DSTU2

This page is part of the FHIR Specification (v0.0.82: (v1.0.2: DSTU 1). 2). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

4.18.5 4.17.7 Resource NutritionOrder - Detailed Descriptions

Detailed Descriptions for the elements in the NutritionOrder resource.

NutritionOrder
Definition

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

Control 1..1
Alternate Names Diet Order; Diet; Nutritional Supplement; Enteral Nutrition
Comments

Referenced by an Order Request (workflow).

Invariants Defined on this element
nor-1 : Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula class (xpath: exists(f:oralDiet) or exists(f:supplement) or exists(f:enteralFormula))
NutritionOrder.patient
Definition

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

Control 1..1
Type Reference ( Patient )
Summary true
NutritionOrder.orderer
Definition

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

Control 0..1
Type Reference ( Practitioner )
Summary true
NutritionOrder.identifier
Definition

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

Note This is a business identifer, not a resource identifier (see discussion )
Control 0..*
Type Identifier
NutritionOrder.encounter
Definition

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

Control 0..1
Type Reference ( Encounter )
NutritionOrder.dateTime
Definition

The date and time that this nutrition order was requested.

Control 1..1
Type dateTime
Summary true
NutritionOrder.status
Definition

The workflow status of the nutrition order/request.

Control 0..1
Binding NutritionOrderStatus: Required : http://hl7.org/fhir/nutrition-order-status (Codes Codes specifying the state of the request. Describes the lifecycle of the nutrition order.) order. ( Required )
Type code
Is Modifier true
Summary true
Comments

Typically the system placing the order sets the status to requested. There after, "requested". Thereafter, the order is maintained by the receiver that updates the status as the request is handled.

NutritionOrder.allergyIntolerance
Definition

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

Control 0..*
Type Reference ( AllergyIntolerance )
Comments

Information on a patient's food allergies and intolerances, inform healthcare personnel about the type of foods that the patient should receive or consume.

NutritionOrder.foodPreferenceModifier
Definition

This modifier is used to convey order-specific modifiers about the type of food that should be given. These can be derived from patient allergies, intolerances, or preferences such as Halal, Vegan or Kosher. This modifier applies to the entire nutrition order inclusive of the oral diet, nutritional supplements and enteral formula feedings.

Control 0..*
Binding PatientDiet: Example : Diet: See http://hl7.org/fhir/vs/encounter-diet (Medical, Medical, cultural or ethical food preferences to help with catering requirements) requirements ( Example )
Type CodeableConcept
Comments

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

NutritionOrder.excludeFoodModifier
Definition

This modifier is used to convey order-specific modifiers about the type of food 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 feedings.

Control 0..*
Binding FoodType: Example : Food Type Codes: See http://hl7.org/fhir/vs/food-type (Codes Codes used to indicate the type of food that should NOT be given to the patient.) patient. ( Example )
Type CodeableConcept
Comments

Information on a patient's food allergies and intolerances, and preferences inform healthcare personnel about the type of foods that the patient should receive or consume.

NutritionOrder.oralDiet
Definition

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

Control 0..1
Invariants Affect this element
nor-1 : Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula class (xpath: exists(f:oralDiet) or exists(f:supplement) or exists(f:enteralFormula))
NutritionOrder.oralDiet.type
Definition

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

Control 0..*
Binding OralDiet: Example : Diet Codes: See http://hl7.org/fhir/vs/diet-type (Codes Codes used to indicate the type of diet being ordered for a patient.) patient. ( Example )
Type CodeableConcept
Summary true
NutritionOrder.oralDiet.scheduled NutritionOrder.oralDiet.schedule
Definition

The time period and frequency at which the diet should be given.

Control 0..1 0..*
Type Timing
Alternate Names frequency
NutritionOrder.oralDiet.nutrient
Definition

Class that defines the quantity and type of nutrient modifications required for the oral diet.

Control 0..*
NutritionOrder.oralDiet.nutrient.modifier
Definition

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

Control 0..1
Binding NutrientModifier: Example : Nutrient Modifier Codes: See http://hl7.org/fhir/vs/nutrient-code (Codes Codes for types of nutrient that is being modified such as carbohydrate or sodium.) sodium. ( Example )
Type CodeableConcept
NutritionOrder.oralDiet.nutrient.amount
Definition

The quantity of the specified nutrient to include in diet.

Control 0..1
Type Quantity SimpleQuantity
NutritionOrder.oralDiet.texture
Definition

Class that describes any texture modifications required for the patient to safely consume various types of solid foods.

Control 0..*
NutritionOrder.oralDiet.texture.modifier
Definition

Any texture modifications (for solid foods) that should be made, e.g. easy to chew, chopped, ground, and pureed.

Control 0..1
Binding TextureModifier: Example : Texture Modifier Codes: See http://hl7.org/fhir/vs/texture-code (Codes Codes for food consistency types or texture modifications to apply to foods.) foods. ( Example )
Type CodeableConcept
Comments

Coupled with the foodType (Meat).

NutritionOrder.oralDiet.texture.foodType
Definition

The food type(s) (e.g., (e.g. meats, all foods) that the texture modification applies to. This could be all foods types.

Control 0..1
Binding TextureModifiedFoodType: Example : Texture Modified Food Type Codes: See http://hl7.org/fhir/vs/modified-foodtype (Codes Codes for types of foods that are texture modified.) modified. ( Example )
Type CodeableConcept
Comments

Coupled with the textureModifier; could be (All Foods).

NutritionOrder.oralDiet.fluidConsistencyType
Definition

The required consistency (e.g., (e.g. honey-thick, nectar-thick, thin, thickened.) of liquids or fluids served to the patient.

Control 0..*
Binding FluidConsistencyType: Example : Fluid Consistency Type Codes: See http://hl7.org/fhir/vs/consistency-type (Codes Codes used to represent the consistency of fluids and liquids provided to the patient.) patient. ( Example )
Type CodeableConcept
NutritionOrder.oralDiet.instruction
Definition

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

Control 0..1
Type string
Summary true
Comments

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

NutritionOrder.supplement
Definition

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

Control 0..*
Invariants Affect this element
nor-1 : Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula class (xpath: exists(f:oralDiet) or exists(f:supplement) or exists(f:enteralFormula))
NutritionOrder.supplement.type
Definition

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

Control 0..1
Binding SupplementType: Example : Supplement Type Codes: See http://hl7.org/fhir/vs/supplement-type (Codes Codes for nutritional supplements to be provided to the patient) patient ( Example )
Type CodeableConcept
Summary true
NutritionOrder.supplement.productName
Definition

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

Control 0..1
Type string
NutritionOrder.supplement.scheduled NutritionOrder.supplement.schedule
Definition

The time period and frequency at which the supplement(s) should be given.

Control 0..1 0..*
Type Timing
Alternate Names frequency
NutritionOrder.supplement.quantity
Definition

The amount of the nutritional supplement to be given.

Control 0..1
Type Quantity SimpleQuantity
NutritionOrder.supplement.instruction
Definition

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

Control 0..1
Type string
Summary true
Comments

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

NutritionOrder.enteralFormula
Definition

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

Control 0..1
Invariants Affect this element
nor-1 : Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula class (xpath: exists(f:oralDiet) or exists(f:supplement) or exists(f:enteralFormula))
NutritionOrder.enteralFormula.administrationInstructions Definition Free text formula administration, feeding instructions or additional instructions or information. Control 0..1 Type string Comments Free text dosage instructions can be used for cases where the instructions are too complex to code. NutritionOrder.enteralFormula.baseFormulaType
Definition

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

Control 0..1
Binding EnteralFormulaType: Example : Enteral Formula Type Codes: See http://hl7.org/fhir/vs/entformula-type (Codes Codes for type of enteral formula to be administered to patient.) patient. ( Example )
Type CodeableConcept
Summary true
NutritionOrder.enteralFormula.baseFormulaProductName
Definition

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

Control 0..1
Type string
NutritionOrder.enteralFormula.scheduled Definition The time period and frequency at which the enteral formula should be delivered to the patient. Control 0..1 Type Timing Alternate Names frequency NutritionOrder.enteralFormula.additiveType
Definition

Indicates the type of modular component such as protein, carbohydrate, fat or fiber to be provided in addition to or mixed with the base formula.

Control 0..1
Binding EnteralFormulaAdditiveType: Example : Enteral Formula Additive Type Code: See http://hl7.org/fhir/vs/entformula-additive (Codes 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.) formula. ( Example )
Type CodeableConcept
NutritionOrder.enteralFormula.additiveProductName
Definition

The product or brand name of the type of modular component to be added to the formula.

Control 0..1
Type string
NutritionOrder.enteralFormula.caloricDensity
Definition

The amount of energy (Calories) that the formula should provide per specified volume, typically per mL or fluid oz. For example, an infant may require a formula the that provides 24 Calories per fluid ounce or an adult may require an enteral formula that provides 1.5 Calorie/mL.

Control 0..1
Type Quantity SimpleQuantity
NutritionOrder.enteralFormula.routeofAdministration
Definition

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

Control 0..1
Binding EnteralRouteOfAdministration: Required : Enteral Route Codes: See http://hl7.org/fhir/vs/enteral-route (Codes Codes specifying the route of administration of enteral formula.) formula. ( Extensible )
Type CodeableConcept
NutritionOrder.enteralFormula.quantity NutritionOrder.enteralFormula.administration
Definition

The Formula administration instructions as structured data. This repeating structure allows for changing the administration rate or volume over time for both bolus and continuous feeding. An example of formula this would be an instruction to provide increase the rate of continuous feeding every 2 hours.

Control 0..*
Comments

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

NutritionOrder.enteralFormula.administration.schedule
Definition

The time period and frequency at which the patient per enteral formula should be delivered to the specified administration schedule. patient.

Control 0..1
Type Quantity Timing
Alternate Names frequency
NutritionOrder.enteralFormula.rate NutritionOrder.enteralFormula.administration.quantity
Definition

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

Control 0..1
Type Ratio SimpleQuantity
NutritionOrder.enteralFormula.rateAdjustment NutritionOrder.enteralFormula.administration.rate[x]
Definition

The change in the rate of administration over of formula via a given time, feeding pump, e.g. increase by 10 mL/hour every 4 hours. 60 mL per hour, according to the specified schedule.

Control 0..1
Type Quantity SimpleQuantity | Ratio
[x] Note See Choice of Data Types for further information about how to use [x]
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".

NutritionOrder.enteralFormula.maxVolumeToDeliver
Definition

The maximum total quantity of formula that may be administered to a subject over the period of time, e.g., e.g. 1440 mL over 24 hours.

Control 0..1
Type Quantity SimpleQuantity
NutritionOrder.enteralFormula.administrationInstruction
Definition

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

Control 0..1
Type string
Summary true
Comments

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