Scope and Usage

Purpose of the resource

The purpose of the Personal Functioning and Engagement Nutrition Order Profile is to facilitate the exchange of nutrition orders that include details about a patient’s oral diet, supplementation, or enteral formula. It was profiled with the complex needs of Post-Acute Care (PAC) patients in mind, but may be used to exchange this information between other settings. For this profile, “post-acute care” is defined as “care that is provided to individuals who need additional help recuperating from an acute illness or serious medical procedure” cite; Personal Functioning and Engagement data are the details of the person's functioning in terms of body functions, activities, and participation cite.

What is in this resource

The Personal Functioning and Engagement Nutrition Order Profile includes data elements for the following nutritional considerations or restrictions:

• For oral diet, the type (e.g., salt free diet), nutrient (e.g., sodium), and texture (e.g., pureed)
• For nutritional supplement, the type (e.g., Diabetic meal replacement bar), schedule (e.g., daily at noon), quantity (e.g., 1 serving size), and instruction (e.g., cut meal replacement bar into quarters). Nutrition supplements may be the same product as an enteral formula, but are intended to be consumed orally.
• For enteral formulas, the type (e.g., adult standard formula with fiber), additive type (e.g., fiber), caloric density (e.g., 1.5 calories/mL), administration route (e.g., nasogastric tube), schedule, quantity, and administration instructions.

A nutrition order must include at least one of the following: oralDiet, supplement, enteralFormula. Individually, each of these three data elements is optional, but they cannot all be blank. Without at least one of these three data elements, a Nutrition Order is not meaningful.

The resource also includes data elements for dietary allergies and intolerances, patient's food preferences including cultural and religious needs, foods that should be excluded, and exceptions to diet texture.

This IG can be used by healthcare providers and facilities to determine the appropriate formulation and format of a patient’s diet. This IG supports multidisciplinary care through: integrating of other relevant IGs (e.g., the Encounter IG that provides information about the healthcare context in which the order is made), supporting standardized data related to nutrition (e.g., Diet and Food Type nutrition code value sets), and facilitating consideration of data from multiple disciplines with expertise regarding nutrition and feeding (e.g., speech pathology, dietician, nursing) when developing and documenting the order.

Example of the Nutrition Order resource supporting documentation of a nutrition order for a patient in a skilled nursing facility which has implemented the resource into their electronic health record (EHR): A speech pathologist conducts an evaluation of the patient. Based on their findings, they determine that the patient needs to be supervised while eating. They document their assessment findings and determination about supervision in the EHR. The nurse practitioner overseeing the patient uses the EHR to review the speech pathologist's documentation in addition to other relevant data in the patient's record relevant to eating. In consultation with the speech pathologist, nutritionist, and nurse supporting the patient, the nurse practitioner enters data into the EHR, which includes data entry options for information included in the Personal Functioning and Engagement Nutrition Order resource, to complete a nutrition order indicating that the patient needs supervision while eating.

What is not in this resource

his resource does not include intravenous (IV) nutrition, vitamin supplements, or mineral supplements – these should be handled using the US Core IG’s Medication Request profile US Core MedicationRequest.

Intended audience and setting for the resource

This resource has been developed for post-acute and acute healthcare providers who are involved with a patient's nutrition and diet, such as physicians, nurse practitioners, nutritionists/dieticians, and speech language pathologists/therapists, as well as EHR implementors. It accommodates the variety of scopes of practice by different disciplines that can be involved in ordering, determining, managing, or documenting a patient's nutrition and diet. The profile can be used in any post-acute care setting, such as long-term care hospitals, skilled nursing facilities, and home health.

What the resource can be used for

This resource can be used by post-acute care facilities, as well as acute care hospitals, to provide orders that can vary from simple to complex orders. It supports input and updates from multiple healthcare providers.

How this resource was developed

The Personal Functioning and Engagement Nutrition Order Profile was developed by the Personal Functioning and Engagement subgroup of the Post-Acute Care InterOperability (PACIO) project. The subgroup was comprised of clinical and technical experts including dieticians, speech language pathologists, physical therapists, occupational therapists, nurses, physicians, and home and community-based service professionals.

Boundaries and Relationships

Within boundaries/scope of the resource

The scope of the Personal Functioning and Engagement Nutrition Order Profile encompasses a patient's oral diet, nutritional supplements, and/or enteral (tube feeding) diet.

Other resources that address related content outside the boundaries/scope of this resource

For IV nutrition, mineral supplements, or vitamin supplements, use a the US Core IG’s Medication Request profile (US Core MedicationRequest).

Relationship to other resources

This profile is derived from the FHIR R4 base Nutrition Order resource. Normally profiles in U.S. based implementation guides are derived from U.S. Core profiles, but an exception was made because no U.S. Core 6.1.0 Nutrition Order profile exists.

Within the Personal Functioning and Engagement Nutrition Order Profile, Allergy Intolerance is a required data element. The Allergy Intolerance data element must be populated, even if it states that the patient has no known allergies. This is a change from the parent Nutrition Order base FHIR resource, in which Allergy Intolerance is optional. This constraint was added based on feedback from clinicians at the weekly Personal Functioning and Engagement subgroup meeting where they emphasized the importance of the Allergy Intolerance data element due to patient safety. References to encounter and orderer profiles are optional (as in the parent Nutrition Order resource) but have been elevated to Must Support.

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
• All

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
NutritionOrder	C	0..*	NutritionOrder	Diet, formula or nutritional supplement request Constraints: nor-1
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!Σ	1..1	code	draft | active | on-hold | revoked | completed | entered-in-error | unknown Binding: RequestStatus (required): Codes identifying the lifecycle stage of the nutrition order.
intent	?!Σ	1..1	code	proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Binding: RequestIntent (required): Codes indicating the degree of authority/intentionality associated with a nutrition order.
patient	Σ	1..1	Reference(Patient)	The person who requires the diet, formula or nutritional supplement
encounter	S	0..1	Reference(Encounter)	The encounter associated with this nutrition order
dateTime	Σ	1..1	dateTime	Date and time the nutrition order was requested
orderer	SΣ	0..1	Reference(Practitioner | PractitionerRole)	Who ordered the diet, formula or nutritional supplement
allergyIntolerance		1..*	Reference(AllergyIntolerance)	List of the patient's food and nutrition-related allergies and intolerances
foodPreferenceModifier	S	0..*	CodeableConcept	Order-specific modifier about the type of food that should be given Binding: Diet (example): Medical, cultural or ethical food preferences to help with catering requirements.
excludeFoodModifier	S	0..*	CodeableConcept	Order-specific modifier about the type of food that should not be given Binding: FoodTypeCodes (example): Codes used to indicate the type of food that should NOT be given to the patient.
oralDiet	SC	0..1	BackboneElement	Oral diet components
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	0..*	CodeableConcept	Type of oral diet or diet restrictions that describe what can be consumed orally Binding: DietCodes (example): Codes used to indicate the type of diet being ordered for a patient.
nutrient	S	0..*	BackboneElement	Required nutrient modifications
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
modifier	S	0..1	CodeableConcept	Type of nutrient that is being modified Binding: NutrientModifierCodes (example): Codes for types of nutrients that are being modified such as carbohydrate or sodium.
amount	S	0..1	SimpleQuantity	Quantity of the specified nutrient
texture	S	0..*	BackboneElement	Required texture modifications
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
modifier	S	0..1	CodeableConcept	Code to indicate how to alter the texture of the foods, e.g. pureed Binding: TextureModifierCodes (example): Codes for food consistency types or texture modifications to apply to foods.
foodType	S	0..1	CodeableConcept	Concepts that are used to identify an entity that is ingested for nutritional purposes Binding: TextureModifiedFoodTypeCodes (example): Codes for types of foods that are texture-modified.
fluidConsistencyType	S	0..*	CodeableConcept	The required consistency of fluids and liquids provided to the patient Binding: FluidConsistencyTypeCodes (example): Codes used to represent the consistency of fluids and liquids provided to the patient.
instruction	SΣ	0..1	string	Instructions or additional information about the oral diet
supplement	SC	0..*	BackboneElement	Supplement components
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	0..1	CodeableConcept	Type of supplement product requested Binding: SupplementTypeCodes (example): Codes for nutritional supplements to be provided to the patient.
schedule	S	0..*	Timing	Scheduled frequency of supplement
quantity	S	0..1	SimpleQuantity	Amount of the nutritional supplement
instruction	SΣ	0..1	string	Instructions or additional information about the oral supplement
enteralFormula	SC	0..1	BackboneElement	Enteral formula components
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
baseFormulaType	SΣ	0..1	CodeableConcept	Type of enteral or infant formula Binding: EnteralFormulaTypeCodes (example): Codes for type of enteral formula to be administered to patient.
additiveType	S	0..1	CodeableConcept	Type of modular component to add to the feeding Binding: EnteralFormulaAdditiveTypeCode (example): Codes for the type of modular component such as protein, carbohydrate or fiber to be provided in addition to or mixed with the base formula.
caloricDensity	S	0..1	SimpleQuantity	Amount of energy per specified volume that is required
routeofAdministration	S	0..1	CodeableConcept	How the formula should enter the patient's gastrointestinal tract Binding: EnteralRouteCodes (extensible): Codes specifying the route of administration of enteral formula.
administration	S	0..*	BackboneElement	Formula feeding instruction as structured data
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
schedule	S	0..1	Timing	Scheduled frequency of enteral feeding
quantity	S	0..1	SimpleQuantity	The volume of formula to provide
rate[x]	S	0..1		Speed with which the formula is provided per period of time
rateQuantity			Quantity(SimpleQuantity)
rateRatio			Ratio
administrationInstruction	SΣ	0..1	string	Formula feeding instructions expressed as text
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
NutritionOrder.status	required	RequestStatus http://hl7.org/fhir/ValueSet/request-status|4.0.1 From the FHIR Standard
NutritionOrder.intent	required	RequestIntent http://hl7.org/fhir/ValueSet/request-intent|4.0.1 From the FHIR Standard
NutritionOrder.foodPreferenceModifier	example	Diet http://hl7.org/fhir/ValueSet/encounter-diet From the FHIR Standard
NutritionOrder.excludeFoodModifier	example	FoodTypeCodes http://hl7.org/fhir/ValueSet/food-type From the FHIR Standard
NutritionOrder.oralDiet.type	example	DietCodes http://hl7.org/fhir/ValueSet/diet-type From the FHIR Standard
NutritionOrder.oralDiet.nutrient.modifier	example	NutrientModifierCodes http://hl7.org/fhir/ValueSet/nutrient-code From the FHIR Standard
NutritionOrder.oralDiet.texture.modifier	example	TextureModifierCodes http://hl7.org/fhir/ValueSet/texture-code From the FHIR Standard
NutritionOrder.oralDiet.texture.foodType	example	TextureModifiedFoodTypeCodes http://hl7.org/fhir/ValueSet/modified-foodtype From the FHIR Standard
NutritionOrder.oralDiet.fluidConsistencyType	example	FluidConsistencyTypeCodes http://hl7.org/fhir/ValueSet/consistency-type From the FHIR Standard
NutritionOrder.supplement.type	example	SupplementTypeCodes http://hl7.org/fhir/ValueSet/supplement-type From the FHIR Standard
NutritionOrder.enteralFormula.baseFormulaType	example	EnteralFormulaTypeCodes http://hl7.org/fhir/ValueSet/entformula-type From the FHIR Standard
NutritionOrder.enteralFormula.additiveType	example	EnteralFormulaAdditiveTypeCode http://hl7.org/fhir/ValueSet/entformula-additive From the FHIR Standard
NutritionOrder.enteralFormula.routeofAdministration	extensible	EnteralRouteCodes http://hl7.org/fhir/ValueSet/enteral-route From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	NutritionOrder	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	NutritionOrder	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	NutritionOrder	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	NutritionOrder	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	NutritionOrder	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
nor-1	warning	NutritionOrder	Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula class : oralDiet.exists() or supplement.exists() or enteralFormula.exists()

This structure is derived from NutritionOrder

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
NutritionOrder		0..*	NutritionOrder	Diet, formula or nutritional supplement request
encounter	S	0..1	Reference(Encounter)	The encounter associated with this nutrition order
orderer	S	0..1	Reference(Practitioner | PractitionerRole)	Who ordered the diet, formula or nutritional supplement
allergyIntolerance		1..*	Reference(AllergyIntolerance)	List of the patient's food and nutrition-related allergies and intolerances
foodPreferenceModifier	S	0..*	CodeableConcept	Order-specific modifier about the type of food that should be given
excludeFoodModifier	S	0..*	CodeableConcept	Order-specific modifier about the type of food that should not be given
oralDiet	S	0..1	BackboneElement	Oral diet components
type	S	0..*	CodeableConcept	Type of oral diet or diet restrictions that describe what can be consumed orally
nutrient	S	0..*	BackboneElement	Required nutrient modifications
modifier	S	0..1	CodeableConcept	Type of nutrient that is being modified
amount	S	0..1	SimpleQuantity	Quantity of the specified nutrient
texture	S	0..*	BackboneElement	Required texture modifications
modifier	S	0..1	CodeableConcept	Code to indicate how to alter the texture of the foods, e.g. pureed
foodType	S	0..1	CodeableConcept	Concepts that are used to identify an entity that is ingested for nutritional purposes
fluidConsistencyType	S	0..*	CodeableConcept	The required consistency of fluids and liquids provided to the patient
instruction	S	0..1	string	Instructions or additional information about the oral diet
supplement	S	0..*	BackboneElement	Supplement components
type	S	0..1	CodeableConcept	Type of supplement product requested
schedule	S	0..*	Timing	Scheduled frequency of supplement
quantity	S	0..1	SimpleQuantity	Amount of the nutritional supplement
instruction	S	0..1	string	Instructions or additional information about the oral supplement
enteralFormula	S	0..1	BackboneElement	Enteral formula components
baseFormulaType	S	0..1	CodeableConcept	Type of enteral or infant formula
additiveType	S	0..1	CodeableConcept	Type of modular component to add to the feeding
caloricDensity	S	0..1	SimpleQuantity	Amount of energy per specified volume that is required
routeofAdministration	S	0..1	CodeableConcept	How the formula should enter the patient's gastrointestinal tract
administration	S	0..*	BackboneElement	Formula feeding instruction as structured data
schedule	S	0..1	Timing	Scheduled frequency of enteral feeding
quantity	S	0..1	SimpleQuantity	The volume of formula to provide
rate[x]	S	0..1	SimpleQuantity, Ratio	Speed with which the formula is provided per period of time
administrationInstruction	S	0..1	string	Formula feeding instructions expressed as text
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
NutritionOrder	C	0..*	NutritionOrder	Diet, formula or nutritional supplement request Constraints: nor-1
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
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
instantiates		0..*	uri	Instantiates protocol or definition
status	?!Σ	1..1	code	draft | active | on-hold | revoked | completed | entered-in-error | unknown Binding: RequestStatus (required): Codes identifying the lifecycle stage of the nutrition order.
intent	?!Σ	1..1	code	proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Binding: RequestIntent (required): Codes indicating the degree of authority/intentionality associated with a nutrition order.
patient	Σ	1..1	Reference(Patient)	The person who requires the diet, formula or nutritional supplement
encounter	S	0..1	Reference(Encounter)	The encounter associated with this nutrition order
dateTime	Σ	1..1	dateTime	Date and time the nutrition order was requested
orderer	SΣ	0..1	Reference(Practitioner | PractitionerRole)	Who ordered the diet, formula or nutritional supplement
allergyIntolerance		1..*	Reference(AllergyIntolerance)	List of the patient's food and nutrition-related allergies and intolerances
foodPreferenceModifier	S	0..*	CodeableConcept	Order-specific modifier about the type of food that should be given Binding: Diet (example): Medical, cultural or ethical food preferences to help with catering requirements.
excludeFoodModifier	S	0..*	CodeableConcept	Order-specific modifier about the type of food that should not be given Binding: FoodTypeCodes (example): Codes used to indicate the type of food that should NOT be given to the patient.
oralDiet	SC	0..1	BackboneElement	Oral diet components
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	0..*	CodeableConcept	Type of oral diet or diet restrictions that describe what can be consumed orally Binding: DietCodes (example): Codes used to indicate the type of diet being ordered for a patient.
schedule		0..*	Timing	Scheduled frequency of diet
nutrient	S	0..*	BackboneElement	Required nutrient modifications
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
modifier	S	0..1	CodeableConcept	Type of nutrient that is being modified Binding: NutrientModifierCodes (example): Codes for types of nutrients that are being modified such as carbohydrate or sodium.
amount	S	0..1	SimpleQuantity	Quantity of the specified nutrient
texture	S	0..*	BackboneElement	Required texture modifications
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
modifier	S	0..1	CodeableConcept	Code to indicate how to alter the texture of the foods, e.g. pureed Binding: TextureModifierCodes (example): Codes for food consistency types or texture modifications to apply to foods.
foodType	S	0..1	CodeableConcept	Concepts that are used to identify an entity that is ingested for nutritional purposes Binding: TextureModifiedFoodTypeCodes (example): Codes for types of foods that are texture-modified.
fluidConsistencyType	S	0..*	CodeableConcept	The required consistency of fluids and liquids provided to the patient Binding: FluidConsistencyTypeCodes (example): Codes used to represent the consistency of fluids and liquids provided to the patient.
instruction	SΣ	0..1	string	Instructions or additional information about the oral diet
supplement	SC	0..*	BackboneElement	Supplement components
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	0..1	CodeableConcept	Type of supplement product requested Binding: SupplementTypeCodes (example): Codes for nutritional supplements to be provided to the patient.
productName		0..1	string	Product or brand name of the nutritional supplement
schedule	S	0..*	Timing	Scheduled frequency of supplement
quantity	S	0..1	SimpleQuantity	Amount of the nutritional supplement
instruction	SΣ	0..1	string	Instructions or additional information about the oral supplement
enteralFormula	SC	0..1	BackboneElement	Enteral formula components
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
baseFormulaType	SΣ	0..1	CodeableConcept	Type of enteral or infant formula Binding: EnteralFormulaTypeCodes (example): Codes for type of enteral formula to be administered to patient.
baseFormulaProductName		0..1	string	Product or brand name of the enteral or infant formula
additiveType	S	0..1	CodeableConcept	Type of modular component to add to the feeding Binding: EnteralFormulaAdditiveTypeCode (example): Codes for the type of modular component such as protein, carbohydrate or fiber to be provided in addition to or mixed with the base formula.
additiveProductName		0..1	string	Product or brand name of the modular additive
caloricDensity	S	0..1	SimpleQuantity	Amount of energy per specified volume that is required
routeofAdministration	S	0..1	CodeableConcept	How the formula should enter the patient's gastrointestinal tract Binding: EnteralRouteCodes (extensible): Codes specifying the route of administration of enteral formula.
administration	S	0..*	BackboneElement	Formula feeding instruction as structured data
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
schedule	S	0..1	Timing	Scheduled frequency of enteral feeding
quantity	S	0..1	SimpleQuantity	The volume of formula to provide
rate[x]	S	0..1		Speed with which the formula is provided per period of time
rateQuantity			Quantity(SimpleQuantity)
rateRatio			Ratio
maxVolumeToDeliver		0..1	SimpleQuantity	Upper limit on formula volume per unit of time
administrationInstruction	SΣ	0..1	string	Formula feeding instructions expressed as text
note		0..*	Annotation	Comments
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
NutritionOrder.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
NutritionOrder.status	required	RequestStatus http://hl7.org/fhir/ValueSet/request-status|4.0.1 From the FHIR Standard
NutritionOrder.intent	required	RequestIntent http://hl7.org/fhir/ValueSet/request-intent|4.0.1 From the FHIR Standard
NutritionOrder.foodPreferenceModifier	example	Diet http://hl7.org/fhir/ValueSet/encounter-diet From the FHIR Standard
NutritionOrder.excludeFoodModifier	example	FoodTypeCodes http://hl7.org/fhir/ValueSet/food-type From the FHIR Standard
NutritionOrder.oralDiet.type	example	DietCodes http://hl7.org/fhir/ValueSet/diet-type From the FHIR Standard
NutritionOrder.oralDiet.nutrient.modifier	example	NutrientModifierCodes http://hl7.org/fhir/ValueSet/nutrient-code From the FHIR Standard
NutritionOrder.oralDiet.texture.modifier	example	TextureModifierCodes http://hl7.org/fhir/ValueSet/texture-code From the FHIR Standard
NutritionOrder.oralDiet.texture.foodType	example	TextureModifiedFoodTypeCodes http://hl7.org/fhir/ValueSet/modified-foodtype From the FHIR Standard
NutritionOrder.oralDiet.fluidConsistencyType	example	FluidConsistencyTypeCodes http://hl7.org/fhir/ValueSet/consistency-type From the FHIR Standard
NutritionOrder.supplement.type	example	SupplementTypeCodes http://hl7.org/fhir/ValueSet/supplement-type From the FHIR Standard
NutritionOrder.enteralFormula.baseFormulaType	example	EnteralFormulaTypeCodes http://hl7.org/fhir/ValueSet/entformula-type From the FHIR Standard
NutritionOrder.enteralFormula.additiveType	example	EnteralFormulaAdditiveTypeCode http://hl7.org/fhir/ValueSet/entformula-additive From the FHIR Standard
NutritionOrder.enteralFormula.routeofAdministration	extensible	EnteralRouteCodes http://hl7.org/fhir/ValueSet/enteral-route From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	NutritionOrder	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	NutritionOrder	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	NutritionOrder	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	NutritionOrder	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	NutritionOrder	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
nor-1	warning	NutritionOrder	Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula class : oralDiet.exists() or supplement.exists() or enteralFormula.exists()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
NutritionOrder	C	0..*	NutritionOrder	Diet, formula or nutritional supplement request Constraints: nor-1
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!Σ	1..1	code	draft | active | on-hold | revoked | completed | entered-in-error | unknown Binding: RequestStatus (required): Codes identifying the lifecycle stage of the nutrition order.
intent	?!Σ	1..1	code	proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Binding: RequestIntent (required): Codes indicating the degree of authority/intentionality associated with a nutrition order.
patient	Σ	1..1	Reference(Patient)	The person who requires the diet, formula or nutritional supplement
encounter	S	0..1	Reference(Encounter)	The encounter associated with this nutrition order
dateTime	Σ	1..1	dateTime	Date and time the nutrition order was requested
orderer	SΣ	0..1	Reference(Practitioner | PractitionerRole)	Who ordered the diet, formula or nutritional supplement
allergyIntolerance		1..*	Reference(AllergyIntolerance)	List of the patient's food and nutrition-related allergies and intolerances
foodPreferenceModifier	S	0..*	CodeableConcept	Order-specific modifier about the type of food that should be given Binding: Diet (example): Medical, cultural or ethical food preferences to help with catering requirements.
excludeFoodModifier	S	0..*	CodeableConcept	Order-specific modifier about the type of food that should not be given Binding: FoodTypeCodes (example): Codes used to indicate the type of food that should NOT be given to the patient.
oralDiet	SC	0..1	BackboneElement	Oral diet components
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	0..*	CodeableConcept	Type of oral diet or diet restrictions that describe what can be consumed orally Binding: DietCodes (example): Codes used to indicate the type of diet being ordered for a patient.
nutrient	S	0..*	BackboneElement	Required nutrient modifications
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
modifier	S	0..1	CodeableConcept	Type of nutrient that is being modified Binding: NutrientModifierCodes (example): Codes for types of nutrients that are being modified such as carbohydrate or sodium.
amount	S	0..1	SimpleQuantity	Quantity of the specified nutrient
texture	S	0..*	BackboneElement	Required texture modifications
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
modifier	S	0..1	CodeableConcept	Code to indicate how to alter the texture of the foods, e.g. pureed Binding: TextureModifierCodes (example): Codes for food consistency types or texture modifications to apply to foods.
foodType	S	0..1	CodeableConcept	Concepts that are used to identify an entity that is ingested for nutritional purposes Binding: TextureModifiedFoodTypeCodes (example): Codes for types of foods that are texture-modified.
fluidConsistencyType	S	0..*	CodeableConcept	The required consistency of fluids and liquids provided to the patient Binding: FluidConsistencyTypeCodes (example): Codes used to represent the consistency of fluids and liquids provided to the patient.
instruction	SΣ	0..1	string	Instructions or additional information about the oral diet
supplement	SC	0..*	BackboneElement	Supplement components
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	0..1	CodeableConcept	Type of supplement product requested Binding: SupplementTypeCodes (example): Codes for nutritional supplements to be provided to the patient.
schedule	S	0..*	Timing	Scheduled frequency of supplement
quantity	S	0..1	SimpleQuantity	Amount of the nutritional supplement
instruction	SΣ	0..1	string	Instructions or additional information about the oral supplement
enteralFormula	SC	0..1	BackboneElement	Enteral formula components
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
baseFormulaType	SΣ	0..1	CodeableConcept	Type of enteral or infant formula Binding: EnteralFormulaTypeCodes (example): Codes for type of enteral formula to be administered to patient.
additiveType	S	0..1	CodeableConcept	Type of modular component to add to the feeding Binding: EnteralFormulaAdditiveTypeCode (example): Codes for the type of modular component such as protein, carbohydrate or fiber to be provided in addition to or mixed with the base formula.
caloricDensity	S	0..1	SimpleQuantity	Amount of energy per specified volume that is required
routeofAdministration	S	0..1	CodeableConcept	How the formula should enter the patient's gastrointestinal tract Binding: EnteralRouteCodes (extensible): Codes specifying the route of administration of enteral formula.
administration	S	0..*	BackboneElement	Formula feeding instruction as structured data
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
schedule	S	0..1	Timing	Scheduled frequency of enteral feeding
quantity	S	0..1	SimpleQuantity	The volume of formula to provide
rate[x]	S	0..1		Speed with which the formula is provided per period of time
rateQuantity			Quantity(SimpleQuantity)
rateRatio			Ratio
administrationInstruction	SΣ	0..1	string	Formula feeding instructions expressed as text
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
NutritionOrder.status	required	RequestStatus http://hl7.org/fhir/ValueSet/request-status|4.0.1 From the FHIR Standard
NutritionOrder.intent	required	RequestIntent http://hl7.org/fhir/ValueSet/request-intent|4.0.1 From the FHIR Standard
NutritionOrder.foodPreferenceModifier	example	Diet http://hl7.org/fhir/ValueSet/encounter-diet From the FHIR Standard
NutritionOrder.excludeFoodModifier	example	FoodTypeCodes http://hl7.org/fhir/ValueSet/food-type From the FHIR Standard
NutritionOrder.oralDiet.type	example	DietCodes http://hl7.org/fhir/ValueSet/diet-type From the FHIR Standard
NutritionOrder.oralDiet.nutrient.modifier	example	NutrientModifierCodes http://hl7.org/fhir/ValueSet/nutrient-code From the FHIR Standard
NutritionOrder.oralDiet.texture.modifier	example	TextureModifierCodes http://hl7.org/fhir/ValueSet/texture-code From the FHIR Standard
NutritionOrder.oralDiet.texture.foodType	example	TextureModifiedFoodTypeCodes http://hl7.org/fhir/ValueSet/modified-foodtype From the FHIR Standard
NutritionOrder.oralDiet.fluidConsistencyType	example	FluidConsistencyTypeCodes http://hl7.org/fhir/ValueSet/consistency-type From the FHIR Standard
NutritionOrder.supplement.type	example	SupplementTypeCodes http://hl7.org/fhir/ValueSet/supplement-type From the FHIR Standard
NutritionOrder.enteralFormula.baseFormulaType	example	EnteralFormulaTypeCodes http://hl7.org/fhir/ValueSet/entformula-type From the FHIR Standard
NutritionOrder.enteralFormula.additiveType	example	EnteralFormulaAdditiveTypeCode http://hl7.org/fhir/ValueSet/entformula-additive From the FHIR Standard
NutritionOrder.enteralFormula.routeofAdministration	extensible	EnteralRouteCodes http://hl7.org/fhir/ValueSet/enteral-route From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	NutritionOrder	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	NutritionOrder	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	NutritionOrder	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	NutritionOrder	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	NutritionOrder	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
nor-1	warning	NutritionOrder	Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula class : oralDiet.exists() or supplement.exists() or enteralFormula.exists()

Differential View

This structure is derived from NutritionOrder

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
NutritionOrder		0..*	NutritionOrder	Diet, formula or nutritional supplement request
encounter	S	0..1	Reference(Encounter)	The encounter associated with this nutrition order
orderer	S	0..1	Reference(Practitioner | PractitionerRole)	Who ordered the diet, formula or nutritional supplement
allergyIntolerance		1..*	Reference(AllergyIntolerance)	List of the patient's food and nutrition-related allergies and intolerances
foodPreferenceModifier	S	0..*	CodeableConcept	Order-specific modifier about the type of food that should be given
excludeFoodModifier	S	0..*	CodeableConcept	Order-specific modifier about the type of food that should not be given
oralDiet	S	0..1	BackboneElement	Oral diet components
type	S	0..*	CodeableConcept	Type of oral diet or diet restrictions that describe what can be consumed orally
nutrient	S	0..*	BackboneElement	Required nutrient modifications
modifier	S	0..1	CodeableConcept	Type of nutrient that is being modified
amount	S	0..1	SimpleQuantity	Quantity of the specified nutrient
texture	S	0..*	BackboneElement	Required texture modifications
modifier	S	0..1	CodeableConcept	Code to indicate how to alter the texture of the foods, e.g. pureed
foodType	S	0..1	CodeableConcept	Concepts that are used to identify an entity that is ingested for nutritional purposes
fluidConsistencyType	S	0..*	CodeableConcept	The required consistency of fluids and liquids provided to the patient
instruction	S	0..1	string	Instructions or additional information about the oral diet
supplement	S	0..*	BackboneElement	Supplement components
type	S	0..1	CodeableConcept	Type of supplement product requested
schedule	S	0..*	Timing	Scheduled frequency of supplement
quantity	S	0..1	SimpleQuantity	Amount of the nutritional supplement
instruction	S	0..1	string	Instructions or additional information about the oral supplement
enteralFormula	S	0..1	BackboneElement	Enteral formula components
baseFormulaType	S	0..1	CodeableConcept	Type of enteral or infant formula
additiveType	S	0..1	CodeableConcept	Type of modular component to add to the feeding
caloricDensity	S	0..1	SimpleQuantity	Amount of energy per specified volume that is required
routeofAdministration	S	0..1	CodeableConcept	How the formula should enter the patient's gastrointestinal tract
administration	S	0..*	BackboneElement	Formula feeding instruction as structured data
schedule	S	0..1	Timing	Scheduled frequency of enteral feeding
quantity	S	0..1	SimpleQuantity	The volume of formula to provide
rate[x]	S	0..1	SimpleQuantity, Ratio	Speed with which the formula is provided per period of time
administrationInstruction	S	0..1	string	Formula feeding instructions expressed as text
Documentation for this format

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
NutritionOrder	C	0..*	NutritionOrder	Diet, formula or nutritional supplement request Constraints: nor-1
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
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
instantiates		0..*	uri	Instantiates protocol or definition
status	?!Σ	1..1	code	draft | active | on-hold | revoked | completed | entered-in-error | unknown Binding: RequestStatus (required): Codes identifying the lifecycle stage of the nutrition order.
intent	?!Σ	1..1	code	proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Binding: RequestIntent (required): Codes indicating the degree of authority/intentionality associated with a nutrition order.
patient	Σ	1..1	Reference(Patient)	The person who requires the diet, formula or nutritional supplement
encounter	S	0..1	Reference(Encounter)	The encounter associated with this nutrition order
dateTime	Σ	1..1	dateTime	Date and time the nutrition order was requested
orderer	SΣ	0..1	Reference(Practitioner | PractitionerRole)	Who ordered the diet, formula or nutritional supplement
allergyIntolerance		1..*	Reference(AllergyIntolerance)	List of the patient's food and nutrition-related allergies and intolerances
foodPreferenceModifier	S	0..*	CodeableConcept	Order-specific modifier about the type of food that should be given Binding: Diet (example): Medical, cultural or ethical food preferences to help with catering requirements.
excludeFoodModifier	S	0..*	CodeableConcept	Order-specific modifier about the type of food that should not be given Binding: FoodTypeCodes (example): Codes used to indicate the type of food that should NOT be given to the patient.
oralDiet	SC	0..1	BackboneElement	Oral diet components
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	0..*	CodeableConcept	Type of oral diet or diet restrictions that describe what can be consumed orally Binding: DietCodes (example): Codes used to indicate the type of diet being ordered for a patient.
schedule		0..*	Timing	Scheduled frequency of diet
nutrient	S	0..*	BackboneElement	Required nutrient modifications
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
modifier	S	0..1	CodeableConcept	Type of nutrient that is being modified Binding: NutrientModifierCodes (example): Codes for types of nutrients that are being modified such as carbohydrate or sodium.
amount	S	0..1	SimpleQuantity	Quantity of the specified nutrient
texture	S	0..*	BackboneElement	Required texture modifications
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
modifier	S	0..1	CodeableConcept	Code to indicate how to alter the texture of the foods, e.g. pureed Binding: TextureModifierCodes (example): Codes for food consistency types or texture modifications to apply to foods.
foodType	S	0..1	CodeableConcept	Concepts that are used to identify an entity that is ingested for nutritional purposes Binding: TextureModifiedFoodTypeCodes (example): Codes for types of foods that are texture-modified.
fluidConsistencyType	S	0..*	CodeableConcept	The required consistency of fluids and liquids provided to the patient Binding: FluidConsistencyTypeCodes (example): Codes used to represent the consistency of fluids and liquids provided to the patient.
instruction	SΣ	0..1	string	Instructions or additional information about the oral diet
supplement	SC	0..*	BackboneElement	Supplement components
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	0..1	CodeableConcept	Type of supplement product requested Binding: SupplementTypeCodes (example): Codes for nutritional supplements to be provided to the patient.
productName		0..1	string	Product or brand name of the nutritional supplement
schedule	S	0..*	Timing	Scheduled frequency of supplement
quantity	S	0..1	SimpleQuantity	Amount of the nutritional supplement
instruction	SΣ	0..1	string	Instructions or additional information about the oral supplement
enteralFormula	SC	0..1	BackboneElement	Enteral formula components
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
baseFormulaType	SΣ	0..1	CodeableConcept	Type of enteral or infant formula Binding: EnteralFormulaTypeCodes (example): Codes for type of enteral formula to be administered to patient.
baseFormulaProductName		0..1	string	Product or brand name of the enteral or infant formula
additiveType	S	0..1	CodeableConcept	Type of modular component to add to the feeding Binding: EnteralFormulaAdditiveTypeCode (example): Codes for the type of modular component such as protein, carbohydrate or fiber to be provided in addition to or mixed with the base formula.
additiveProductName		0..1	string	Product or brand name of the modular additive
caloricDensity	S	0..1	SimpleQuantity	Amount of energy per specified volume that is required
routeofAdministration	S	0..1	CodeableConcept	How the formula should enter the patient's gastrointestinal tract Binding: EnteralRouteCodes (extensible): Codes specifying the route of administration of enteral formula.
administration	S	0..*	BackboneElement	Formula feeding instruction as structured data
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
schedule	S	0..1	Timing	Scheduled frequency of enteral feeding
quantity	S	0..1	SimpleQuantity	The volume of formula to provide
rate[x]	S	0..1		Speed with which the formula is provided per period of time
rateQuantity			Quantity(SimpleQuantity)
rateRatio			Ratio
maxVolumeToDeliver		0..1	SimpleQuantity	Upper limit on formula volume per unit of time
administrationInstruction	SΣ	0..1	string	Formula feeding instructions expressed as text
note		0..*	Annotation	Comments
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
NutritionOrder.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
NutritionOrder.status	required	RequestStatus http://hl7.org/fhir/ValueSet/request-status|4.0.1 From the FHIR Standard
NutritionOrder.intent	required	RequestIntent http://hl7.org/fhir/ValueSet/request-intent|4.0.1 From the FHIR Standard
NutritionOrder.foodPreferenceModifier	example	Diet http://hl7.org/fhir/ValueSet/encounter-diet From the FHIR Standard
NutritionOrder.excludeFoodModifier	example	FoodTypeCodes http://hl7.org/fhir/ValueSet/food-type From the FHIR Standard
NutritionOrder.oralDiet.type	example	DietCodes http://hl7.org/fhir/ValueSet/diet-type From the FHIR Standard
NutritionOrder.oralDiet.nutrient.modifier	example	NutrientModifierCodes http://hl7.org/fhir/ValueSet/nutrient-code From the FHIR Standard
NutritionOrder.oralDiet.texture.modifier	example	TextureModifierCodes http://hl7.org/fhir/ValueSet/texture-code From the FHIR Standard
NutritionOrder.oralDiet.texture.foodType	example	TextureModifiedFoodTypeCodes http://hl7.org/fhir/ValueSet/modified-foodtype From the FHIR Standard
NutritionOrder.oralDiet.fluidConsistencyType	example	FluidConsistencyTypeCodes http://hl7.org/fhir/ValueSet/consistency-type From the FHIR Standard
NutritionOrder.supplement.type	example	SupplementTypeCodes http://hl7.org/fhir/ValueSet/supplement-type From the FHIR Standard
NutritionOrder.enteralFormula.baseFormulaType	example	EnteralFormulaTypeCodes http://hl7.org/fhir/ValueSet/entformula-type From the FHIR Standard
NutritionOrder.enteralFormula.additiveType	example	EnteralFormulaAdditiveTypeCode http://hl7.org/fhir/ValueSet/entformula-additive From the FHIR Standard
NutritionOrder.enteralFormula.routeofAdministration	extensible	EnteralRouteCodes http://hl7.org/fhir/ValueSet/enteral-route From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	NutritionOrder	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	NutritionOrder	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	NutritionOrder	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	NutritionOrder	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	NutritionOrder	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
nor-1	warning	NutritionOrder	Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula class : oralDiet.exists() or supplement.exists() or enteralFormula.exists()

This structure is derived from NutritionOrder

Summary

Mandatory: 1 element
Must-Support: 29 elements

Maturity: 3