Codes for nutritional supplements to be provided to the patient. This value set is composed of SNOMED CT Concepts from SCTID 346415002 (Enteral and supplement feeds (product)).
NutritionOrder.supplement.schedule.asNeededFor SNOMEDCTMedicationAsNeededReasonCodes Example

This value set includes all clinical findings from SNOMED CT - provided as an exemplar value set.
NutritionOrder.enteralFormula.type EnteralFormulaTypeCodes Preferred

SupplementType : Codes for nutritional supplements to be provided to the patient. This value set is composed of SNOMED CT Concepts from SCTID 346415002 (Enteral and supplement feeds (product)).
NutritionOrder.enteralFormula.routeOfAdministration EnteralRouteCodes Extensible

EnteralRouteOfAdministration: Codes specifying the route of administration of enteral formula. This value set is composed of HL7 V3 codes and is provided as a suggestive example.
NutritionOrder.enteralFormula.administration.schedule.asNeededFor SNOMEDCTMedicationAsNeededReasonCodes Example

This value set includes all clinical findings from SNOMED CT - provided as an exemplar value set.
NutritionOrder.additive.modularType EnteralFormulaAdditiveTypeCode Preferred

Codes for modular components to be added to the diet.

12.19.4.2 Constraints

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

12.19.5 Notes:

12.19.5.1 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.

12.19.5.2 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.

12.19.6 Search Parameters

Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name Type Description Expression In Common
additive token Type of module component to add to the diet NutritionOrder.additive.modularType.concept
datetime date Return nutrition orders requested on this date NutritionOrder.dateTime
encounter reference Return nutrition orders with this encounter identifier NutritionOrder.encounter
(Encounter)		 29 Resources
formula token Type of enteral or infant formula NutritionOrder.enteralFormula.type.concept
group-identifier token Composite Request ID NutritionOrder.groupIdentifier
identifier token Return nutrition orders with this external identifier NutritionOrder.identifier 65 Resources
oraldiet token Type of diet that can be consumed orally (i.e., take via the mouth). NutritionOrder.oralDiet.type
patient reference The identity of the individual or set of individuals who requires the diet, formula or nutritional supplement NutritionOrder.subject.where(resolve() is Patient)
(Patient)		 65 Resources
provider reference The identity of the provider who placed the nutrition order NutritionOrder.orderer
(Practitioner, PractitionerRole)
status token Status of the nutrition order. NutritionOrder.status
subject reference The identity of the individual or set of individuals who requires the diet, formula or nutritional supplement NutritionOrder.subject
(Group, Patient)
supplement token Type of supplement product requested NutritionOrder.supplement.type.concept