Release 4 FHIR CI-Build

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Responsible Owner: Orders and Observations icon Work Group Maturity Level : 2   Trial Use Normative Security Category : Patient Compartments : Encounter , Group , Patient , Practitioner

Detailed Descriptions for the elements in the NutritionOrder resource.

Comments true Element Id NutritionOrder.instantiates Definition CodeableConcept true Comments
Element Id NutritionOrder
Definition

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

Short Display Diet, formula or nutritional supplement request
Cardinality 0..*
Type DomainResource
Alternate Names Nutrition Order; Diet Order; Diet; Nutritional Supplement; Enteral Nutrition
Comments Summary false
Comments

Referenced by an Order Request (workflow).

Invariants Constraints
Defined on this element
nor-1 Warning Rule Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula class oralDiet.exists() or supplement.exists() or enteralFormula.exists()
Element Id NutritionOrder.identifier
Definition

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

Note Short Display Identifiers assigned to this order
Note This is a business identifier, not a resource identifier (see discussion )
Cardinality 0..*
Type Identifier
Comments Summary false
Comments

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

Element Id NutritionOrder.instantiatesCanonical NutritionOrder.basedOn
Definition

The URL pointing to a FHIR-defined protocol, guideline, orderset A plan or other definition request that is adhered to fulfilled in whole or in part by this NutritionOrder. nutrition order.

Short Display What this order fulfills
Cardinality 0..*
Type canonical Reference ( ActivityDefinition CarePlan | PlanDefinition NutritionOrder | ServiceRequest | RequestOrchestration )
Summary true false
Element Id NutritionOrder.instantiatesUri NutritionOrder.groupIdentifier
Definition

The URL pointing A shared identifier common to an externally maintained protocol, guideline, orderset or other definition all nutrition orders that is adhered to in whole were authorized more or in part less simultaneously by this NutritionOrder. a single author, representing the composite or group identifier.

Cardinality Short Display 0..* Composite Request ID
Type Cardinality uri 0..1
Summary Type Comments This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier. Identifier NutritionOrder.instantiates
Alternate Names The URL pointing to a protocol, guideline, orderset or other definition that is adhered to in whole or in part by this NutritionOrder. grouperId; groupIdentifier
Cardinality Summary 0..* true
Element Id NutritionOrder.status
Definition

The workflow status of the nutrition order/request.

Short Display draft | active | on-hold | entered-in-error | ended | completed | revoked | unknown
Cardinality 1..1
Terminology Binding RequestStatus ( Required )
Type code
Is Modifier true (Reason: This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid)
Summary true
Comments

Typically the system placing the order sets the status to "requested". Thereafter, the order is maintained by the receiver that updates the status as the request is handled. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Element Id NutritionOrder.intent
Definition

Indicates the level of authority/intentionality associated with the NutrionOrder and where the request fits into the workflow chain.

Short Display proposal | solicit-offer | offer-response | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
Cardinality 1..1
Terminology Binding RequestIntent ( Required )
Type code
Is Modifier true (Reason: This element changes the interpretation of all descriptive attributes. For example "the time the request is recommended to occur" vs. "the time the request is authorized to occur" or "who is recommended to perform the request" vs. "who is authorized to perform the request)
Requirements

Proposals/recommendations, plans and orders all use the same structure and can exist in the same fulfillment chain.

Alternate Names category
Summary true
Comments

When resources map to this element, they are free to define as many codes as necessary to cover their space and will map to "proposal, plan or order". Can have multiple codes that map to one of these. E.g. "original order", "encoded order", "reflex order" would all map to "order". Expectation is that the set of codes is mutually exclusive or a strict all-encompassing hierarchy.

Element Id NutritionOrder.patient NutritionOrder.priority
Definition

Indicates how quickly the Nutrition Order should be addressed with respect to other requests.

Short Display routine | urgent | asap | stat
Cardinality 0..1
Terminology Binding RequestPriority ( Required )
Type code
Summary false
Element Id NutritionOrder.subject
Definition

The person (patient) or set of individuals who needs the nutrition order for an oral diet, nutritional supplement and/or enteral or formula feeding.

Short Display Who requires the diet, formula or nutritional supplement
Cardinality 1..1
Type Reference ( Patient | Group )
Summary true
Element Id NutritionOrder.encounter
Definition

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

Short Display The encounter associated with this nutrition order
Cardinality 0..1
Type Reference ( Encounter )
Summary false
Element Id NutritionOrder.supportingInformation
Definition

Information to support fulfilling (i.e. dispensing or administering) of the nutrition, for example, patient height and weight).

Short Display Information to support fulfilling of the nutrition order
Cardinality 0..*
Type Reference ( Any )
Summary false
Element Id NutritionOrder.dateTime
Definition

The date and time that this nutrition order was requested.

Short Display Date and time the nutrition order was requested
Cardinality 1..1
Type dateTime
Summary true
Element Id NutritionOrder.orderer NutritionOrder.requester
Definition

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

Short Display Who ordered the diet, formula or nutritional supplement
Cardinality 0..1
Type Reference ( Practitioner | PractitionerRole )
Summary true
Element Id NutritionOrder.performer
Definition

The specified desired performer of the nutrition order.

Short Display Who is intended to perform the administration of the nutrition order
Cardinality 0..*
Type CodeableReference ( CareTeam | Practitioner | PractitionerRole | RelatedPerson | Patient | Organization | Group )
Summary false
Element Id NutritionOrder.allergyIntolerance
Definition

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

Short Display List of the patient's food and nutrition-related allergies and intolerances
Cardinality 0..*
Type Reference ( AllergyIntolerance )
Comments Summary false
Comments

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

Element Id NutritionOrder.foodPreferenceModifier
Definition

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 feedings.

Short Display Order-specific modifier about the type of food that should be given
Cardinality 0..*
Terminology Binding Diet Types of Edible Substances ( Example Preferred )
Type CodeableConcept
Comments Summary false
Comments

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

Element Id NutritionOrder.excludeFoodModifier
Definition

This modifier is used to convey Order-specific modifier about the type of oral food or oral fluids modifiers 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 what should be eliminated from the patient’s diet for any reason. This modifier applies to the entire nutrition order inclusive of the oral diet, nutritional supplements and enteral formula feedings.

Short Display Food that should not be given
Cardinality 0..*
Terminology Binding Food Type Codes Types of Edible Substances ( Example Preferred )
Type CodeableConcept
Summary false
Comments

Specific types of oral food (solid/liquid) to avoid.

Element Id NutritionOrder.outsideFoodAllowed
Definition

Information on This modifier is used to convey whether a patient's food allergies, intolerances and preferences to inform healthcare personnel about item, brought in by the type of foods patient, family, and/or caregiver, can be consumed by the patient. If set to true, indicates that the patient shouldn't receive or consume. receiving system does not need to supply the food item.

Short Display Capture if patient is permitted to consume food from outside of current setting brought by the patient, family, and/or caregiver
Cardinality 0..1
Type boolean
Summary false
Element Id NutritionOrder.oralDiet
Definition

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

Short Display Oral diet components
Cardinality 0..1
Invariants Summary false
Constraints
Affect this element
nor-1 Warning Rule Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula class oralDiet.exists() or supplement.exists() or enteralFormula.exists()
Element Id NutritionOrder.oralDiet.type
Definition

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

Short Display Type of oral diet or diet restrictions that can be consumed orally
Cardinality 0..*
Terminology Binding Diet Codes ( Example Preferred )
Type CodeableConcept
Summary true
Element Id NutritionOrder.oralDiet.schedule
Definition

Schedule information for an oral diet.

Short Display Scheduling information for oral diets
Cardinality 0..1
Summary false
Element Id NutritionOrder.oralDiet.schedule.timing
Definition

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

Short Display Scheduled frequency of diet
Cardinality 0..*
Type Timing
Alternate Names Frequency
Summary false
Element Id NutritionOrder.oralDiet.schedule.asNeeded
Definition

Indicates whether the diet is only taken when needed within a specific administration schedule.

Short Display Take 'as needed'
Cardinality 0..1
Type boolean
Summary false
Element Id NutritionOrder.oralDiet.schedule.asNeededFor
Definition

Indicates whether the diet is only taken based on a precondition for taking the diet.

Short Display Take 'as needed' for x
Cardinality 0..1
Terminology Binding SNOMED CT Medication As Needed Reason Codes ( Example )
Type CodeableConcept
Summary false
Element Id NutritionOrder.oralDiet.nutrient
Definition

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

Short Display The nutrient that is modified and the quantity in the diet
Cardinality 0..*
Summary false
Element Id NutritionOrder.oralDiet.nutrient.modifier
Definition

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

Short Display Nutrient modified in the oral diet type
Cardinality 0..1
Terminology Binding Nutrient Modifier Codes ( Example Preferred )
Type CodeableConcept
Summary false
Element Id NutritionOrder.oralDiet.nutrient.amount
Definition

The quantity of the specified nutrient to include in diet.

Short Display Quantity of the specified nutrient
Cardinality 0..1
Type Quantity
SimpleQuantity Summary false
Element Id NutritionOrder.oralDiet.texture
Definition

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 foods. and/or liquid).

Short Display Texture modifications in addition to the oral diet type
Cardinality 0..*
Summary false
Element Id NutritionOrder.oralDiet.texture.modifier
Definition

Any texture Texture modifications (for solid foods) in the addition to the oral diet type that should be made, e.g. easy to chew, chopped, ground, and pureed.

Short Display Food (i.e. solid and/or liquid) texture modifications in addition to those in the oral diet type
Cardinality 0..1
Terminology Binding Texture Modifier Codes ( Example Preferred )
Type CodeableConcept
Comments Summary false
Comments

Coupled with the foodType (Meat).

Element Id NutritionOrder.oralDiet.texture.foodType NutritionOrder.oralDiet.texture.type
Definition

The food (i.e. solid and/or liquid) type(s) (e.g. meats, all foods) that the texture modification applies to. This could be all foods types.

Short Display Food (i.e. solid and/or liquid) types that undergo texture alteration
Cardinality 0..1
Terminology Binding Texture Modified Food Type Codes ( Example Preferred )
Type CodeableConcept
Comments Summary Coupled with the texture.modifier ; could be (All Foods). false
Element Id NutritionOrder.oralDiet.fluidConsistencyType NutritionOrder.oralDiet.instruction
Definition

The required consistency (e.g. honey-thick, nectar-thick, thin, thickened.) of liquids Free text or fluids served additional instructions or information pertaining to the patient. oral diet.

Short Display Instructions or additional information about the oral diet
Cardinality 0..* 0..1
Terminology Binding Type Fluid Consistency Type Codes ( Example string )
Type Summary true
Comments

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

Element Id NutritionOrder.oralDiet.instruction NutritionOrder.oralDiet.caloricDensity
Definition

Free text or additional instructions The amount of energy (calories or information pertaining to kilojoules) that the oral diet. diet should provide. For example, an infant formula feeding of 30 ounces of 20 kcal/ounce (67 kcal/100 mL) formula per day.

Short Display Amount of energy per specified volume of oral diet
Cardinality 0..1
Type string Quantity
Summary Free text dosage instructions can be used for cases where the instructions are too complex to code. false
Element Id NutritionOrder.supplement
Definition

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

Short Display Supplement components
Cardinality 0..*
Invariants Summary false
Constraints
Affect this element
nor-1 Warning Rule Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula class oralDiet.exists() or supplement.exists() or enteralFormula.exists()
Element Id NutritionOrder.supplement.type
Definition

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

Short Display Type of supplement product requested
Cardinality 0..1
Terminology Binding Supplement Type Codes ( Example Preferred )
Type CodeableConcept CodeableReference ( NutritionProduct )
Summary true
Element Id NutritionOrder.supplement.productName
Definition

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

Short Display Product or brand name of the nutritional supplement
Cardinality 0..1
Type string
Summary false
Element Id NutritionOrder.supplement.schedule
Definition

Schedule information for a supplement.

Short Display Scheduling information for supplements
Cardinality 0..1
Summary false
Element Id NutritionOrder.supplement.schedule.timing
Definition

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

Short Display Scheduled frequency of supplement
Cardinality 0..*
Type Timing
Alternate Names Frequency
Summary false
Element Id NutritionOrder.supplement.schedule.asNeeded
Definition

Indicates whether the supplement is only taken when needed within a specific dosing schedule.

Short Display Take 'as needed'
Cardinality 0..1
Type boolean
Summary false
Element Id NutritionOrder.supplement.schedule.asNeededFor
Definition

Indicates whether the supplement is only taken based on a precondition for taking the supplement.

Short Display Take 'as needed' for x
Cardinality 0..1
Terminology Binding SNOMED CT Medication As Needed Reason Codes ( Example )
Type CodeableConcept
Summary false
Element Id NutritionOrder.supplement.quantity
Definition

The amount of the nutritional supplement to be given.

Short Display Amount of the nutritional supplement
Cardinality 0..1
Type Quantity
SimpleQuantity Summary false
Element Id NutritionOrder.supplement.instruction
Definition

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

Short Display Instructions or additional information about the oral supplement
Cardinality 0..1
Type string
Summary true
Comments

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

Element Id NutritionOrder.supplement.caloricDensity
Definition

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 ounce.

Short Display Amount of energy per specified volume of supplement that is required
Cardinality 0..1
Type Quantity
Summary false
Element Id NutritionOrder.enteralFormula
Definition

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

Short Display Enteral formula product
Cardinality 0..1
Invariants Summary false
Constraints
Affect this element
nor-1 Warning Rule Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula class oralDiet.exists() or supplement.exists() or enteralFormula.exists()
Element Id NutritionOrder.enteralFormula.baseFormulaType NutritionOrder.enteralFormula.type
Definition

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

Short Display Type of patient enteral feeding
Cardinality 0..1
Terminology Binding Enteral Formula Type Codes ( Example Preferred )
Type CodeableConcept CodeableReference ( NutritionProduct )
Summary true
Element Id NutritionOrder.enteralFormula.baseFormulaProductName NutritionOrder.enteralFormula.productName
Definition

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

Short Display Product or brand name of the enteral feeding
Cardinality 0..1
Type string
Summary false
Element Id NutritionOrder.enteralFormula.additiveType NutritionOrder.enteralFormula.deliveryDevice[x]
Definition

Indicates the The intended type of modular component such as protein, carbohydrate, fat or fiber device that is to be provided in addition to or mixed with used for the base administration of the enteral formula.

Short Display Intended type of device for the enteral feeding administration
Cardinality 0..1
Terminology Binding Enteral Formula Additive Type Delivery Device Code ( Example )
Type CodeableConcept | canonical NutritionOrder.enteralFormula.additiveProductName Element Id NutritionOrder.enteralFormula.additiveProductName ( DeviceDefinition )
Definition [x] Note The product or brand name of the type See Choice of modular component to be added Datatypes for further information about how to the formula. use [x]
Cardinality Summary 0..1 false
Element Id NutritionOrder.enteralFormula.caloricDensity
Definition

The amount of energy (calories) (calories or kilojoules) that the formula 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/mL.

Short Display Amount of energy per specified volume of feeding that is required
Cardinality 0..1
Type Quantity
SimpleQuantity Summary false
Element Id NutritionOrder.enteralFormula.routeofAdministration NutritionOrder.enteralFormula.routeOfAdministration
Definition

The route or physiological path of administration into the patient's gastrointestinal tract for purposes of providing the formula feeding, e.g. nasogastric tube. tube, oral.

Short Display How the enteral feeding should enter the patient's gastrointestinal tract
Cardinality 0..1 0..*
Terminology Binding Enteral Route Codes ( Extensible )
Type CodeableConcept
Summary false
Element Id NutritionOrder.enteralFormula.administration
Definition

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 hours.

Short Display Formula feeding instruction as structured data
Cardinality 0..*
Comments Summary false
Comments

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

Element Id NutritionOrder.enteralFormula.administration.schedule
Definition

Schedule information for an enteral feeding.

Short Display Scheduling information for enteral feeding products
Cardinality 0..1
Summary false
Element Id NutritionOrder.enteralFormula.administration.schedule.timing
Definition

The time period and frequency at which the enteral formula feeding should be delivered to given. The enteral feeding should be given for the patient. combination of all schedules if more than one schedule is present.

Short Display Scheduled frequency of enteral feeding
Cardinality 0..1 0..*
Type Timing
Alternate Names Frequency
Summary false
Element Id NutritionOrder.enteralFormula.administration.schedule.asNeeded
Definition

Indicates whether the enteral feeding is only taken when needed within a specific dosing schedule.

Short Display Take 'as needed'
Cardinality 0..1
Type boolean
Summary false
Element Id NutritionOrder.enteralFormula.administration.schedule.asNeededFor
Definition

Indicates whether the enteral feeding is only taken based on a precondition for taking the enteral feeding.

Short Display Take 'as needed' for x
Cardinality 0..1
Terminology Binding SNOMED CT Medication As Needed Reason Codes ( Example )
Type CodeableConcept
Summary false
Element Id NutritionOrder.enteralFormula.administration.quantity
Definition

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

Short Display The volume of formula feeding to provide
Cardinality 0..1
Type Quantity
SimpleQuantity Summary false
Element Id NutritionOrder.enteralFormula.administration.rate[x]
Definition

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

Short Display Speed with which the formula feeding is provided per period of time
Cardinality 0..1
Type SimpleQuantity Quantity | Ratio
[x] Note See Choice of Data Types Datatypes for further information about how to use [x]
Comments Summary false
Comments

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

Element Id NutritionOrder.enteralFormula.maxVolumeToDeliver NutritionOrder.enteralFormula.maxVolumeToAdminister
Definition

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 hours.

Short Display Upper limit on formula feeding volume per unit of time
Cardinality 0..1
Type Quantity
SimpleQuantity Summary false
Element Id NutritionOrder.enteralFormula.administrationInstruction
Definition

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

Short Display Formula feeding instructions expressed as text
Cardinality 0..1
Type string markdown
Summary true
Comments

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

Element Id NutritionOrder.additive
Definition

Indicates modular components to be provided in addition or mixed with the oral diet, supplement, and/or enteral feeding.

Short Display Modular additive to add to the oral diet, supplement, and/or enteral feeding
Cardinality 0..*
Summary false
Element Id NutritionOrder.additive.modularType
Definition

Indicates 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 feeding.

Short Display Type of modular component to add to the oral diet, supplement, and/or enteral feeding
Cardinality 0..1
Terminology Binding Enteral Formula Additive Type Code ( Preferred )
Type CodeableReference ( NutritionProduct )
Summary false
Element Id NutritionOrder.additive.productName
Definition

The product or brand name of the type of modular additive to be added to the oral diet, supplement, and/or enteral feeding.

Short Display Product or brand name of the modular additive
Cardinality 0..1
Type string
Summary false
Element Id NutritionOrder.additive.quantity
Definition

The amount of additive to be given in addition or to be mixed in with the oral diet, supplement, and/or enteral feeding.

Short Display Amount of additive to be given or mixed in with the oral diet, supplement, and/or enteral feeding
Cardinality 0..1
Type Quantity
Summary false
Element Id NutritionOrder.additive.routeOfAdministration
Definition

The administration into the patient's gastrointestinal tract for purposes of providing the additive, e.g. nasogastric tube, oral.

Short Display How the additive should enter the patient's gastrointestinal tract
Cardinality 0..*
Terminology Binding Enteral Route Codes ( Extensible )
Type CodeableConcept
Summary false
Element Id NutritionOrder.note
Definition

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

Short Display Comments
Cardinality 0..*
Type Annotation
Comments Summary false
Comments

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